Voters More Likely to See Fraud in the Tax System, Defense, and Foreign Aid Than Health Programs and Least Likely to See It in the ACA Marketplaces
Health care costs top the list of voters’ health care priorities for the midterm elections, with half (51%) of all voters and more than half of Democratic (60%) and independent (55%) voters saying the issue is extremely important for candidates to talk about, according to a new KFF Health Tracking Poll. At the same time, Trump administration statements about and actions targeting suspected health care fraud appear to be registering with Republican voters—more than half (55%) of whom say it is extremely important for candidates to discuss the issue of fraud in government health programs.
Voter Perceptions of Fraud in Government Health Programs
Most voters say there is at least “some” fraud in government health programs, but larger shares say there is fraud in other areas of government. About half of all voters say there is “a lot” of fraud in the federal tax system (52%), federal military and defense contracts (46%), and foreign aid programs (46%). Smaller shares of voters say there is a lot of fraud in Medicaid (40%), Medicare (36%), and the Affordable Care Act (ACA) Marketplaces (29%).
Compared to the other areas of government asked about in the survey, fewer voters (29%) say there is a lot of fraud in the ACA Marketplaces—though nearly half of Republican voters (47%) say a lot of fraud is occurring there. Trump administration officials have attributed this year’s drop in ACA enrollment to their efforts to combat fraud, rather than the expiration of the enhanced tax credits that made coverage much more costly for some Marketplace enrollees.
Partisan divisions also emerge over fraud in other health care programs, including Medicaid and Medicare, in which Republican voters are more likely (62% and 54% respectively) than both Democratic (21% and 19%) and independent voters (39% and 38%) to say there is a lot of fraud.
Across partisans, however, voters are much more likely to attribute fraud in Medicaid and Medicare primarily to health care providers, rather than individual patients, but about three in ten are not sure who is primarily responsible. About half of Democratic, Republican and independent voters say providers are mostly responsible for fraud in these programs, compared to between one in ten and three in ten who say patients are mostly responsible.
Voter Perceptions of Federal Fraud Actions in Medicaid
The Trump administration has launched sweeping fraud, waste, and abuse initiatives across all 50 states and taken targeted actions—including deferring federal Medicaid payments and decertifying fraud control units—that have so far mostly focused on Democratic-led states. Asked about the potential impact of deferred Medicaid payments, voters are much more likely to say these actions will harm beneficiaries and unfairly target states based on politics than reduce fraud or lower costs.
When asked to choose, most (71%) voters say ensuring Medicaid beneficiaries can access the care they need should be a higher priority than reducing fraud, even if it means some fraud may occur. Republican voters are closely split on this trade-off, with about half (52%) saying access to care should be a priority and half (47%) saying preventing fraud should be a priority, even if it harms access for some eligible people. Three-fourths of voters (77%) say delayed federal payments to state Medicaid programs would likely cause some eligible low-income people to lose access to health care services, including majorities of Democratic (89%), independent (81%), and Republican (61%) voters.
Nearly two-thirds of voters overall—including large majorities of Democratic (89%) and independent (70%) voters—say the Medicaid deferral approach is motivated by politics, while most Republicans (69%) say it is mostly motivated by protecting Medicaid. Meanwhile, voters are evenly split (50% vs. 50%) over whether delaying federal funding to states is likely to significantly reduce fraud, and fewer than half of voters across partisans say it is likely to lower health costs for people like them, including 46% of Republican voters and smaller shares of independent (25%) and Democratic (26%) voters.
Designed and analyzed by public opinion researchers at KFF, this survey was conducted June 25 – June 30, 2026, online and by telephone among a nationally representative sample of 1,321 U.S. adults, including 1,055 voters, in English and in Spanish. The margin of sampling error is plus or minus three percentage points for the full sample and plus or minus four percentage points for the sample of voters. For results based on other subgroups, the margin of sampling error may be higher.
Facts Only
* Half of all voters (51%) say health care costs are extremely important for candidates to discuss in the midterms.
* More than half of Democratic (60%) and independent (55%) voters say healthcare is extremely important for candidates.
* More than half of Republican voters (55%) say it is extremely important for candidates to discuss fraud in government health programs.
* About half of all voters say there is "a lot" of fraud in the federal tax system (52%).
* Federal military and defense contracts have a reported fraud rate of 46%.
* Foreign aid programs have a reported fraud rate of 46%.
* Voters estimate "a lot" of fraud exists in Medicaid (40%), Medicare (36%), and ACA Marketplaces (29%).
* Republican voters are more likely than Democratic or independent voters to say there is a lot of fraud in Medicaid (62% vs. 21% and 19%, respectively) and Medicare (54% vs. 19% and 38%, respectively).
* Most voters (about half) attribute fraud in Medicaid and Medicare primarily to health care providers, compared to one in ten to three in ten attributing it to individual patients.
* Seventy-seven percent of voters say delayed federal payments to state Medicaid programs would likely cause some eligible low-income people to lose access to health care services.
Executive Summary
Full Take
The data reveals a significant divergence in voter focus regarding government financial integrity and healthcare delivery, highlighting how partisan identity shapes perceptions of risk and responsibility. While general voter concern centers on the macro issue of healthcare costs, Republican voters show specific sensitivity toward fraud within the context of the Trump administration's actions, particularly concerning health programs. The attribution of fraud responsibility creates a complex layer of dynamic. Voters tend to diffuse accountability in core health programs like Medicaid and Medicare, placing the burden on providers rather than patients, suggesting an implicit acceptance of systemic complexity over individual culpability when viewing large-scale administrative issues.
The treatment of Medicaid funding further illustrates this split: voters prioritize access to care over fraud reduction, creating a direct conflict between immediate humanitarian concerns and fiscal oversight. The stark difference in how Republican versus Democratic voters view the impact of delayed federal payments demonstrates that policy objectives—protecting vulnerable populations versus pursuing cost-saving measures—are filtered through pre-existing political alignments. This suggests that framing public health as a zero-sum game between access and control is fundamentally dependent on which side of the political spectrum the voter occupies.
The focus on specific areas like ACA Marketplaces, where Republican sentiment about fraud is significantly higher than overall voter perception, suggests a selective engagement with policy concerns based on political affiliation, rather than a uniform assessment of systemic risk. This pattern indicates that narratives around fraud are not monolithic; they are strategically deployed and received according to the viewer's political lens, forcing an analysis of what foundational assumptions about government and public trust underpin these disparate views on health and finance.
Bridge Questions: If voters prioritize access over fraud reduction in Medicaid, how should policymakers balance immediate service guarantees with long-term fiscal accountability? Does focusing blame on providers obscure potential systemic failures within the administrative structures themselves? How do different political groups reconcile their differing views on personal responsibility versus institutional responsibility when assessing public health risks?
Sentinel — Human
This text reads as a factual synthesis of polling data, structured to reveal political divides concerning health care costs and government fraud perceptions, exhibiting high coherence with human-driven statistical journalism.