Healthcare ranks second in importance among likely voters in the upcoming presidential election, according to an analysis of 37 polls conducted by 17 organizations.

The ranking is the highest for healthcare as a presidential election issue since 1992. When likely voters were asked to choose from a list of issues, similar to the approach used in election-day exit polls, 20% named "healthcare and Medicare" as the most important issue in their 2012 voting choice, far behind "the economy and jobs" (51%).

"The economy dominates most voters’ thinking in terms of their priorities for choosing a candidate," Robert J. Blendon, ScD, professor of health policy and political analysis at Harvard School of Public Health and co-author of the analysis, which appeared Oct. 10 on the New England Journal of Medicine’s website, said in a news release.

"But in a close election, the two candidates’ stands on healthcare issues could help swing the balance among voters."

Affordable Care Act: Likely voters who said "healthcare and Medicare" would be the most important issue in deciding their presidential vote were much more supportive of the Affordable Care Act than is the public in general. Although several elements of the law are popular, an average of current polls shows that 44% approve of the ACA and 45% disapprove.

Among likely voters who said "healthcare/Medicare" was the most important issue in their voting choice, 41% said they were much less likely to vote for a candidate who supported repealing all or part of the ACA; 14% said they were much more likely to vote for such a candidate.

Medicare: The analysts also examined the issue of changing Medicare in the future to a system in which the government provides seniors with a fixed sum of money to purchase either private health insurance or Medicare coverage. An average of current polls of the general public shows that 27% favor such a proposed change, while 66% are opposed.

Among likely voters who said "healthcare/Medicare" was the most important issue in their voting choice, 39% said they were much less likely to vote for a candidate who supported such a change in Medicare; 11% said they were much more likely to vote for such a candidate.

These results suggest that "healthcare/Medicare voters" are siding with President Barack Obama over former Massachusetts Gov. Mitt Romney on the ACA and Medicare issues in the election, the analysts said.

Abortion: Another issue that has emerged during the 2012 campaign is placing substantial new limits on the availability of abortion services. Abortion was found to be the top issue for 4% of likely voters. Among the general public, about half (52%) say that abortion should be illegal in all circumstances or legal in only a few circumstances; 44% believe abortion should be legal under any or most circumstances. A large majority (83%) of the public believes abortion should be legal when the pregnancy was caused by rape or incest.

Among likely voters who said abortion would be the most important issue in their presidential voting choice, 61% said they were much more likely to vote for a candidate who favored placing substantial new limits on abortion services, a position similar to that advocated by Romney; 24% said they were much less likely to vote for such a candidate.

Other considerations: The analysts noted that many likely voters who are opposed to the ACA or favor major changes in Medicare may not rank "healthcare and Medicare" as the top issue in their voting choice. They may see "the economy and jobs" or "the federal deficit and taxes" as most important.

Obama’s approval rating on handling healthcare is 41%, with 52% disapproving. In terms of perceptions of progress, a majority (65%) of Americans believe the problem of healthcare costs in the United States has worsened during the past five years. Only 27% see quality of care as having improved, although about equally few (25%) think it has worsened.

To read the analysis, visit www.nejm.org/doi/full/10.1056/NEJMsr1211472.