The rising cost and reduced access to health care appears to be the most important domestic issue on the minds of Iowa voters. This conclusion is based on findings of the IowaLife Survey conducted October 14-19 with 502 registered voters who say they will "definitely" or "probably vote" in the November 2^nd election. Central Surveys, Inc. of Shenandoah, Iowa conducted the poll for the Iowa Newspaper Association. The margin of error for this statewide poll is + 4.4 percentage points.

The rising cost of and access to health care is of greater concern to Iowa voters than the availability of quality jobs, by a ratio of nearly 2 to 1 (56% to 27%).

Iowa voters age 35 or older indicate being more concerned about the cost of/access to health care than about jobs by a ratio of nearly 3 to 1. Younger voters (age 34 or under) are equally concerned about access to health care and availability of quality jobs. There is no significant difference in response patterns by Bush supporters and Kerry supporters on this question.

Less than one-third (31%) say they are "very secure" regarding their ability to pay for health care or health insurance. Two-thirds of the Iowa voters in the survey sample say they are only "somewhat secure" (41%) or "not secure" (26%).

Bush supporters are twice as likely as Kerry supporters to say they are "very secure" regarding their ability to pay for health care or health insurance. Nearly two-fifths (39%) of Kerry supporters say they are "not secure," compared to 12% of the Bush supporters in the sample.

In regard to the bill passed by Congress in early 2004 addressing prescription drug coverage as a Medicare benefit for seniors, only 12% of Iowa voters are satisfied that the bill provides adequate help for senior citizens. Nearly three-fourths (73%) believe more should be done to make prescription drugs available and affordable to seniors. Eighty-seven percent of Democrats and Kerry supporters and 72% of nonpartisan voters share this view, while nearly three-fifths of Republicans (59%) and Bush supporters (58%) agree that more needs to be done.

Seventeen percent say the cost of prescription drugs has prevented them (or a family member) from filling a prescription for a needed medication, and 17% say the cost of medical care has prevented them from seeking a doctor's care. Nearly one-third (31%) of voters age 18 to 24 say they have gone without a needed prescription medication specifically because of the cost.

Ninety-two percent of the registered voters in the sample believe all Iowans should have access to health care regardless of their income.

Opinions vary regarding who should bear the cost of providing health care to low-income or uninsured people; however, a relatively large proportion of Iowans say the cost should be borne by the government (44%).

Iowans tend to blame large pharmaceutical companies (39%), health insurance companies (37%) and malpractice lawsuits (28%) rather than hospitals (7%) or doctors (6%) for the rising health-care costs.

Nearly half (48%) of the Iowans in the study are aware that Iowa doctors and hospitals receive a lower level of reimbursement for services provided to Medicare-eligible senior citizens, compared to doctors/hospitals in other states. A few believe Iowa hospitals receive the same level of reimbursement (12%) or a higher level (4%), while 36% admit they don't know.

Overall, Iowans are more concerned about the economy and domestic issues than about foreign policy and national security issues by a margin of 3 to 2. Those Iowans who place relatively more emphasis on the economy and domestic issues tend to favor Kerry over Bush (by a margin of 55% to 34%). Iowans who are more concerned about foreign policy and national security favor Bush over Kerry (by a margin of 64% to 28%).

A strong majority of Iowans approve (56%) rather than disapprove (26%) of the way Governor Tom Vilsack is handling his job as Governor of Iowa, while nearly one-fifth (18%) offer no opinion regarding his job performance. Predictably, approval ratings of Vilsack differ significantly according to the party affiliation of voters. Four-fifths (80%) of the Democrats approve of the way Vilsack is handling his job, compared to 55% of the nonpartisan voters and only 33% of the Republicans in the sample.

Nearly half (45%) believe Iowa is below average in its ability to attract businesses and keep jobs in Iowa. Majorities among women (52%) and Iowans age 45 to 64 (55%) rate Iowa below average in this regard. Nearly three-fifths (58%) of Iowa voters have heard of the Iowa Values Fund; however, only 22 percent of voters age 18 to 24 have heard of it. Nearly four-fifths (78%) approve of the state government using a multi-million dollar fund to give grants and loans to companies that create or keep quality jobs in Iowa.

Iowa voters are slightly more likely to say they are "worse off" (29%) rather than "better off" (26%) financially than they were four years ago, while the remainder say "the same." There are significant differences on this question based on age. Voters age 25 to 44 are more than twice as likely to say "better off" than "worse off." The opposite pattern is evident among Iowa voters age 55 or older. This age pattern correlates strongly with preference for Bush vs. Kerry - voters age 25 to 44 strongly favor Bush and those age 55 or older strongly favor Kerry.

Race Too Close to Call

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