Why older voters have stuck with Biden more than younger generations

Analysis by Ron Brownstein, CNN

(CNN) — The silver lining in the generation gap confronting the nation’s oldest president ever may be, well, silver.

President Joe Biden’s struggles with younger voters have drawn enormous attention. But there’s been much less focus on the 81-year-old’s relative strength among his contemporaries.

While Biden’s support among young voters in polls now typically runs well below his vote share with them in 2020, multiple surveys show him holding, or even expanding, his backing among seniors. And while Biden’s plan to forgive student loan debts – his signature effort to bolster younger voters economically – was derailed by the Supreme Court, he has already finalized an array of concrete economic benefits for seniors, with more moving toward implementation.

On that front, a date that some Democrats are already circling on the election calendar is September 1, 2024. That’s when the administration is scheduled to announce the results of the first-ever negotiations between Medicare and large pharmaceutical companies to lower drug prices. The outcome could be substantial savings for seniors on 10 drugs taken by millions of Medicare recipients – announced only a little over two months before Election Day. And that’s just one component of an interlocked agenda on controlling drug and health care costs that could provide Biden a powerful calling card with older voters as it snaps into effect in the months ahead.

“Even though the vast majority of these benefits haven’t kicked in yet, I think people are very hopeful,” said Nancy LeaMond, executive vice president and chief advocacy and engagement officer for AARP, the giant lobby for seniors. “We thought there would be a lot of complaints about why can’t it be sooner. But what I’ve found as I talk to seniors is they may say I wish it was in effect today, but they also say at least it’s coming down the road. We never thought we’d see Big Pharma have to cut its prices.”

A better showing with seniors alone is unlikely to save Biden if he can’t regain at least some of the ground polls show that he’s lost with young people since 2020. But Biden’s standing among older voters has been a relative strength for him since that 2020 campaign.

Seniors, a predominantly White and often culturally conservative group, have consistently favored Republican presidential candidates in the 21st century. The major data sources on voting behavior – including the exit polls conducted by Edison Research for a consortium of media organizations including CNN and the calculations by Catalist, a Democratic targeting firm – all agree that Biden narrowly lost seniors to Donald Trump in 2020.

But the same data sources agreed that Biden improved slightly over Hillary Clinton’s performance with older voters in 2016. In office, many polls have found that Biden has maintained more of his support among seniors than among other age groups, particularly young people. In the latest CNN national poll released earlier this month, for instance, Biden’s approval rating among voters 65 and older stood at 49%. That was almost exactly equal to his share of the vote among them in 2020 – and much higher than his current approval rating among younger groups. Other recent surveys, including a New York Times/Siena College poll of swing states and national polls by Fox News Channel, NBC and PBS NewsHour/NPR/Marist College, have also recorded a much higher approval rating for Biden among seniors than with any younger age group.

Many of these same polls have found Biden running at least even with Trump among seniors, or slightly ahead, as a CNN survey in early November did; recent national polls by NBC and Quinnipiac University have even shown double-digit advantages for Biden among voters 65 and older. (A project that attempts to average the crosstabs of all major surveys, including some that CNN does not consider methodologically sound, found Biden slightly trailing Trump among seniors but improving on his 2020 showing with them.) In several of these surveys, seniors are now Biden’s best group against Trump; in others they are tied with young people as the most supportive. But the two generations are moving in opposite directions, with Biden gaining or holding steady with seniors in most polls compared with 2020, while his vote among young people is often around 15 points lower than his performance last time.

Older Americans are hardly immune to all the crosswinds that have battered Biden’s standing. But they have proven somewhat more resistant than younger voters to those trends. In the latest CNN national survey, for instance, most seniors describe the economy as fair or poor, but the share that describe it in positive terms (43%) is at least 15 percentage points higher than among any other age group. LeaMond noted that while inflation obviously pinches seniors living on fixed incomes, they are benefiting from a significant Social Security cost-of-living increase and higher interest rates on savings. “The way we look at it is, seniors seem to feel, in general, more comfortable economically than other groups,” she said.

Seniors also appear somewhat more resistant to the idea that Biden should step aside because of his age. In the New York Times/Siena poll, most swing-state seniors agreed that Biden is too old to serve effectively as president, but fewer of them said so than younger generations. In that same survey, seniors were far more likely than younger generations to say that Biden has the mental sharpness to serve effectively (though only about half of them agreed with that sentiment).

Biden’s biggest asset with seniors may be that he has a much longer list of policies he can point to that directly benefit them financially than he has for any other age group. He has made progress particularly in advancing plans to help seniors manage their prescription drug costs, one of the most pressing financial concerns for older Americans.

Primarily through the Inflation Reduction Act he signed last year, Biden is advancing a comprehensive suite of initiatives that provide seniors relief from high drug costs. Some are already in place. The administration last January established a $35 monthly cap on insulin payments for people on Medicare, which it projects will save some 1.5 million Medicare recipients an average of $500 annually. Under the Inflation Reduction Act, the administration has also already eliminated co-payments for Medicare recipients for all vaccines – a change that has benefited 4 million seniors annually. Using yet another provision of the IRA, the administration has required manufacturers that raised prices faster than the inflation rate to provide rebates to Medicare for dozens of drugs, which in turn lowers co-payments for the hundreds of thousands of seniors taking those medications.

“There are meaningful steps that have already occurred that people can feel in their everyday lives, starting with insulin, but then going on to these other areas,” said Leslie Dach, chair of Protect Our Care, a liberal group that advocates for expanded health care access.

Dach notes that research has found that a majority of diabetes patients previously said they had gone into debt to afford insulin and as many as 1 in 8 said they had skipped doses to save money. “All of this, it affects your health and your economics,” Dach said. “People are skipping doses because they can’t afford to, but they [are] doing it with great anxiety. It’s not like they won’t go out to dinner this week. It’s not a discretionary expense, and when you have to skip a dose of your insulin or your cancer drug, it eats you up.”

The measures the Biden administration has implemented so far represent just the start of its agenda for high prescription drug costs. A new provision limiting out-of-pocket drug expenses for Medicare recipients to $2,000 annually will go into effect in 2025. The administration projects that cap could benefit as many as 19 million seniors now paying more than that annually, with the roughly 2 million facing the highest drug costs saving as much as $2,500 per year.

The centerpiece of Biden’s efforts to contain drug costs is the authority the Inflation Reduction Act provided Medicare to use its massive buying power to negotiate with pharmaceutical companies for lower prices. Advocates for seniors, most congressional Democrats and fiscal hawks had been seeking that authority since Congress created Medicare’s prescription drug benefit in 2003. But opposition from the drug industry had always blocked the idea.

As a candidate in 2016, Trump broke from Republican orthodoxy and endorsed allowing Medicare to negotiate for lower prices. But in office, amid continuing industry opposition, he backed away from the idea, and did not include it in various plans he announced to try to constrain drug prices. Alex Azar, Trump’s secretary of Health and Human Services and a former drug industry executive, said at the time that allowing Medicare to negotiate for lower prices would quash innovation and “move us toward the kind of socialized medicine systems that are notorious for poor quality and access.”

Biden and congressional Democrats finally broke the long stalemate by including the negotiating authority in the Inflation Reduction Act – over the opposition of every Republican in both the House and Senate. The administration is now conducting the first-ever price negotiations between Medicare and the manufacturers of 10 drugs taken by millions of seniors, including popular medications for blood clots, diabetes and heart failure. The impact could be huge: Medicare recipients paid $3.4 billion in out-of-pocket costs on these drugs in 2022, and one recent study concluded that Medicare negotiations could reduce patient expenses on the most expensive drugs by nearly one-fourth.

Any price reductions Medicare negotiates for these drugs will not go into effect until 2026. But, under the law, the negotiations must be completed – and the new prices announced – by September 1, 2024. And because the IRA authorizes Medicare to negotiate for lower prices on more new drugs each year, Biden at that point will be able to promise seniors that reductions are coming on more common medicines.

Beyond drug prices, Biden can also tout his administration’s efforts to help seniors remain in their homes rather than move into group settings, such as nursing homes. The administration recently disbursed $37 billion in grants across the 50 states to bolster local programs to support independent living for seniors, particularly by strengthening the home health care workforce.

And Biden has signaled that in the 2024 campaign he intends to continue highlighting his proposal to provide billions in Medicaid funding to help more seniors live at home – an initiative that West Virginia Democratic Sen. Joe Manchin stripped out of the Inflation Reduction Act during the final efforts to pass the bill.

“How many of you have a mom or dad that they don’t want to have to give up all the value in their home, sell it, and go to a nursing home – but you know if they just had someone there at dinner time to help them with the dinner or just had them in the morning there – just a little bit – they could stay, save a lot of money, and be a hell of a lot happier?” Biden said during a recent appearance in Colorado.

All of these programs are broadly popular in polls, both with the overall public and especially among seniors. Polling by the nonpartisan KFF has found that roughly four-fifths of Americans supported the insulin and annual drug spending caps, as well as providing Medicare the authority to negotiate for lower prices. Among seniors, support for all three ideas was closer to 9 in 10. (When presented the competing argument that Medicare negotiations will slow the introduction of new drugs, just one-third of Americans said they agreed with it.)

Similarly, AARP polling has found preponderant support for measures to strengthen the home health care workforce and to help seniors stay in their homes. LeaMond said that is “a sleeper issue” that resonates powerfully not only with the elderly but with millions of younger relatives providing them care. “There are few good things to say about Covid, but Covid really crystallized people’s views about where they want to deal with health issues,” LeaMond said. “They want to stay in their home. And they know they need support to stay in their home. I think it’s a very big issue.”

The political impact of all these programs may be muffled somewhat since seniors will not tangibly feel them by Election Day. But Dach and LeaMond both believe these efforts are coming soon enough to still resonate with many older voters. All of these ideas “will be well discussed and I think it will be real to people that it’s on its way,” said Dach.

A bigger problem for Biden is that KFF polling in November found that only about one-fourth of Americans know about his major initiatives to constrain drug prices, with awareness among seniors only slightly better. (More seniors know about Medicare’s new authority to negotiate lower prices, but just 44% of them are aware even of that, KFF found.) Yet that very lack of awareness suggests Biden may have more room to grow his overall support among seniors as more of them become aware of his initiatives to lower drug costs.

Trump’s campaign team is well aware that seniors have been a relative bright spot for Biden amid the deepening gloom of his recent poll results. Jim McLaughlin, a pollster for Trump, agreed that Biden “might” be in a stronger position with seniors than with other age groups, but said that in a matchup between the former and current presidents, Trump could reverse one of the most familiar debates between the parties. Noting that Trump has generally opposed efforts to cut Social Security and Medicare, while Biden backed some during his long years in the Senate, McLaughlin previewed a likely argument from the former president: “There is only one candidate who has [voted to] cut Social Security and Medicare – it’s Joe Biden, not Donald Trump,” he said.

But Biden can draw powerful contrasts of his own: Multiple congressional Republicans have introduced proposals to rescind the various new provisions the president is using to lower drug prices for seniors, particularly the Medicare negotiating authority. In a measure of the attitudes in Trump circles, Azar has continued to assert that negotiating lower prices through Medicare will squelch drug company innovation and that, as he put it, “Americans aren’t going to be happy when France gets drugs before we do.”

Advocates like Dach believe Biden can also sharpen the contrasts by emphasizing legislation to extend any drug savings Medicare negotiates to Americans in all age groups-a step Republicans are highly unlikely to follow.

Whatever happens with seniors, Biden’s weakness with younger Americans remains a huge source of concern for Democrats. Younger voters born after 1980 (millennials and Generation Z) are growing a share of the electorate, while older voters born before 1964 (the baby boomers and Silent Generation) are shrinking: The nonpartisan States of Change Project forecasts that for the first time, the younger group will equal the older as a share of all voters in 2024.

Still, except for Georgia, each of the other four states most likely to decide the 2024 election rank near the top for the share of their residents 65 and older – Arizona, Michigan, Pennsylvania and Wisconsin.

There’s no single cure for all of Biden’s electoral ailments. But in any scenario for political recovery, seniors welcoming federal relief from high drug costs looks like an essential ingredient in the prescription.

The-CNN-Wire
™ & © 2023 Cable News Network, Inc., a Warner Bros. Discovery Company. All rights reserved.