After some close races in Iowa, presidential candidates have moved on to New Hampshire, a sharply divided state with few supporters of the Affordable Care Act and a growing concern about prescription drug overuse.
The state holds its primary, the second in the nation, Tuesday night. After that, the attention shifts to South Carolina and Nevada.
Andy Smith, political science professor at the University of New Hampshire and director of its survey center, said healthcare hasn't been a particularly big issue recently for the state's voters. “It's way down on the list,” he said, adding that because New Hampshire is a state with a relatively older population, residents are still concerned about Medicare solvency and long-term care.
Still, it's opposition of the ACA that gets the spotlight. And Republican candidates are competing to see who can bash the ACA the most.
About 30% of Iowa's Democratic caucus-goers said healthcare is the nation's top concern, according to entrance polls. Nearly 60% of those people voted for Clinton and about 38% cast ballots for Sanders.
Sanders has proposed a Medicare-for-all plan that is projected to cost far more than the campaign says it will. Clinton says that plan wouldn't stand a chance in Congress and instead suggests building on the successes of the ACA.
Sen. Ted Cruz of Texas won Iowa on the Republican side. Behind him was Donald Trump, with Florida Sen. Marco Rubio coming in at a strong third. All have repeatedly said they want to repeal the ACA and replace it but have offered few details on how they would do it.
Republicans who caucused in Iowa did not list healthcare as a top concern. Most polls show Trump with the lead in New Hampshire.
Smith said candidates in both parties were caught a bit off guard by how interested New Hampshire citizens were in finding ways to curb opioid misuse. After being confronted with the issue at events, most of the candidates developed a response and began adding it to their stump speeches. Some hopefuls have discussed ways that addiction and drug abuse have affected their families and said they understand the issue must be addressed.
Clinton has said she was struck by the number of people in New Hampshire who ask her about opioid abuse and tell stories of how it has affected them personally. She presented a $10 billion plan to give grants to states with programs for combating addiction. She also showed support for medication-assisted treatment and said first responders should all be carrying naloxone, which is a drug that can reverse an opioid overdose.
During a Democratic debate in New Hampshire in December, both candidates said people with addiction should be treated, not incarcerated. That was days after a report from the Centers for Disease Control and Prevention found that a record number of people died from opioid overdoses in 2014.
Republican candidates have also said treatment should be more available but emphasized closing the borders to prevent drugs from getting into the country.