A recent Pew Research Center poll shows that health care affordability tops the list of concerns for American voters—ahead of worries about the federal budget, immigration, and gun violence.

Adults over 50 made up more than half of voters in the 2020 election, making the concerns of this key demographic some of the most critical to the upcoming presidential election.

A new study conducted by the University of Michigan’s Institute for Healthcare Policy and Innovation, using data from the National Poll on Healthy Aging conducted in February and March 2024, shows the health-related issues most worrying to older adults. 

Health care and insurance costs among top concerns

Concerns about health care and health insurance costs made up five of the six top issues from a list of 26. Respondents said they were very worried about the cost of home care, assisted living, and nursing home care (56%); the cost of medical care (56%); the cost of prescription medications (54%); financial scams and fraud (53%); and the cost of health insurance and Medicare (52%). 

“The cost of health care and the need for health care are both so substantial for older adults in the U.S.,” says the study’s lead author, Dr. John Ayanian, director of the Institute of Healthcare Policy and Innovation.

“We’ve had some great advances in helping people manage chronic conditions and reduce their risk of cancer and other major health problems,” Ayanian says, “but the costs of those services have outpaced the growth in inflation in the past 20 to 30 years.”

Older adults feel that more acutely, he says, as they spend more of their income on health care as their health problems grow—which becomes especially difficult for retired people living on a limited fixed income.

“Older adults would like political leaders to be devoting greater effort to controlling all forms of health care costs,” Ayanian tells Fortune. 

The mental toll of financial fraud

One of the top concerns that emerged from the study was one not explicitly related to health care: financial fraud and scams. Ayanian and his team found that many older adults have been victims of financial scams or know people who have been impacted by them. The Government Accountability Office estimates that older Americans lose $2.9 billion each year from financial fraud.

Researchers chose to include it in the survey because of the high degree of mental distress those scams can cause, Ayanian says, which snowballs into other health problems if victims of financial fraud struggle to seek medical care, access food, or find housing as a result.

Of the top five health-related concerns, over half of respondents answered they were “very concerned.” But there were some demographic divisions.

Within those top six issues from the study, more women reported being very concerned than men, and more liberals and moderates reported being very concerned than conservatives.

Roughly 53.1% of the respondents were women, 46.6% were men, and 0.3% were transgender or nonbinary. The overwhelming majority were white (77%), while political ideologies were split between liberal (17.3%), moderate (46.8%), and conservative (35.9%).

Participants with household incomes below $60,000 per year made up roughly 51% of respondents, while those making above $60,000 were 49% of the group.

Regardless of household incomes, health care and insurance costs were of equal concern. Of respondents earning less than $60,000 per year, 58.4% said they were very concerned about health care and insurance costs, compared to 54.1% of respondents who earned more than that.

The authors conclude that, “To engage older voters, candidates for president and Congress should prioritize communicating their plans for controlling health care costs.”

For more on health care and politics: 

• Could a Harris and Walz win reshape U.S. health care? 
• Kamala Harris, once Joe Biden’s voice on abortion, would take an outspoken approach to health
• The 24/7 news cycle is brutal. Here’s how to prioritize your mental health while digesting it all