The Six Fault Lines Shaping Americans’ Views on Health Care

As the midterms approach, communicators must increasingly look beyond broad labels like “Republican,” “Democratic” or “swing” to the values and belief systems that shape how audiences think about health care.

Using PRISM, Reservoir’s audience intelligence platform, we mapped all 435 congressional districts across 16 behavioral and ideological audience segments.

What we found:

‍Audiences in districts with similar voting patterns can have very different views on health care – requiring different engagement strategies. For example:

• Two Republican districts: Lubbock, Texas (TX-19) and Greenville-Spartanburg, South Carolina (SC-04) are both consistently Republican but respond to different messages.
• • Lubbock has nearly four times the national concentration of “Consumer Empowerment Champions” – one of PRISM’s 10 Republican audience segments. They believe health care should operate more like a consumer marketplace and prioritize patient choice, transparency and control. They are especially receptive to messages about empowering patient decision-making.
  • Greenville-Spartanburg, by contrast, has emerged as one of the Southeast’s fastest-growing manufacturing and life sciences corridors. Key audiences here, like those we’ve identified as “Trust-the-Science Pragmatists,” are likely to find science, evidence-based innovation and access to rural health care most compelling.
• Two Democratic districts: Seattle, Washington (WA-07) and Jackson, Mississippi (MS-02) both consistently elect Democrats but represent different health care coalitions.
  • Seattle has long been a bastion of progressive politics – a trend reflected in its exceptionally high concentration of “Universal Care Progressives” – one of PRISM’s 6 Democratic audience segments. They strongly support universal, single-payer health care and respond best to messages about expanding access and systemic reform.
  • By contrast, Jackson and the surrounding Mississippi Delta reflect a different Democratic coalition. This district has nearly five times the national concentration of “Faith & Justice Progressives.” Their views are shaped by faith communities and lived health disparities, and they are especially persuaded by fairness, equity and affordability.
• Two swing districts: Scottsdale, Arizona (AZ-01) and southwestern Washington (WA-03) are both closely contested. But they aren’t simply “moderate” districts. Looking closer reveals that they have different fault lines and sources of common ground.
  • Scottsdale has roughly twice the national concentration of both Democratic “Health Care Incrementalists” and Republican “Health Futurists” – a distinctly suburban mix of audiences that share a desire for progress but differ over how fast it should happen. Messages that balance progress with practicality and proven benefits to patients are most likely to resonate with these voters.
  • Southwestern Washington is home to a high concentration of Democratic “Universal Care Progressives” alongside Republican “Wellness Evangelists” – an audience focused on prevention, healthy lifestyles and personal responsibility. Both share a commitment to healthier communities, but “Universal Care Progressives” look to public institutions and policy to drive progress, while “Wellness Evangelists” place that responsibility with individuals and families.

The key takeaway:

‍How a district votes doesn’t paint the full picture. Effective audience engagement starts with understanding the values and belief systems that drive the audiences within a district.

Turning insights into action:

‍PRISM turns district-level audience intelligence into actionable strategy and direct activation. These insights can help organizations:

• Prioritize districts: Identify the audiences most likely to be mobilized on your issue and where those key audiences are most concentrated.
• Tailor communications: Align messages with the values and belief systems most likely to resonate among priority audiences.
• Activate key audiences: Reach priority audiences directly through precision targeting, delivering tailored messages to the voters and influencers most likely to engage.

Go deeper:

‍Click here to explore the PRISM district map, including the audience segments shaping health care opinions in these congressional districts.

Democratic health care audiences are increasingly fractured – not just by policy preferences, but by deeper beliefs about justice, reform, American leadership and the role of the private sector. For organizations trying to communicate effectively, those differences matter: a message that motivates one audience may fall flat with another.

Zooming in:  

Our research has identified six distinct Democratic audience segments – each with their own unique values and belief systems.

This month, we’re spotlighting two Democratic segments that look similar on traditional political measures: Both trust science. Both support innovation. Both favor public investment in health care. Yet they disagree fundamentally about progress. Messages that resonate with one often fall flat with the other.

1. Health Abundance Democrats – Democrats who see American innovation and industry as keys to making health care more accessible. They view government as a partner in expanding health care capacity: funding research, increasing transparency, promoting affordable coverage and regulating in targeted ways that do not slow private-sector progress. For example, they are 8 percentage points more likely to support public policy that drives research to extend the human lifespan than other Americans. Culturally, they are center-left populists – patriotic, protective of American workers and more traditional on social issues than other Democratic audiences.  
2. Global Health Institutionalists – Democrats who believe that modern health challenges like climate change, pandemics and supply chain instability transcend national borders and view coordinated global institutions as fundamental to achieving a healthier world. As a result, they are 28 percentage points less likely to favor efforts to remove the U.S. from global institutions like the World Health Organization than other Americans. They favor private-sector innovation and support strong government funding for public health institutions, but view structural reforms as key to strengthening institutions and improving access. They are socially and culturally liberal and staunchly pro-science – both in their political beliefs and in their personal lives.  

The unifying thread:

• Industry & Innovation. Both audiences are pro-science and pro-innovation, and both want to ensure that policy does not impede scientific progress in the private sector. But beneath that shared support for innovation are important differences in how each audience defines progress and what is required to achieve it. These differences are critical to inform strategic engagement with these audiences.

Why they’re different:

1. Global Focus. The most significant difference between these audiences is the geographic lens through which they view health care. Health Abundance Democrats see health care as a domestic challenge that can be addressed through American industry and ingenuity. Global Health Institutionalists see health care as a global challenge that requires international cooperation and strong global health institutions.  
2. Reform. Health Abundance Democrats favor working within existing systems to expand the capacity of our health care system and are skeptical of broad or sweeping reforms. Global Health Institutionalists favor broader institutional reforms that improve access and affordability, while continuing to support private-sector innovation.  For example, Global Health Institutionalists are 12 percentage points more likely to support single-payer reforms versus Health Abundance Democrats.
3. Messaging. Health Abundance Democrats respond best to messages that are pragmatic and innovation-forward. Global Health Institutionalists respond to messages that emphasize global cooperation and public health leadership and are validated by institutional experts. The same messages do not work for both audiences.  

Go deeper:

1. Reservoir’s audience intelligence platform, PRISM, maps 16 distinct audience segments across the health care landscape, each with distinct values and belief systems.
2. The Health Abundance Democrats and Global Health Institutionalists are just two of six Democratic segments – each requiring a tailored approach to messaging and engagement.  

Get in touch to learn more about how PRISM can inform your strategy: prism@reservoircg.com

Democratic health care audiences are increasingly fractured – not just by policy preferences, but by deeper beliefs about justice, reform, American leadership and the role of the private sector. For organizations trying to communicate effectively, those differences matter: a message that motivates one audience may fall flat with another.

Zooming in:

Our research has identified six distinct Democratic audience segments – each with their own unique values and belief systems. This month, we’re spotlighting two Democratic segments that look similar on traditional political measures: Both trust science. Both support innovation. Both favor public investment in health care. Yet they disagree fundamentally about progress. Messages that resonate with one often fall flat with the other.

• Health Abundance Democrats – Democrats who see American innovation and industry as keys to making health care more accessible. They view government as a partner in expanding health care capacity: funding research, increasing transparency, promoting affordable coverage and regulating in targeted ways that do not slow private-sector progress. For example, they are 8 percentage points more likely to support public policy that drives research to extend the human lifespan than other Americans. Culturally, they are center-left populists – patriotic, protective of American workers and more traditional on social issues than other Democratic audiences.

• Global Health Institutionalists – Democrats who believe that modern health challenges like climate change, pandemics and supply chain instability transcend national borders and view coordinated global institutions as fundamental to achieving a healthier world. As a result, they are 28 percentage points less likely to favor efforts to remove the U.S. from global institutions like the World Health Organization than other Americans. They favor private-sector innovation and support strong government funding for public health institutions, but view structural reforms as key to strengthening institutions and improving access. They are socially and culturally liberal and staunchly pro-science – both in their political beliefs and in their personal lives.

The unifying thread:

• Industry & Innovation. Both audiences are pro-science and pro-innovation, and both want to ensure that policy does not impede scientific progress in the private sector. But beneath that shared support for innovation are important differences in how each audience defines progress and what is required to achieve it. These differences are critical to inform strategic engagement with these audiences.

Why they’re different:

• Global Focus. The most significant difference between these audiences is the geographic lens through which they view health care. Health Abundance Democrats see health care as a domestic challenge that can be addressed through American industry and ingenuity. Global Health Institutionalists see health care as a global challenge that requires international cooperation and strong global health institutions.

• Reform. Health Abundance Democrats favor working within existing systems to expand the capacity of our health care system and are skeptical of broad or sweeping reforms. Global Health Institutionalists favor broader institutional reforms that improve access and affordability, while continuing to support private-sector innovation. For example, Global Health Institutionalists are 12 percentage points more likely to support single-payer reforms versus Health Abundance Democrats.

• Messaging. Health Abundance Democrats respond best to messages that are pragmatic and innovation-forward. Global Health Institutionalists respond to messages that emphasize global cooperation and public health leadership and are validated by institutional experts. The same messages do not work for both audiences.

Go deeper:

Reservoir’s audience intelligence platform, PRISM, maps 16 distinct audience segments across the health care landscape, each with distinct values and belief systems. The Health Abundance Democrats and Global Health Institutionalists are just two of six Democratic segments – each requiring a tailored approach to messaging and engagement.   Get in touch to learn more about how PRISM can inform your strategy: prism@reservoirhealth.com