Vanderbilt Poll: Tennesseans support Medicare expansion, gun reform

The latest semiannual, statewide Vanderbilt Poll reflects that the election had little impact on Tennesseans' stances on key issues.

A notable exception was increased approvals for state lawmakers since May, despite often holding positions on some issues that are out of step with Tennesseans.

Registered voters in Tennessee voiced overwhelming support for Medicaid expansion, including 55% of MAGA Republicans, and, further, they believe health insurers and pharmaceutical companies are largely responsible for high healthcare costs.

Widespread support continues for women's health and reproductive care, with more than half of Tennesseans identifying as pro-choice and robust support for some specific allowances for abortion. Also notable was the misalignment between the public and the state government's action and inaction on issues including gun reform and legalization of recreational marijuana, both of which have bipartisan backing.

"While much ink has been spilled about what the election results mean about the electorate, these results suggest little change in the opinions of Tennesseans, which means the misalignment between voters and elected officials continues," said John Geer, co-director of the Vanderbilt Poll, senior advisor to Chancellor Daniel Diermeier, professor of political science and holder of a Gertrude Conaway Vanderbilt Chair.

Vanderbilt University's fall 2024 survey canvassed 955 Tennessee registered voters from Nov. 18 to Dec. 4. The poll was conducted in English.

Tennessee split, but consistent

Tennesseans are divided on whether the state is on the right track or the wrong track — 50% and 46%, respectively.

Views vary greatly by gender, with 60% of men believing the state is on the right track, compared to 41% of women. Independents were roughly split on their view of the direction of the state. Three-quarters of non-MAGA Republicans view the state as on the right track — five points higher than MAGA Republicans — while 80% of Democrats view the state as on the wrong track.

Since the fall of 2022, the Vanderbilt Poll has asked self-identified Republican registered voters whether they view themselves more as a supporter of the GOP or the MAGA movement. This latest poll saw a notable increase in those who identify as a supporter of MAGA, from 46% in May 2024 to 60% now.

"On the face of it, this would seem to indicate Tennessee is becoming more conservative, but the basic way people describe themselves — such as 'conservative' or 'very liberal' — hasn't shifted in a decade," said Vanderbilt Poll co-director Josh Clinton, who holds the Abby and Jon Winkelried Chair at Vanderbilt and is a professor of political science. "The shift we see is almost certainly a statement about how the MAGA brand has overtaken the Republican brand in the state — especially coming off of a successful election. The policies Tennesseans support and the opinions they express have not dramatically changed since we have been tracking the views of registered Tennessee voters."

In November 2015, 47% of Tennesseans identified themselves as conservative or very conservative. Nearly a decade later it stands at 48%.

State official approval

The Vanderbilt Poll revealed that 53% of registered voters surveyed approve of the job the Tennessee State Legislature is doing, a seven-point jump from the 46% approval rating in May 2024. Gov. Bill Lee received a similar bump in approval, with 60% of Tennesseans surveyed approving of the job he is doing as governor, up from 54% in May. Sen. Marsha Blackburn's approval ratings jumped from 46% to 53%, while Sen. Bill Hagerty's rose from 40% to 46%. Approval is sharply divided by citizens' party loyalty.

"Tennesseans expressed increased satisfaction with their state officials as well as the U.S. Congress," said Clinton. "This is likely an afterglow of the election and possibly reflective of a fading memory of the contentious last session. Approvals have increased six to seven points since the May 2024 poll."

These marked increases were not reflected in presidential ratings, with President Joe Biden's approval among Tennesseans remaining low at 29%. Similarly, President-elect Donald Trump's approval by registered Tennessee voters was 55%, up just one point from December 2020, the last time his approval was measured by the poll.

Women's and reproductive healthcare

While registered voters in Tennessee expressed increased support of state officials, their views on women's health issues diverged from those of most elected leaders. Tennessee is among the 13 states that have banned nearly all abortions, while Tennessee's registered voters overwhelmingly support several exceptions.

Since first being polled on this topic by Vanderbilt, Tennesseans' identification as pro-choice has climbed from 37% in 2012 to 48% a decade later in May 2022. Today, it stands at 53% and likely reflects the changing nature of the debate and accompanying political environment.

Support for exceptions was even more pronounced. When asked if abortion should be legal in cases of rape, 82% of registered voters said yes — the same figure for if a fetus could not survive outside the womb because of medical issues. For incest, 81% of voters polled said abortion should be legal. Each of these scenarios had strong majority support across the partisan spectrum.

When it comes to IVF (in vitro fertilization), 87% of Tennessee voters believe this route to pregnancy should be legal. This is a five-point increase from the last Vanderbilt Poll six months ago in May 2024. Eighty-eight percent of voters view IVF as morally acceptable (24%) or not a moral issue (64%).

Guns and cannabis

There continues to be a misalignment between Tennessee voters and the officials elected to represent them on long-discussed issues in the state. Two key issues of note are gun reform and the legalization of recreational marijuana. Both share strong bipartisan support among registered voters, contrasting with lawmakers on the issues.

Regarding the medicinal or recreational legalization of marijuana, bills have been before the Tennessee Legislature for many years. The Vanderbilt Poll found 63% of voters support recreational legalization, with 36% opposing. Most Republicans (53%) and Democrats (78%) support legalization.

"All four gun reform options tested in this poll gained strong support from Tennesseans," Clinton said. "They by and large support legislative action to increase the regulation of guns — including requiring owners to report lost and stolen guns and limiting gun access for individuals at high risk of harming themselves or others."

A full 86% of Tennessee registered voters said they strongly or somewhat support passing laws that would require gun owners to report if their gun is lost or stolen. That includes 74% of MAGA Republicans. Only 8% oppose such a law. At a margin of more than 5-to-1 (78% versus 14%), voters would support a so-called red flag law, which would temporarily restrict gun access for individuals deemed at high risk for harming themselves or others.

The Vanderbilt Poll revealed that Tennesseans oppose, 3-to-1, expanding the right to carry long guns such as hunting rifles, assault rifles and shotguns. Opposition increased slightly from 71% in May of this year to 74% today. Laws that would require gun owners to store firearms securely in their vehicle or home see similar levels of support at 69% and 67%, respectively.

Women consistently supported gun reforms at higher rates than men — from 16 to 29 percentage points higher.

Medicaid expansion

When asked if they support a state expansion of Medicaid to cover more low-income and uninsured people, 73% of registered voters strongly agreed or somewhat agreed, including a majority of Republicans. This issue has a clear gender divide, with women supporting expansion at 79% compared to 66% of men.

Tennesseans' support of access to care wasn't limited to Medicaid. Eighty-eight percent of voters surveyed agreed that mental health access should be a top priority for the state. This opinion enjoyed a strong majority across all party affiliations and demographics.

On federal healthcare issues, Tennessee registered voters expressed similar support, with 87% of Tennesseans surveyed agreeing that healthcare costs are too high and the federal government should be doing more to negotiate cheaper prices. Regarding out-of-pocket costs for prescription medications, 87% of registered voters agreed that costs for prescription medication should be capped for adults with health insurance.

When it comes to the parties deemed responsible for high healthcare costs in Tennessee, respondents ranked health insurance companies as carrying the largest weight of responsibility (34%) with pharmaceutical companies ranked second (30%). Doctors and hospitals ranked a distant fourth in culpability for costs, with only 10% of voters considering them most responsible.

"These numbers are a positive indicator of approval for Nashville's healthcare economy, which is historically rooted in the provider space — the doctors and hospitals that receive little blame especially when compared to the other sectors of the industry," Geer said.

Other notable findings

Deportation — Whether someone living in the country illegally has a criminal record dramatically changes Tennesseans' views about deportation. If they have a criminal record, 84% of voters strongly or somewhat support deportation, cutting across all affiliations and demographics. If the individual does not have a criminal record, support decreases dramatically. Those who are neutral double when the individual does not have a criminal record.

Economic worry — Tennessee voters are dramatically more worried about their financial stability today when compared to responses to the May 2021 poll. Worrying about not having enough money to pay for emergencies, like medical care or car repairs, increased 22 points to 54%. Worrying about having enough to pay normal monthly bills, like housing, food and transportation, increased 16 points to 38%. Worrying about not having enough in savings for things like retirement or a child's education increased 17 points to 59%.

Election confidence — Registered voters in Tennessee have a high level of confidence in the fairness and accuracy of the recent election. Eighty-one percent are somewhat or very confident in the election nationwide, with confidence in the Tennessee-run election at 90%. This is a notable change from the turmoil following the 2020 election.

Democracy in danger — Similarly, views about threats to democracy are largely shaped by political affiliation and the outcome of the election. Views of American democracy being under attack eased from 63% in May to 52% in December. In May, 5% of respondents said American democracy isn't in danger, which increased to 12% in this poll.

Education — Tennesseans believe education should be the top priority for the state government, with 1% selecting it above all other issues; however, there is no clear direction on the school voucher issue. Forty-seven percent support vouchers, 44% oppose and 7% are neutral.

Climate change — There is no real shift in views on climate change among registered voters in Tennessee. Compared to responses to the May 2024 poll, the belief that climate change is "not happening" increased a meager two points to 19%, "not sure" increased four points to 20%, and "is happening" decreased by seven points to 60%. Those are very or somewhat worried about climate change decreased from 51% to 46%.

Nuclear power — Tennesseans show support for nuclear power as a way to generate low-carbon energy. Such findings are important as power companies, including the Tennessee Valley Authority, grapple with how to shrink their carbon footprint.