“Even among Democrats, the top issues are pocketbook issues — not the big system reform debates,” said Robert Blendon, a Harvard professor of health policy and political analysis who helped design the poll. “They’re worried about their own lives, their own payments, and what they can afford.”

Roughly 80 percent of those surveyed ranked “taking steps to lower the cost of health care” as “extremely” or “very” important, including 89 percent of Democrats and 76 percent of Republicans. Reducing prescription-drug costs saw similar support at 75 percent, with majorities in both parties ranking it as extremely or very important.

By contrast, implementing a Medicare buy-in program or enacting Medicare for All ranked sixth and 10th, respectively, among the 22 issues survey respondents were asked to prioritize.

Climate change was 11th, with just 52 percent overall agreeing that it was crucial to drastically increase federal spending and regulation to combat the issue.

Americans’ focus on health care costs is consistent with polling over the past two years, and has underpinned congressional Democrats’ emphasis on passing legislation designed to lower drug prices and shore up the Affordable Care Act.

Trump has similarly touted his efforts on drug pricing, though his administration has made little headway on the issue. A bipartisan drug bill endorsed by officials including Vice President Mike Pence and HHS Secretary Alex Azar remains stalled in the Senate amid GOP resistance.

Yet the 2020 presidential race has largely discarded those concerns in favor of high-profile debates over the future of the health system, Blendon said, with Democratic candidates clashing over how they’d achieve universal coverage.

The current frontrunner, Sen. Bernie Sanders (I-Vt.), has vowed to pass Medicare for All as part of an ambitious platform that’s aided his rise in the polls — and in the process invited attacks from Democratic rivals and the Trump campaign over the plan’s cost and the new taxes that could be required to help pay for it. Most other 2020 Democrats have plans of their own for expanding government-funded health care.

“These are people who are not thinking policy wise — they’re thinking about things that they or their friends have read, about how things are outrageously expensive,” Blendon said of 2020 voters. “There’s no need to get in a fight over who has the best big plan for the future.”

Republicans also have little interest in a major health care overhaul after the GOP’s failed 2017 repeal-and-replace attempt, with just 37 percent saying it’s important to try again to gut Obamacare. That’s lower even than Republicans’ support for a Medicare buy-in, a Democratic idea that 43 percent of GOP respondents ranked as an extremely or very important priority.

GOP voters instead appeared more focused on cutting the federal deficit, despite a Trump administration agenda that has the deficit on track to top $1 trillion this year.

And while the survey was conducted during Trump’s Senate impeachment trial, comparatively few in either party ranked impeaching and removing the president among their top domestic priorities this year.

“If you’re going to have a general election in eight months, you better be talking about something beyond hearings we should’ve had in the impeachment trial,” Blendon said of the takeaway. “Health care will be a real, live issue.”

The poll surveyed 1,011 U.S. adults between Jan. 21 and Jan. 26. The margin of error was plus or minus 3.5 percentage points overall, and plus or minus 5 percentage points for questions asked of smaller samples.