If voters like a politician — or dislike his opponent — does his health matter to them? What if they’re on the fence about whom to vote for?

Those are the questions Pennsylvanians might answer this November as Republican Mehmet Oz questions the fitness of his opponent in the Senate race, Democratic Lt. Gov. John Fetterman, who had a stroke in May.

When Fetterman returned to the campaign trail in August, he did so while still fighting off some lingering effects, including an auditory processing disorder that has made it difficult for him to understand some things said aloud to him.  

After commanding a solid lead in the polls much of the summer, Fetterman saw it narrow recently amid reports of the ongoing challenges to his recovery. Inside Elections with Nathan L. Gonzales calls the race a “Toss-up,” and Real Clear Politics shows Oz averaging just 1.3 points behind in the polls.

Still, Pennsylvania voters don’t seem to care about Fetterman’s health, said Berwood Yost, director of the Franklin and Marshall College poll. “We ask a specific question about why they are supporting the candidate they chose for the Senate, and health doesn’t come up,” Yost said, adding that only 13 percent of voters said they were unaware of Fetterman’s stroke.

History suggests that voters don’t really care about their preferred candidate’s physical fitness for office — at least, not as a stand-alone issue. Americans have consistently ignored politicians’ infirmities and age to elect them. Most dramatically, we’ve elected candidates who died before election day multiple times, including Mel Carnahan to the Senate in 2000.

But when a politician’s medical problems are evidence of some other personal failing, such attacks may play a larger role.

Oz’s attacks on Fetterman are echoes of those Donald Trump lobbed at Hillary Clinton in 2016 following a bout of pneumonia. The issue wasn’t really Clinton’s health — glad-handing candidates get sick all the time — but Clinton’s initial reaction to hide the illness, reportedly even from her own staff. “The problem with the Clinton situation was that it was occurring in a political context where she covered things up,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania.

Some of Oz’s surrogates have questioned Fetterman’s health directly — Sen. Patrick J. Toomey, R-Pa., said Fetterman wouldn’t be physically qualified to handle debates on the Senate floor (not that they ever really happen). Oz himself has accused Fetterman of “hiding,” raising questions of his trustworthiness and pressuring him into a debate.  

But unlike Clinton, Fetterman has been relatively open about his ongoing recovery issues (although he has refused Oz’s demands to release his health records, instead offering a note from his doctor saying he is recovering well). According to Yost, most effective attack ads either reveal something disqualifying about a candidate’s personality or highlight an unpopular policy position. Oz’s broadsides don’t seem to do either. “Most people see health issues acting on a person, not a person creating them for themselves,” Yost said. “It doesn’t reveal a thing about a person’s character.”

The attacks may even backfire, Yost warned, especially given that Oz is a heart surgeon who has treated stroke victims. The attacks might smack of nasty opportunism and undercut Oz’s attempts to cast himself as the moderate in the race.

However, Oz’s health focus may have succeeded in forcing Fetterman to debate: The two face off Tuesday night. “If he appears incapable of functioning,” Yost warned, then Fetterman’s health could become a bigger issue with some independent voters.

But for Republican or Democratic voters, the question of whether they will accept that Fetterman is perfectly capable, with a technological assist from a closed captioning system, will have very little to do with Fetterman’s actual performance. “Tribal identification will decide that,” said Jamieson.

Recent history

It’s difficult to say how much a candidate’s health problems ever discourage voters, even when that candidate loses. The closest historical analogy to Fetterman this year might be Illinois Republican Sen. Mark S. Kirk’s unsuccessful reelection campaign in 2016 following a stroke in 2012.

Kirk’s stroke was much more severe than Fetterman’s. Kirk spent nearly a year in recovery before returning to the Senate and needed to relearn how to walk and talk. To show voters that he had recovered fully, he participated in a charity stair climb, walking up 37 floors of the Willis Tower in Chicago. After having endorsed Kirk in 2010, the conservative-leaning Chicago Tribune editorial board backed his Democratic opponent in 2016, then-Rep. Tammy Duckworth, citing Kirk’s health issues.

Still, it’s unclear how much Kirk’s health mattered — a completely healthy Kirk probably wouldn’t have fared much better in 2016. Illinois was a deeply blue state voting in a highly partisan presidential election year. Kirk alienated his base by trying to distance himself from Donald Trump, and he uttered a series of gaffes on the trail. Duckworth was a war hero who nearly doubled Kirk’s fundraising totals and led him by double digits in most polls before her 55-40 win.

In Pennsylvania, voters in 1990 ignored the quadruple heart bypass that Gov. Bob Casey Sr. underwent in his first term as he cruised to victory. 

The last Senate candidate in the Keystone State to face serious health questions was Sen. Arlen Specter in 2010. While in office, Specter, then age 80, had undergone two brain operations and open-heart surgery, plus a few rounds of chemotherapy to fight Hodgkin lymphoma. In the lead-up to the Republican primary, a poll showed that 60 percent of GOP voters wanted Specter out, but only 8 percent of them cited his age or health for their opposition.

Specter then switched parties, gaining the support of President Barack Obama, Gov. Ed Rendell, and nearly every labor and Democratic organization in the commonwealth. Despite that, he still ended up losing the Democratic primary to Rep. Joe Sestak.

During that campaign, Specter’s health rarely came up. To the extent that Sestak raised the issue, it was subtly, using images of a particularly haggard-looking Specter recovering from chemotherapy in his television ads. In the campaign autopsies and Specter’s obituaries after his death in 2012, journalists said it was his Republican past that had haunted him in the Democratic primary, not the shadow of death.  

Similarly, Yost said the GOP’s focus on other issues — most notably crime — have made the current Senate race more competitive, not medical concerns. “That information about Fetterman’s health was out for a long time and didn’t seem to be moving anything,” said Yost. But, “when Oz started to hit him on crime, that’s when polls started to move.”

Oz has attacked Fetterman as a soft-on-crime candidate, despite the former mayor’s support for increasing police funding, pointing to his votes to recommend pardons and clemency for inmates while chairing Pennsylvania’s Board of Pardons. Fetterman has defended his time on the board, arguing the merits of individual cases and noting that he voted in sync with a Republican-appointed corrections expert on the board more often than not.

But such nuances might be lost on voters who aren’t paying close attention to the race. “That’s a complicated topic to defend in 30 seconds,” said Yost.

Health issues can also hurt a campaign simply by keeping the candidate off the trail. Vermont independent Sen. Bernie Sanders dropped in the polls during the 2020 Democratic presidential primary after his heart attack in 2019. Yost noted that primary voters often react to events differently from general election voters. “In a primary, you don’t have the party [affiliation] to use, so voters are looking for other things to distinguish a candidate,” he said.

Fetterman’s stroke occurred on May 13, just four days before the primary and after early voting had begun. He took three months to recover before resuming public appearances in August. His campaign continued to hold events during that time with his wife as a leading surrogate and to release videos of Fetterman needling Oz as a carpetbagger from New Jersey.

Disappearing stigma

Questioning a candidate’s physical fitness was once considered verboten among campaigns and journalists. The Washington press corps famously ignored President Franklin D. Roosevelt’s polio, even as his health demonstrably worsened ahead of his fourth reelection in 1944. He died a few months later.

More recently, Sen. Tim Johnson, a South Dakota Democrat, nearly died in 2006 from a massive brain hemorrhage that considerably affected his speech afterward. But Republicans largely ignored his health issues in 2008, allowing Johnson to win reelection by 25 points even as Republican presidential nominee John McCain carried the state by 8 points.

Even if voters do care, there’s the question of whether they should. “The question is: Under the stress, would he be able to make good judgments?” Jamieson said.

She pointed to President John F. Kennedy, who hid his Addison’s disease from voters by blaming his chronic back pain on injuries suffered when he saved his crew following the sinking of PT-109. Though a side effect of the desoxycorticosterone injections he took for Addison’s was impaired decision-making (particularly in stressful situations), Kennedy guided the nation safely through the Cuban Missile Crisis.

As for Fetterman, he might even turn the situation into an asset, said Yost. Nearly half of adults in Pennsylvania, or 47 percent, have a chronic illness, he said. “Many Pennsylvania adults … either know someone who has a chronic health condition or they themselves have one,” said Yost. “And they don’t feel like they’re incapable of doing their jobs.”

If Fetterman wins, he’ll be the third recent stroke survivor in the Senate, joining Democrats Ben Ray Luján of New Mexico and Chris Van Hollen of Maryland, who each had a stroke in January and May, respectively.