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Far more Americans disapprove of President Donald Trump’s handling of several high-profile health care issues than give him positive marks, underscoring the challenge the president faces in claiming health care as a political asset in his reelection bid.

The findings, from the latest , released Thursday, found Trump’s approval ratings on various health care topics — including how he has handled the cost of prescription drugs and protecting people with preexisting conditions — lag behind those on his overall job performance. (Kaiser Health News is an editorially independent program of the foundation.)

Overall, 54% of adults disapprove of Trump’s handling of prescription drug costs, an area that he has repeatedly pledged to address and that federal officials see as crucial to his reelection pitch. In contrast, 3 in 10 said they approve.

At the same time, 35% of Americans approved of Trump’s handling of preexisting conditions and the Affordable Care Act.

The president’s overall job approval rating clocked in at 42%. He has repeatedly vowed to improve health care and lower prescription drug prices.

Trump has often misleadingly spoken about his record on preexisting conditions, one of the most popular pieces of the ACA. “I was the person who saved Pre-Existing Conditions in your healthcare,” he earlier this month, a claim that was widely debunked by fact-checkers.

Democrats’ focus on protections for preexisting conditions and other health issues helped propel the party’s successes in the 2018 midterm congressional elections. Some of the Democratic presidential contenders, especially former New York Mayor Michael Bloomberg, have hit Trump hard on his health policies.

Although certain parts of Trump’s health agenda have generated bipartisan praise — such as initiatives revamping care for Americans with kidney disease and vowing to stop the spread of HIV in the U.S. by 2030 — efforts related to the Affordable Care Act and health care entitlements have been controversial and subject to legal challenge. A narrow majority of the public — 51%  — said they disapproved of the president’s handling of Medicaid, compared with 35% who approve, the �鶹Ů�� poll found. The Trump administration has made significant changes to the ACA’s expansion of Medicaid, most notably approving some states’ efforts to set work requirements for adults who qualify for the program.

Multiple administration proposals on drug pricing have either been scuttled or have faltered in recent months — including an effort to overhaul drug rebates and an initiative to tie certain drug payments to prices in other countries — as has competing legislation in Congress. The �鶹Ů�� poll found that lowering drug prices and continuing the health law’s preexisting condition protections  ranked as the public’s top health care priorities for Congress to address, a finding that’s consistent with a �鶹Ů�� survey from a year ago.

The poll also questioned adults on the popularity of the two main proposals from Democratic presidential candidates to expand health coverage: instituting a government-run “public option” that competes with private insurers or a “Medicare for All” national health plan. Nearly 7 in 10 Americans  support a public option, whereas a smaller majority — 56%  — support Medicare for All.

While support was higher among Democrats, most independents also said they favor both approaches.

The poll found that nearly two-thirds of people have heard about a case brought by Republican state officials in a federal court in Texas and supported by the Trump administration that challenges the constitutionality of the ACA. Fifty-eight percent said they are “very” or “somewhat” worried that if the judge’s decision to strike down the law is upheld they or someone in their family will lose health coverage.

�鶹Ů�� Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at �鶹Ů��—an independent source of health policy research, polling, and journalism. Learn more about .