Editor's Note: This research was conducted in partnership with , a family of nonprofit and nonpartisan organizations focused on healthcare and aging.
WASHINGTON, D.C. -- Sixty-two percent of U.S. adults, the highest percentage in more than a decade, say it is the federal government’s responsibility to ensure all Americans have healthcare coverage. The figure had slipped to as low as 42% in 2013 during the troubled rollout of the Affordable Care Act’s (ACA's) healthcare exchanges. It has been as high as 69% in 2006.
The results are based on Â鶹´«Ã½AV’s annual Health and Healthcare survey, conducted Nov. 6-20. The same poll finds fewer Americans than in the recent past rating U.S. healthcare coverage and quality positively.
Between 2000 and 2008, consistent majorities of Americans believed the government should make sure all people in the U.S. have health coverage. That changed during Barack Obama’s presidency, as he worked with a Democratic Congress to pass the ACA (also known as “Obamacare”) to increase health coverage in the U.S., sparking opposition by some Americans to a larger government role in healthcare.
By 2009, U.S. adults were divided on whether the government was responsible for ensuring healthcare coverage for all Americans, and from 2012 through 2014, majorities did not believe the government should have that role, as support among independents and Republicans waned. Public opinion shifted back to seeing healthcare access as a government responsibility in the latter years of Obama’s presidency, and this has been the prevailing view since.
More recently, agreement that the government has a responsibility to ensure healthcare coverage for all Americans has increased among independents and Republicans. While a minority of Republicans hold this view, the 32% who do so is up from 22% in 2020. The percentage of independents who believe the government is responsible for ensuring health coverage, 65%, is up six points from 2020.
Large majorities of Democrats have consistently believed the government should make sure all Americans have health coverage. The 90% of Democrats who now say the government should ensure health coverage for all is the highest Â鶹´«Ã½AV has measured for the group to date. The high points for Republicans and independents were registered in the 2000s: In 2001 and 2004, 44% of Republicans said the government was responsible, while 71% of independents, in 2006 and 2007, expressed that opinion.
Public Now Divides on Government vs. Private Healthcare System
Apart from asking whether the government should ensure people have healthcare coverage, Â鶹´«Ã½AV measures public support for a government-run U.S. healthcare system, such as those in Canada, the United Kingdom and elsewhere around the world.
Americans divide about evenly on this question, with 46% saying the U.S. should have a government-run healthcare system, while 49% are in favor of a system based mostly on private health insurance. Only in a 2017 survey were Americans as closely divided as they are today. In most years, majorities -- as high as 61% -- favored a system based on private insurance.
Democrats and Republicans hold opposite views of the best approach to providing healthcare -- 71% of Democrats favor a government-run system and 20% a private system, while 76% of Republicans favor private insurance and 21% a government-run system. Forty-seven percent of independents want a government system, and 49% a private one.
Republicans’ current support for a government-run system is the highest they have expressed to date, up from 12% in 2020. The percentages of independents and Democrats wanting a government system are on the high end of what Â鶹´«Ã½AV has measured since 2010, but not the highest.
Obamacare Approval Near High Point
Fifty-four percent of U.S. adults approve of the ACA, essentially tying the record-high 55% readings in April 2017 (during Republican-led attempts to repeal the law) and November 2020 (after Joe Biden won election as president). Approval has generally been 50% or above since Obama left office in 2017, but the law was far less popular during his tenure, ranging from 37% to 48% approval.
Ninety-four percent of Democrats and 19% of Republicans approve of the law, both highs for those groups. Fifty-three percent of independents approve.
Those who approve of the ACA divide evenly between wanting the law kept in place largely as it is (48%) and keeping the law but making significant changes to it (48%). This is a shift from the past, when larger shares of those who approved of the law wanted changes to it than do now.
Among those who disapprove of the Affordable Care Act, most would prefer that it be repealed and replaced with a different plan (66%), as opposed to keeping it in place but making significant changes to it (27%). Disapprovers -- who are mostly Republicans -- have consistently wanted the law repealed, which President Donald Trump and the Republican-led Congress attempted to do in 2017 but were unsuccessful.
Bottom Line
Trump’s plans for healthcare in his second administration are unclear, but making a second attempt at repealing the Affordable Care Act could be a daunting task. Public support for the law is as high today as in Trump’s first term. At the same time, Americans are even more likely today to agree with the driving principle behind the ACA -- that government should ensure all Americans have coverage.
During his September presidential candidate debate with Democratic nominee Kamala Harris, Trump remained critical of the ACA and said he had “concepts of a plan” to replace it. His lack of a firm plan for healthcare suggests the issue may not be a high priority for him, in contrast to issues, such as immigration and trade, that he made more specific policy proposals about during the campaign.
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