WASHINGTON, DC – 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 that all Americans have health coverage. The figure had fallen to as low as 42% in 2013 during the difficult rollout of the Affordable Care Act (ACA) health care exchanges. This figure reached 69% in 2006.
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The findings are based on Gallup’s annual Health and Healthcare Survey, conducted Nov. 6-20. The same survey reveals Fewer Americans than in the recent past rate health care coverage and quality in the United States positively.
Between 2000 and 2008, a consistent majority of Americans believed that the government should ensure that all Americans have health coverage. That changed under President Barack Obama, as he worked with a Democratic Congress to pass the ACA (also known as “Obamacare”) to increase health coverage in the United States, sparking opposition among some Americans to a greater government role in health care.
In 2009, American adults were divided on whether the government was responsible for providing health coverage to all Americans, and from 2012 to 2014, the majority did not think the government should play this role, while support from independents and Republicans was waning. Public opinion returned to viewing access to health care as a government responsibility during the final years of Obama’s presidency, and this has been the prevailing view ever since.
More recently, more and more independents and Republicans agree that the government has a responsibility to provide health coverage to all Americans. Although a minority of Republicans share this view, the 32% who support it is an increase from 22% in 2020. The percentage of independents who believe the government is responsible for providing health coverage, 65% , is up six points compared to 2020.
A large majority of Democrats have always believed that the government should ensure that all Americans have health coverage. The 90% of Democrats who now say the government should guarantee health coverage for all is the highest figure Gallup has measured for this group to date. The high points for Republicans and independents came in the 2000s: in 2001 and 2004, 44 percent of Republicans said the government was responsible, while 71 percent of independents in 2006 and 2007 expressed this view. .
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The public is now divided between the government health system and the private health system
In addition to asking whether the government should ensure that people have health coverage, Gallup measures public support for a government-run U.S. health care system, like that of Canada, the United Kingdom and elsewhere around the world .
Americans are evenly split on this issue, with 46% saying the United States should have a government-run health care system, while 49% favor a system based primarily on private health insurance. Only in a 2017 survey were Americans as divided as they are today. In most years, majorities – as high as 61% – favored a system based on private insurance.
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Democrats and Republicans have opposing views on the best approach to providing health care: 71% of Democrats favor a government-run system and 20% favor a private system, while 76% of Republicans favor private insurance and 21% favor a government-run system. Forty-seven percent of independents want a government system and 49% want a private system.
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 at the high end. scale of what Gallup has measured since 2010, but not the highest.
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Obamacare approval nears climax
Fifty-four percent of American adults approve of the ACA, essentially tying the record figure of 55% in April 2017 (during Republican attempts to repeal the law) and November 2020 (after Joe Biden won the presidential election). Approval has generally been 50% or higher since Obama left office in 2017, but the law has been much less popular during his tenure, ranging from 37% to 48% approval.
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Ninety-four percent of Democrats and 19% of Republicans approve of the law, both highs for these groups. Fifty-three percent of independents approve.
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Those who approve of the ACA are evenly split between wanting the law to remain largely as it is (48%) and keeping the law but making significant changes (48%). This is a change from the past, when a greater proportion of those who approved of the law wanted changes than today.
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Among those who disapprove of the Affordable Care Act, most would prefer to see it repealed and replaced with a different plan (66%), rather than keeping it in place but making significant changes (27%). Disapprovers — who are mostly Republicans — have always wanted the law repealed, something President Donald Trump and the Republican-led Congress tried to do in 2017, but failed.
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Conclusion
Trump’s plans for health care in his second administration are unclear, but making a second attempt to repeal the Affordable Care Act could prove a daunting task. Public support for the law is as high today as it was during Trump’s first term. At the same time, Americans are even more likely today to agree with the ACA’s guiding principle: The government should ensure that all Americans have coverage.
During his September debate with Democratic candidate Kamala Harris, Trump remained critical of the ACA and said he had “the idea of a plan” to replace it. His lack of a firm plan on health care suggests that this issue may not be a priority for him, unlike issues such as immigration and trade, on which he has made policy proposals more specific during the campaign.
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