Access to health care – and how to pay for it – was a key issue in this fall’s presidential and congressional elections. More than 6 in 10 Americans (62%) now say it is the responsibility of the federal government to ensure that all Americans have health care coverage, according to a Gallup poll conducted in early to mid-November.

This percentage was the highest in a decade, after dropping as low as 42% in 2013 and climbing as high as 69% in 2006. Public sentiment has ebbed and flowed in recent decades:

  • Between 2000 and 2008, consistent majorities of Americans believed the government should make sure all people in the United States have health coverage.
  • That changed during Barack Obama’s presidency, as he worked with a Democratic Congress to pass the Affordable Care Act to increase health coverage, sparking opposition by some Americans to a larger government role in health care.
  • By 2009, U.S. adults were divided on whether the government was responsible for ensuring health care coverage for all Americans.
  • 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 health care access as a government responsibility in the latter years of Obama’s presidency, and this has been the prevailing view since then.
Although Republicans and Democrats have long viewed the role of the federal government differently, agreement that the government has a responsibility to ensure health care coverage for all Americans has increased among independents and Republicans. Although a minority of Republicans still 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.

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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 Gallup has measured for the group to date. In 2001 and 2004, 44% of Republicans said the government was responsible, while 71% of independents, in 2006 and 2007, expressed that opinion.

Americans divide about evenly on whether the nation should have a government-run
government-run health care system, with 49% 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. Again, Democrats and

Republicans hold opposite views of the best approach to providing health care.

  • Republicans’ current support for a government-run system is the highest they have expressed to date, up from 12% in 2020. Seventy-one percent of Democrats favor a government-run system and 20% prefer a private system.
  • Three-fourths of Republicans favor private insurance, and 21% support a government-run system.
  • Forty-seven percent of independents want a government system, and 49% would rather have a private one.
Related: Almost 75% of ACA buyers will not compare plans for 2025

Meanwhile, 54% of U.S. adults approve of the ACA, essentially tying the record-high 55% approval in April 2017 and November 2020. Approval generally has 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 (also 48%). Among those who disapprove of the ACA, 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%).

The survey results could affect the health care strategies of the incoming Trump administration and Republican Congress.

“Trump’s plans for health care in his second administration are unclear, but making a second attempt at repealing the ACA could be a daunting task,” the survey report concluded. “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.”

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Alan Goforth

Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.