Majority Want Government to Ensure Healthcare Coverage

WASHINGTON, D.C. -- Fifty-six percent of Americans say the federal government should be responsible for making sure all Americans have healthcare coverage, up slightly from 52% last year and the highest level in 10 years.

From 2000, the year Gallup first asked the question, to 2008, a clear majority of Americans (averaging 62%) agreed with the government responsibility premise. But by November 2009, after newly elected President Barack Obama and congressional Democrats had been working for months on healthcare legislation aimed at achieving universal coverage, the percentage of Americans believing government was responsible dropped below the majority level. Agreement generally declined in the years thereafter, reaching a low of 42% in 2013.

Since 2014, however, as the elements of the 2010 Affordable Care Act have been taking effect, Americans' views that the government should ensure universal coverage have been rising, and this has been the majority sentiment in each of the past three years.

This Gallup trend question asks about government responsibility to make sure that all Americans have healthcare coverage -- it does not signify that the government has to provide that coverage.

But another question in Gallup's November Health and Healthcare survey asks about government involvement in providing healthcare. Results show that a slightly smaller 47% of Americans favor a government-run healthcare system. Forty-eight percent favor a system based on private insurance.

The public's combined responses to the two questions -- about government responsibility that all have coverage and about a government-run system -- are as follows:

• 40% of Americans want total government involvement in healthcare -- government taking responsibility for making sure all have healthcare coverage and government running the healthcare system
• 34% adopt a total antigovernment position, believing the government is not obligated to ensure all Americans are covered and opposing a government-run system
• 13% say government is responsible for ensuring everyone has coverage but simultaneously opt for a private health insurance system
• 6% say government should run healthcare, but it does not have a responsibility to provide health coverage

The remaining U.S. adults have no opinion on at least one of the questions.

Democrats and Independents Drive Recent Uptick

For the past 17 years, Democrats have consistently been the party group most likely to think the government is responsible for ensuring coverage, and Republicans have been the least likely.

The views of independents on this question fall in between those of Democrats and Republicans, but they have recently been closer to Democrats'. This partisan divide is not unexpected; views of the federal government's role in healthcare are some of the most partisan of any policy issue on the current political agenda.

As it became clear that Obama intended to increase the government's role in ensuring Americans had healthcare coverage, the percentages of Republicans and independents who said they believed the government should provide healthcare declined. This was likely in reaction to the potential reality of this actually occurring, or because the issue ignited much partisan debate as the new Affordable Care Act dominated political news. Democrats' views also edged down slightly over the years after 2008.

In 2014 more independents began to say that the government bears responsibility for ensuring healthcare coverage, rising from 41% in 2013 to 62% today. Democrats' agreement also surged from a low of 68% four years ago to 80% today. These low points in 2013 may have reflected initial problems with healthcare exchanges and reports of existing plans being canceled as the ACA was implemented.

Republicans' current agreement (17%) is slightly higher than it was from 2010 to 2013 but remains well below the agreement of the other two groups, and it has not increased in the last several years.

Bottom Line

The idea that the government is responsible for making sure that all Americans have healthcare coverage has been at or above the majority level for all but five of the past 18 years. The low point in these attitudes came during the Obama administration as the ACA was being debated and enacted into law, and as it encountered initial problems with its rollout. More recently, however, support for the idea that the government should make sure Americans have healthcare coverage has climbed back to a majority level -- even as Congress may eliminate the ACA's individual insurance coverage mandate as part of new tax reform legislation.

Gallup's research shows that four in 10 Americans would opt to have their government highly involved in running the healthcare system and making sure that all have coverage. A slightly lower percentage want government to keep its hands off of healthcare, while a small percentage in essence agree with the ACA approach: requiring all to have insurance but not running the healthcare system per se. These attitudes can, in part, help explain why support for the ACA is just about at the majority level -- and no higher. The ACA may not go far enough for some, while going too far for others.