Seven in 10 Maintain Negative View of U.S. Healthcare System

WASHINGTON, D.C. -- Seventy percent of Americans describe the current U.S. healthcare system as being "in a state of crisis" or having "major problems." This is consistent with the 65% to 73% range for this figure in all but one poll since Gallup first asked the question in 1994.

In that one poll -- conducted right after the 9/11 attacks in 2001 -- just 49% of Americans said the U.S. healthcare system had major problems or was in crisis. This was because of Americans' heightened concerns about terrorism after the attacks, which temporarily altered their views and behaviors on a variety of issues.

The latest data are from Gallup's annual Healthcare poll, conducted Nov. 1-11.

About Six in Seven Democrats Rate the Healthcare System Negatively

Although the percentage of Americans saying U.S. healthcare has major problems or is in crisis has been fairly flat over the past two decades, Democrats' and Republicans' views have changed within that time frame.

From 2001 to 2009, Democrats and Democratic-leaning independents were considerably more likely than Republicans and Republican-leaning independents to say healthcare had major problems or was in crisis. Democrats' negative assessments then decreased in the rest of President Barack Obama's first term, after passage of the Affordable Care Act (ACA) in 2010, at the same time that Republicans' concerns mounted. By 2012, the lines crossed, so that during most of Obama's second term, Republicans were significantly more likely than Democrats to perceive significant or critical problems in the healthcare system.

Now, with Republican President Donald Trump in office, partisan views have flipped again, with Democrats more likely to be concerned.

The difference between the two major parties on this measure was just five percentage points in 2017, Trump's first year, when 76% of Democrats and 71% of Republicans said healthcare had major problems or was in crisis. This expanded to a 28-point gap in 2018, when 84% of Democrats and 56% of Republicans expressed these views -- the largest partisan gap on this measure in Gallup's trend since 2001.

The 2018 poll was conducted on the heels of last year's midterm elections, in which Democratic candidates highlighted key problems with the healthcare system -- especially coverage.

Although most Americans, including majorities of Republicans and Democrats, give the healthcare system a pessimistic diagnosis, when asked specifically about the quality of U.S. healthcare, 55% rate it positively. Smaller percentages have positive reviews of U.S. healthcare coverage (34%) and costs (20%). Americans rate cost and access as the greatest health problems facing the country.

More broadly, Gallup has found that Americans are much more positive in their assessments of their personal healthcare than they are about the healthcare system nationally.

Bottom Line

Barring any major breakthroughs in healthcare reform, it's difficult to imagine Americans' dim assessments of the state of U.S. healthcare changing anytime soon, given the mostly stable trend Gallup has recorded over nearly a quarter of a century.

The last major feat in healthcare policy reform was met by more disapproval than approval from Americans for many years, and the public's preferences for next steps on the ACA provide an unclear path for policymakers to follow to improve perceptions of the system.

Democratic efforts in the House of Representatives to protect the ACA will likely hit roadblocks with a GOP-controlled Senate and White House, and even some Democratic approaches to lowering drug prices are unlikely to receive Republicans' support. 2018 GOP congressional candidates campaigned on protection for those with pre-existing conditions, which more than a quarter of Americans report having, but there is already disagreement between the two major parties on how to provide that.

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