Editor's Note: This research was conducted in partnership with the West Health-Gallup Center on Healthcare in America, a joint initiative to report the voices and experiences of Americans within the healthcare system.
WASHINGTON, D.C. — Americans’ approval of the 2010 Affordable Care Act has edged up to a new high of 57% as the clock ticks down to Dec. 31, when enhanced healthcare subsidies enacted during the pandemic are set to expire unless Congress takes action.
Gallup has tracked Americans’ approval of the ACA since November 2012, and the latest rating is up three percentage points from last year’s, which was similar to the previous 55% high recorded in April 2017 and in November 2020. Approval has been at or above 50% in most years since 2017, but the law was less popular before then, ranging from 37% to 48%.
These findings are from the West Health-Gallup Health and Healthcare Survey. The Nov. 3-25 poll was conducted during and after the longest federal government shutdown in U.S. history, which ended on Nov. 12. Several Democratic senators joined with Republicans to pass a continuing resolution that ended the shutdown but did not include an extension of the ACA insurance subsidies. A separate vote on those subsidies is expected later this week.
Political independents’ markedly improved rating of the ACA this year is driving the overall increase in approval nationwide. Ratings continue to differ sharply by party, with 91% of Democrats, 63% of independents and 15% of Republicans approving. While Democrats’ and Republicans’ current ratings are roughly in line with last year’s figures, independents’ rating has jumped 10 points to a record high.
Americans Divided in Preferences for ACA
Since November 2016, Gallup has asked respondents what they would like to see happen to the ACA. U.S. adults who approve of the law are currently divided in their preference to keep it in place but make significant changes to it (49%) or keep it in place largely as is (45%). Last year, views were evenly divided, while the four previous readings showed a clear preference for making significant changes to the ACA.
Meanwhile, those who disapprove of the law are much more likely to say they prefer it to be repealed and replaced (72%) than kept in place but with significant changes (24%). This 48-point gap in preferences for the ACA among those who disapprove of it is the largest on record.
All told, 26% of U.S. adults approve of the ACA and prefer to keep it as is, 28% approve of it but would like to see significant changes, 9% disapprove and favor making significant changes to it, and 25% disapprove of the law and think it should be repealed.
Among partisans, the majority of Republicans (62%) disapprove and support repealing the law. A 49% plurality of Democrats approve and support keeping it the way it is, and 38% support it but with significant changes. Independents are more closely divided between approving and keeping it as is (24%) and approving but making significant changes (34%).
Americans Support Federal Funding for Hospital Bills of Uninsured, With Limits
A separate nationally representative web survey using Gallup’s probability-based panel, conducted Nov. 3-16, tested the public’s views on whether the federal government should provide funding to hospitals to cover medical expenses for uninsured Americans. When asked simply if the government should provide such funding, 73% of Americans say it should, and 25% say it should not. While majorities of Democrats (93%) and independents (78%) agree that the government should pay for the care of uninsured patients, a majority of Republicans (53%) disagree.
Americans have a different perspective on covering hospitals’ costs for the uninsured when the question specifies the residency status of those patients. When asked to choose from three options, a slim majority of U.S. adults (51%) favor federal funding to cover medical expenses for uninsured legal residents of the U.S., while 33% think it should cover costs for all uninsured patients, including those living in the country illegally. Another 14% of Americans believe the government should not pay hospitals for any costs incurred by uninsured patients.
A majority of Republicans (70%) and a plurality of independents (50%) support funding for uninsured patients living in the U.S. legally. In contrast, a majority of Democrats (59%) support federal funding for all uninsured patients, regardless of their legal status.
Bottom Line
Americans’ approval of the Affordable Care Act has reached a new high as the future of pandemic-era expanded insurance subsidies hangs in the balance. Approval of the ACA has gradually increased over the past five years, but this year’s record high is largely fueled by a sharp rise in support among political independents. With lawmakers postponing a decision on the subsidies during the recent government shutdown and the Dec. 31 deadline for action fast approaching, the ACA has again become a central point of partisan contention.
Yet, public opinion remains fractured over what should happen next. Even among ACA supporters, Americans diverge between keeping the law largely intact and seeking major changes, while opponents overwhelmingly endorse repealing the law. These divisions mirror broader national debates that are likely to intensify as Congress prepares to vote on the subsidies.
At the same time, Americans’ views on the federal government’s responsibility to cover the cost of care for uninsured patients reveal both broad agreement and sharp limits. Most adults favor federal funding for hospitals treating the uninsured, but support declines considerably when the question involves patients living in the U.S. illegally. These attitudes underscore a public that backs some government role in providing safety-net healthcare funding but is split over how far that support should extend.
Taken together, Americans’ record-high approval of the ACA, their divergent preferences for its future, and their conditional support for funding care for the uninsured highlight a health policy environment defined by partisan polarization.
Stay up to date with the latest insights by following @Gallup on X and on Instagram and @West Health on X and LinkedIn. Explore more of the data and insights at westhealth.gallup.com.
Learn more about how the Gallup Poll Social Series works. View complete question responses and trends (PDF download).
