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Healthcare Coverage: Who's Responsible?

by Deborah Jordan Brooks, Gallup Tuesday Briefing Correspondent

The idea of universal health coverage remains controversial. The Democrats failed to pass a comprehensive healthcare reform package in 1994, and other health-related issues, such as prescription drug coverage for seniors, continue to face major roadblocks in Congress. Nevertheless, a November 2002 Gallup Poll shows that when asked if they "think it is the responsibility of the federal government to make sure all Americans have healthcare coverage," a majority of Americans (62%) say yes.

While a wide variety of people in most demographic groups agree that the federal government is responsible to some degree for Americans' health coverage, some groups are clearly in greater harmony than others are.


Because government traditionally plays a larger role in the Democratic platform than it does in the Republican platform, it is not surprising that more than twice as many Democrats as Republicans think the federal government should be responsible for Americans' healthcare. More than four in five Democrats (83%) agree that it should be a federal responsibility, compared to 68% of independents and 39% of Republicans.

The Republican figure deserves a second look; despite a partisan platform that generally advocates a smaller role for the federal government, nearly two in five Republicans think it should have a larger role with respect to healthcare coverage than it currently has. However, Republicans' expectations for how that responsibility should be enacted may tend to be different from those of Democrats or independents.

Age and Gender

Despite politicians' tendency to see healthcare as a key political issue among older Americans, young people are actually more likely to ascribe responsibility to the federal government for health coverage. Three-quarters of people aged 18 to 29 (75%) agree, compared to 62% of 30- to 49-year-olds, and 56% of those aged 50 and older. Young women are particularly likely to agree with this sentiment: 71% of women aged 18 to 49 agree (71%), compared to 61% of men in that same age group.

In Dire Straits

People in fair or poor physical and financial condition are far more likely to place responsibility for healthcare coverage on the federal government than those who are not. Among people who say that their personal financial situation is fair or poor, 69% think the federal government should be responsible for Americans' health coverage, compared to 56% of people who say that their personal financial situation is excellent or good. Similarly, among people who say that their physical health is fair or poor, 73% say that the government bears responsibility for health coverage, as do 59% of people who say their health is excellent or good.

What might account for these differences? Naturally, the answer may lie in greater need for assistance among those in poor health or financial distress. But it is also possible that the differences lie outside of the realm of personal need. People in excellent health may simply be less cognizant than people in poor health of the challenges that people with serious healthcare needs face, and therefore are less likely to consider that government help might be necessary or desirable for others. Similarly, people in excellent financial condition may be less aware than people in poor financial condition of the financial challenges that people face in obtaining healthcare.

Bottom Line

While the federal government currently does not guarantee healthcare for all Americans, a majority of American adults hold that expectation. Expectations may differ regarding how the government should fulfill this responsibility, but it is clear that many people want the federal government to play some role in ensuring that all Americans have access to medical care.

*Results are based on telephone interviews with 1,001 national adults, aged 18 and older, conducted Nov. 8-11, 2002. For results based on the total sample of national adults, one can say with 95% confidence that the maximum margin of error is ±3%.


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