Washington, D.C. finds that a significant 62% of U.S. adults believe it is the federal government's responsibility to ensure all Americans have healthcare coverage. This marks the highest percentage in over a decade. Back in 2013 during the troubled rollout of the Affordable Care Act's (ACA) healthcare exchanges, the figure had slipped to as low as 42%. Yet, it had reached as high as 69% in 2006.

Unraveling the Public's Stance on Healthcare Responsibility

Historical Trends in Healthcare Responsibility Beliefs

Between 2000 and 2008, a consistent majority of Americans held the view that the government should ensure healthcare coverage for all. However, during Barack Obama's presidency, as he worked with a Democratic Congress to pass the ACA, opposition emerged from some Americans regarding a larger government role in healthcare. By 2009, U.S. adults were divided on this matter. From 2012 to 2014, majorities did not believe the government should have this role, with support among independents and Republicans waning. But in the latter years of Obama's presidency, public opinion shifted back, and this has been the prevailing view since.Nowadays, among independents and Republicans, the agreement that the government has a responsibility to ensure healthcare coverage for all Americans has increased. While a minority of Republicans hold this view (32% in 2020 compared to 22% previously), the percentage of independents (65%, up six points from 2020) believing in this is significant. Large majorities of Democrats have consistently supported this idea, with 90% currently saying the government should ensure health coverage for all, which is the highest Gallup has measured for this group. In the 2000s, the high points for Republicans and independents were 44% in 2001 and 2004 for Republicans, and 71% in 2006 and 2007 for independents.

Public Divide on Government vs. Private Healthcare System

Gallup also measures public support for a government-run U.S. healthcare system. Americans are evenly divided on this question, with 46% favoring a government-run system and 49% in favor of a system based mostly on private health insurance. Only in 2017 were they as closely divided as they are today. In most years, majorities (up to 61%) have favored a system based on private insurance.Democrats and Republicans hold opposite views on the best approach to providing healthcare. 71% of Democrats favor a government-run system, while 20% prefer a private system. Conversely, 76% of Republicans favor private insurance, and 21% support a government-run system. Forty-seven percent of independents want a government system, and 49% a private one. Republicans' current support for a government-run system is the highest they have expressed to date (12% in 2020), and the percentages of independents and Democrats wanting a government system are on the high end since 2010 but not the highest.

Obamacare Approval Near High Point

Fifty-four percent of U.S. adults approve of the ACA, essentially tying the record-high 55% readings in April 2017 (during Republican-led attempts to repeal the law) and November 2020 (after Joe Biden won the presidency). Approval has generally been 50% or above since Obama left office in 2017, but during his tenure, the law was far less popular, ranging from 37% to 48% approval.Ninety-four percent of Democrats and 19% of Republicans approve of the law, which are highs for these groups. Fifty-three percent of independents approve.Those who approve of the ACA are evenly divided between wanting the law kept in place largely as it is (48%) and keeping the law but making significant changes to it (48%). This is a shift from the past when larger shares of approvers wanted changes.Among those who disapprove of the Affordable Care Act, most (66%) would prefer it to be repealed and replaced with a different plan rather than keeping it and making significant changes (27%). Disapprovers, who are mostly Republicans, have consistently wanted the law repealed, which President Donald Trump and the Republican-led Congress attempted to do in 2017 but were unsuccessful.

Bottom Line

Trump's plans for healthcare in his second administration are unclear. Making a second attempt at repealing the Affordable Care Act could be a challenging task as public support for the law is as high today as in his first term. At the same time, Americans are more likely to agree with the driving principle behind the ACA - that government should ensure all Americans have coverage. During his September presidential candidate debate with Democratic nominee Kamala Harris, Trump remained critical of the ACA and said he had "concepts of a plan" to replace it. His lack of a firm plan for healthcare suggests this issue may not be a top priority for him compared to other issues like immigration and trade where he made more specific policy proposals during the campaign.To stay updated with the latest Gallup News insights and updates, follow us on X @Gallup.Learn more about how the Gallup Poll Social Series works.View complete question responses and trends (PDF download).