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).“Unraveling Trump’s Health Care Stance in a Press Interview”
Trump’s Vague Claims and Responses
During the interview, Welker questioned Trump about his claim during the campaign of having “concepts of a plan” for health care. Trump replied that they indeed had concepts that would be better. However, when pressed further about having a fully-developed plan, he stated that they had the biggest health care companies and doctors looking at it. He criticized Obamacare, claiming it stinks and is lousy, while suggesting there are better answers. He also emphasized that if a better answer is found, he would present it to Democrats and others.Trump further stated that Americans with pre-existing conditions will still have coverage under his “concepts of a plan” and that he wants “better health care for less money.” But when asked if Americans will see his “fully-developed” plan, he said he doesn’t know if they will see it at all.
Trump’s Rewriting of Obamacare History
The president-elect, who promised to repeal and replace the Affordable Care Act during his 2016 campaign, has tried to rewrite history by claiming he tried to “save” the law. Earlier in the interview, Welker cited Republicans who said it’s no longer feasible to repeal and replace Obamacare due to its deep entrenchment in the system. Trump used this opportunity to slam the late Sen. John McCain for his thumbs-down vote against repealing the ACA’s individual mandate and described how he made Obamacare “work.”Despite being asked if he did try to overturn Obamacare, Trump insisted it’s lousy. He also mentioned that his Justice Department tried to direct the Supreme Court to overturn it and claimed to have received a “surprising opinion” from the court. He further stated that Americans would have had “much better” health care if it were overturned and that he did the right thing from a human standpoint.
Unraveling the Complexities of UnitedHealthcare's Business Practices
Health Insurance Denials and Delays
After the assassination, it became evident that health insurance companies like UnitedHealthcare are indeed engaged in the practice of "delay, deny and defend" when it comes to patient claims. From surgeries and procedures to drugs and hospitalizations, these denials and delays have raised concerns. Doctors and hospitals submit claims after treating patients who are subscribers to these insurance plans. Insurers make money based on the unspent portion of premium pools. In the case of self-insured employers, insurers also receive administrative fees. The coverage decisions are a collaborative effort between the insurance company and the employer client. In Medicaid for the poor, state lawmakers and governors hold sway over coverage decisions. Almost all states have privatized Medicaid programs with insurers like UnitedHealthcare playing a significant role.Even in Medicare coverage for seniors, the federal government is increasingly relying on privatized insurers through Medicare Advantage plans. Despite insurance industry rules requiring prior authorization, Medicare Advantage has become more popular than government-run fee-for-service Medicare. Both Republicans and Democrats support Medicare Advantage, making single-payer government-run Medicare less likely.
Data from 2022 shows that 7.4% of prior authorizations were denied or partially denied, up from less than 6% in previous years. Meanwhile, under the Affordable Care Act, private individual coverage has seen record enrollment under the Biden White House, with enhanced subsidies helping more Americans afford coverage. However, the looming second Trump administration and a Republican-controlled Congress may not renew these subsidies and could ease industry rules, potentially causing premium spikes and coverage losses for millions.
The Role of Insurance Rules and Politics
Congressional rules endorsed by both Republican and Democratic administrations have supported the march towards Medicare Advantage. But in recent years, it has come under more scrutiny. Rules like prior authorization requirements have been in place, but their enforcement and impact vary.During the Trump administration, there were efforts to repeal and replace the Affordable Care Act, which could have led to a significant increase in the uninsured and the reintroduction of preexisting condition denials. His administration also cut funding for outreach and enrollment assistance. A second Trump administration might restart efforts to add work requirements to Medicaid, which could result in coverage losses.
The interplay between insurance rules and political decisions is complex. It affects not only the insurance industry but also the lives of millions of Americans who rely on these plans for their healthcare.