廖珮岑：More in U.S. See Health Coverage as Government Responsibility--Approval of Affordable Care Act also near high point
（更多美国人认为保障民众享有医疗保险是政府的责任——对《平价医疗法案》的支持率也接近高点）
BY JEFFREY M. JONES
Jeffrey M. Jones，博士，自2000年起担任盖洛普高级编辑，监督盖洛普美国民意调查和其他公开发布调查的研究和分析。他对民意和投票行为的研究已经发表在学术期刊和编辑的书籍上。专业领域：美国民意调查与研究
编者注：这项研究是与West Health合作进行的，West Health是一家专注于医疗保健和老龄化的非营利和无党派组织。
华盛顿特区——62%的美国成年人表示，确保所有美国人都有医疗保险是联邦政府的责任，这是十多年来的最高比例。2013年，由于《平价医疗法案》（Affordable Care Act， ACA）医保交易的推出问题重重，这一数字一度跌至42%。这一比例在2006年曾高达69%。
美国人认为联邦政府有责任确保所有人都有医疗保险
你认为确保所有美国人都有医疗保险是联邦政府的责任，还是这不是联邦政府的责任？
该调查结果是根据盖洛普于11月6日至20日进行的年度健康与医疗保健调查得出的。同一项民意调查发现，对美国医疗保险和医疗质量给予正面评价的美国人比最近减少了。
在2000年至2008年期间，大多数美国人一致认为政府应该确保所有美国人都有医疗保险。这种情况在巴拉克•奥巴马（Barack Obama）担任总统期间发生了变化，因为他与民主党控制的国会合作，通过了ACA（也被称为“奥巴马医改”），以扩大美国的医疗覆盖范围，这引发了一些美国人反对政府在医疗保健领域发挥更大作用。
到2009年，美国成年人对政府是否有责任确保所有美国人的医疗保险存在分歧，从2012年到2014年，随着独立人士和共和党人的支持减弱，大多数人不认为政府应该承担这一角色。在奥巴马总统任期的最后几年，公众舆论又重新把医疗保健视为政府的责任，从那以后，这一直是主流观点。
最近，越来越多的独立人士和共和党人同意，政府有责任确保所有美国人都享有医疗保险。虽然少数共和党人持这种观点，但32%的人持这种观点，高于2020年的22%。认为政府有责任确保医疗保险的独立人士比例为65%，比2020年上升了6个百分点。
大多数民主党人一直认为，政府应该确保所有美国人都有医疗保险。90%的民主党人现在认为政府应该确保全民医保，这是盖洛普迄今为止对该群体进行的最高调查。共和党和无党派人士的支持率在本世纪头十年达到最高点：2001年和2004年，44%的共和党人认为政府有责任，而2006年和2007年，持这一观点的无党派人士比例为71%。
政党对联邦政府有责任确保所有人都有医疗保险的看法
你认为确保所有美国人都有医疗保险是联邦政府的责任，还是这不是联邦政府的责任？
公众现在对政府和私人医疗体系产生分歧
除了询问政府是否应该确保人民享有医疗保险之外，盖洛普还调查了公众对政府运营的美国医疗体系的支持程度，比如加拿大、英国和世界其他地方的医疗体系。
在这个问题上，美国人的意见分歧大致相当，46%的人说美国应该有一个政府运营的医疗体系，49%的人赞成一个主要基于私人医疗保险的体系。只有在2017年的一项调查中，美国人的分歧才像今天这样严重。在大多数年份，大多数人（高达61%）支持以私人保险为基础的医疗体系。
美国人首选的医疗体系
在美国，你更喜欢以下哪一种提供医疗保健的方法——[轮流：政府经营的医疗保健系统或主要基于私人医疗保险的系统]？
民主党人和共和党人对提供医疗保健的最佳方式持相反的观点——71%的民主党人支持政府运营的体系，20%的人支持私营体系，而76%的共和党人支持私营保险体系，21%的人支持政府运营的体系。47%的独立人士希望有一个政府系统，49%的人希望有一个私人系统。
共和党人目前对政府运营体系的支持率是迄今为止最高的，高于2020年的12%。希望建立政府体制的独立人士和民主党人的比例处于盖洛普自2010年以来测量的最高值，但不是最高的。
政党对官办医疗体系的偏好
在美国，你更喜欢以下哪一种提供医疗保健的方法——[轮流：政府经营的医疗保健系统或主要基于私人医疗保险的系统]？
奥巴马医改获得批准接近高点
54%的美国成年人赞成《平价医疗法案》，基本上追平了2017年4月（共和党领导的废除该法的尝试期间）和2020年11月（乔·拜登当选总统后）55%的创纪录高位。自奥巴马2017年卸任以来，该法案的支持率普遍在50%或以上，但在他任职期间，该法案的支持率远不如奥巴马，从37%到48%不等。
美国人对平价医疗法案的认可
你一般是赞成还是不赞成2010年奥巴马总统签署的平价医疗法案，该法案重组了美国的医疗体系？
94%的民主党人和19%的共和党人支持这项法律，这两个群体的支持率都很高。53%的无党派人士表示赞同。
政党通过《平价医疗法案》
你一般是赞成还是不赞成2010年奥巴马总统签署的平价医疗法案，该法案重组了美国的医疗体系？
赞成《平价医疗法案》的人中，有48%的人希望基本保持原判，48%的人希望保留该法案，但对其进行重大修改。这与过去相比是一个转变，当时赞成该法律的人比现在更多地希望对其进行修改。
不赞成平价医疗法案的人对该法案的偏好发生了变化
（被问及那些不赞成《平价医疗法案》的人）如果你必须做出选择，你更愿意——[轮换：废除《平价医疗法案》并用不同的计划取而代之（或）保留《平价医疗法案》，但对其进行重大修改]？
写在后面
特朗普在第二任期政府的医疗保健计划尚不清楚，但第二次尝试废除《平价医疗法案》可能是一项艰巨的任务。如今公众对该法案的支持率与特朗普第一任期时一样高。与此同时，美国人今天更有可能同意ACA背后的驱动原则——政府应该确保所有美国人都有保险。
在9月与民主党候选人卡玛拉·哈里斯的总统候选人辩论中，特朗普仍然对ACA持批评态度，并表示他有一个取代它的“计划概念”。他在医疗保健方面缺乏坚定的计划，这表明这个问题对他来说可能不是优先考虑的问题，而在移民和贸易等问题上，他在竞选期间提出了更具体的政策建议。
Editor's Note: This research was conducted in partnership with West Health, a family of nonprofit and nonpartisan organizations focused on healthcare and aging.
WASHINGTON, D.C. -- Sixty-two percent of U.S. adults, the highest percentage in more than a decade, say it is the federal government’s responsibility to ensure all Americans have healthcare coverage. The figure had slipped to as low as 42% in 2013 during the troubled rollout of the Affordable Care Act’s (ACA's) healthcare exchanges. It has been as high as 69% in 2006.
Americans' Beliefs About the Federal Government's Responsibility to Ensure All Have Healthcare Coverage
Do you think it is the responsibility of the federal government to make sure all Americans have healthcare coverage, or is that not the responsibility of the federal government?
The results are based on Gallup’s annual Health and Healthcare survey, conducted Nov. 6-20. The same poll finds fewer Americans than in the recent past rating U.S. healthcare coverage and quality positively.
Between 2000 and 2008, consistent majorities of Americans believed the government should make sure all people in the U.S. have health coverage. That changed during Barack Obama’s presidency, as he worked with a Democratic Congress to pass the ACA (also known as “Obamacare”) to increase health coverage in the U.S., sparking opposition by some Americans to a larger government role in healthcare.
By 2009, U.S. adults were divided on whether the government was responsible for ensuring healthcare coverage for all Americans, and from 2012 through 2014, majorities did not believe the government should have that role, as support among independents and Republicans waned. Public opinion shifted back to seeing healthcare access as a government responsibility in the latter years of Obama’s presidency, and this has been the prevailing view since.
More recently, agreement that the government has a responsibility to ensure healthcare coverage for all Americans has increased among independents and Republicans. While a minority of Republicans hold this view, the 32% who do so is up from 22% in 2020. The percentage of independents who believe the government is responsible for ensuring health coverage, 65%, is up six points from 2020.
Large majorities of Democrats have consistently believed the government should make sure all Americans have health coverage. The 90% of Democrats who now say the government should ensure health coverage for all is the highest Gallup has measured for the group to date. The high points for Republicans and independents were registered in the 2000s: In 2001 and 2004, 44% of Republicans said the government was responsible, while 71% of independents, in 2006 and 2007, expressed that opinion.
Beliefs About the Federal Government's Responsibility to Ensure All Have Healthcare Coverage, by Political Party
Do you think it is the responsibility of the federal government to make sure all Americans have healthcare coverage, or is that not the responsibility of the federal government?
Public Now Divides on Government vs. Private Healthcare System
Apart from asking whether the government should ensure people have healthcare coverage, Gallup measures public support for a government-run U.S. healthcare system, such as those in Canada, the United Kingdom and elsewhere around the world.
Americans divide about evenly on this question, with 46% saying the U.S. should have a government-run healthcare system, while 49% are in favor of a system based mostly on private health insurance. Only in a 2017 survey were Americans as closely divided as they are today. In most years, majorities -- as high as 61% -- favored a system based on private insurance.
Americans' Preferred Healthcare System
Which of the following approaches for providing healthcare in the United States would you prefer -- [ROTATED: a government-run healthcare system (or) a system based mostly on private health insurance]?
Democrats and Republicans hold opposite views of the best approach to providing healthcare -- 71% of Democrats favor a government-run system and 20% a private system, while 76% of Republicans favor private insurance and 21% 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, up from 12% in 2020. The percentages of independents and Democrats wanting a government system are on the high end of what Gallup has measured since 2010, but not the highest.
Preference for Government-Run Healthcare System, by Political Party
Which of the following approaches for providing healthcare in the United States would you prefer -- [ROTATED: a government-run healthcare system (or) a system based mostly on private health insurance]?
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 election as president). Approval has generally been 50% or above since Obama left office in 2017, but the law was far less popular during his tenure, ranging from 37% to 48% approval.
Americans' Approval of the Affordable Care Act
Do you generally approve or disapprove of the 2010 Affordable Care Act, signed into law by President Obama that restructured the U.S. healthcare system?
Ninety-four percent of Democrats and 19% of Republicans approve of the law, both highs for those groups. Fifty-three percent of independents approve.
Approval of the Affordable Care Act, by Political Party
Do you generally approve or disapprove of the 2010 Affordable Care Act, signed into law by President Obama that restructured the U.S. healthcare system?
Those who approve of the ACA divide evenly 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 those who approved of the law wanted changes to it than do now.
Preferences for Affordable Care Act Changes Among Those Who Disapprove of the Law
(Asked of those who disapprove of the Affordable Care Act) If you had to choose, would you rather -- [ROTATED: repeal the Affordable Care Act and replace it with a different plan (or) keep the Affordable Care Act in place but make significant changes to it]?
Among those who disapprove of the Affordable Care Act, most would prefer that it be repealed and replaced with a different plan (66%), as opposed to keeping it in place but making significant changes to it (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.
Preferences for Affordable Care Act Changes Among Those Who Disapprove of the Law
(Asked of those who disapprove of the Affordable Care Act) If you had to choose, would you rather -- [ROTATED: repeal the Affordable Care Act and replace it with a different plan (or) keep the Affordable Care Act in place but make significant changes to it]?
Bottom Line
Trump’s plans for healthcare in his second administration are unclear, but making a second attempt at repealing the Affordable Care Act could be a daunting task. Public support for the law is as high today as in Trump’s first term. At the same time, Americans are even more likely today 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 the issue may not be a high priority for him, in contrast to issues, such as immigration and trade, that he made more specific policy proposals about during the campaign.
