廖珮岑：More in U.S. See Health Coverage as Government Responsibility--Approval of Affordable Care Act also near high point
（更多美國人認為保障民眾享有醫療保險是政府的責任——對《平價醫療法案》的支持率也接近高點）
BY JEFFREY M. JONES
Jeffrey M. Jones，博士，自2000年起擔任蓋洛普高級編輯，監督蓋洛普美國民意調查和其他公開發布調查的研究和分析。他對民意和投票行為的研究已經發表在學術期刊和編輯的書籍上。專業領域：美國民意調查與研究
編者註：這項研究是與West Health合作進行的，West Health是一家專註於醫療保健和老齡化的非營利和無黨派組織。
華盛頓特區——62%的美國成年人表示，確保所有美國人都有醫療保險是聯邦政府的責任，這是十多年來的最高比例。2013年，由於《平價醫療法案》（Affordable Care Act， ACA）醫保交易的推出問題重重，這一數字一度跌至42%。這一比例在2006年曾高達69%。
美國人認為聯邦政府有責任確保所有人都有醫療保險
你認為確保所有美國人都有醫療保險是聯邦政府的責任，還是這不是聯邦政府的責任？
該調查結果是根據蓋洛普於11月6日至20日進行的年度健康與醫療保健調查得出的。同一項民意調查發現，對美國醫療保險和醫療質量給予正面評價的美國人比最近減少了。
在2000年至2008年期間，大多數美國人一致認為政府應該確保所有美國人都有醫療保險。這種情況在巴拉克•奧巴馬（Barack Obama）擔任總統期間發生了變化，因為他與民主黨控制的國會合作，通過了ACA（也被稱為「奧巴馬醫改」），以擴大美國的醫療覆蓋範圍，這引發了一些美國人反對政府在醫療保健領域發揮更大作用。
到2009年，美國成年人對政府是否有責任確保所有美國人的醫療保險存在分歧，從2012年到2014年，隨著獨立人士和共和黨人的支持減弱，大多數人不認為政府應該承擔這一角色。在奧巴馬總統任期的最後幾年，公眾輿論又重新把醫療保健視為政府的責任，從那以後，這一直是主流觀點。
最近，越來越多的獨立人士和共和黨人同意，政府有責任確保所有美國人都享有醫療保險。雖然少數共和黨人持這種觀點，但32%的人持這種觀點，高於2020年的22%。認為政府有責任確保醫療保險的獨立人士比例為65%，比2020年上升了6個百分點。
大多數民主黨人一直認為，政府應該確保所有美國人都有醫療保險。90%的民主黨人現在認為政府應該確保全民醫保，這是蓋洛普迄今為止對該群體進行的最高調查。共和黨和無黨派人士的支持率在本世紀頭十年達到最高點：2001年和2004年，44%的共和黨人認為政府有責任，而2006年和2007年，持這一觀點的無黨派人士比例為71%。
政黨對聯邦政府有責任確保所有人都有醫療保險的看法
你認為確保所有美國人都有醫療保險是聯邦政府的責任，還是這不是聯邦政府的責任？
公眾現在對政府和私人醫療體系產生分歧
除了詢問政府是否應該確保人民享有醫療保險之外，蓋洛普還調查了公眾對政府運營的美國醫療體系的支持程度，比如加拿大、英國和世界其他地方的醫療體系。
在這個問題上，美國人的意見分歧大致相當，46%的人說美國應該有一個政府運營的醫療體系，49%的人贊成一個主要基於私人醫療保險的體系。只有在2017年的一項調查中，美國人的分歧才像今天這樣嚴重。在大多數年份，大多數人（高達61%）支持以私人保險為基礎的醫療體系。
美國人首選的醫療體系
在美國，你更喜歡以下哪一種提供醫療保健的方法——[輪流：政府經營的醫療保健系統或主要基於私人醫療保險的系統]？
民主黨人和共和黨人對提供醫療保健的最佳方式持相反的觀點——71%的民主黨人支持政府運營的體系，20%的人支持私營體系，而76%的共和黨人支持私營保險體系，21%的人支持政府運營的體系。47%的獨立人士希望有一個政府系統，49%的人希望有一個私人系統。
共和黨人目前對政府運營體系的支持率是迄今為止最高的，高於2020年的12%。希望建立政府體制的獨立人士和民主黨人的比例處於蓋洛普自2010年以來測量的最高值，但不是最高的。
政黨對官辦醫療體系的偏好
在美國，你更喜歡以下哪一種提供醫療保健的方法——[輪流：政府經營的醫療保健系統或主要基於私人醫療保險的系統]？
奧巴馬醫改獲得批准接近高點
54%的美國成年人贊成《平價醫療法案》，基本上追平了2017年4月（共和黨領導的廢除該法的嘗試期間）和2020年11月（喬·拜登當選總統後）55%的創紀錄高位。自奧巴馬2017年卸任以來，該法案的支持率普遍在50%或以上，但在他任職期間，該法案的支持率遠不如奧巴馬，從37%到48%不等。
美國人對平價醫療法案的認可
你一般是贊成還是不贊成2010年奧巴馬總統簽署的平價醫療法案，該法案重組了美國的醫療體系？
94%的民主黨人和19%的共和黨人支持這項法律，這兩個群體的支持率都很高。53%的無黨派人士表示贊同。
政黨通過《平價醫療法案》
你一般是贊成還是不贊成2010年奧巴馬總統簽署的平價醫療法案，該法案重組了美國的醫療體系？
贊成《平價醫療法案》的人中，有48%的人希望基本保持原判，48%的人希望保留該法案，但對其進行重大修改。這與過去相比是一個轉變，當時贊成該法律的人比現在更多地希望對其進行修改。
不贊成平價醫療法案的人對該法案的偏好發生了變化
（被問及那些不贊成《平價醫療法案》的人）如果你必須做出選擇，你更願意——[輪換：廢除《平價醫療法案》並用不同的計劃取而代之（或）保留《平價醫療法案》，但對其進行重大修改]？
寫在後面
特朗普在第二任期政府的醫療保健計劃尚不清楚，但第二次嘗試廢除《平價醫療法案》可能是一項艱巨的任務。如今公眾對該法案的支持率與特朗普第一任期時一樣高。與此同時，美國人今天更有可能同意ACA背後的驅動原則——政府應該確保所有美國人都有保險。
在9月與民主黨候選人卡瑪拉·哈里斯的總統候選人辯論中，特朗普仍然對ACA持批評態度，並表示他有一個取代它的「計劃概念」。他在醫療保健方面缺乏堅定的計劃，這表明這個問題對他來說可能不是優先考慮的問題，而在移民和貿易等問題上，他在競選期間提出了更具體的政策建議。
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.
