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 health care coverage.  

The figure had slipped to as low as 42% in 2013 during the troubled rollout of the Affordable Care Act’s (ACA's) health care exchanges. It has been as high as 69% in 2006. 

The results are based on Gallup’s annual Health and Health Care survey, conducted Nov. 6-20. The same poll finds fewer Americans than in the recent past rating U.S. health care 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 to increase health coverage in the U.S., sparking opposition by some Americans to a larger government role in health care. 

By 2009, U.S. adults were divided on whether the government was responsible for ensuring health care 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 health care 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 health care 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. 

Apart from asking whether the government should ensure people have health care coverage, Gallup measures public support for a government-run U.S. health care 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 health care 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. 

Democrats and Republicans hold opposite views of the best approach to providing health care -- 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. 

Fifty-four percent of U.S. adults approve of the ACA, essentially tying the record-high 55% readings in April 2017 and November 2020. 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. 

Ninety-four percent of Democrats and 19% of Republicans approve of the law, both highs for those groups. Fifty-three percent of independents approve. 

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. 

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 have consistently wanted the law repealed, which President Donald Trump and the Republican-led Congress attempted to do in 2017 but were unsuccessful.