An astonishing change in how Americans think about government-run health care

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For the past few years, pollsters have asked about a thousand or so Americans the same question: Does the government have an obligation to ensure all Americans have health care?

They’ve found a remarkable shift, with Americans swinging sharply toward the belief that the government ought to play a very large role in the health care system.

Specifically, the percentage of Americans who think the government has an obligation to ensure coverage to all citizens has risen from 42 percent in 2013 to 60 percent in 2017.


New England Journal of Medicine

An 18-point swing in just four years is a remarkably fast change in the world of public policy polling.

“When we reviewed everything, nothing else in our data was close to 18 points,” says Harvard’s Robert Blendon, who published the data in today’s New England Medical Journal.

To put that in context: Although much fanfare has been made out of improving views of the health care law, when Blendon averaged together national polling, he found the law’s favorability ratings had only risen 5 percentage points.

Blendon attributes the change in attitudes to Americans thinking through the consequences of repealing the Affordable Care Act, resulting in millions losing coverage. The question didn’t ask about Obamacare specifically, a highly polarizing law. Instead, it asked generally about the government’s role in providing coverage.

“People have not fallen in love with the ACA,” Blendon says. “What they fell in love with was the idea that the federal government can’t drop 30 million people from coverage all at once, that there was a responsibility for universal coverage.”

His article also finds that government health programs, like Medicaid, generally poll better than the expansion of private coverage through insurance subsidies.

Most Republican voters say they do not want to cut the number of people covered through Medicaid, the public program that provides health insurance to low-income Americans. But most Republicans were open to cutting subsidies for private insurance.

“Medicaid emerged out of this debate with an awful lot of sympathy,” Blendon says. “The majority of every group we looked at did not want to see the number of people covered by the program cut.”

For me, Blendon’s findings (and the chart above, in particular) do a lot to explain why Republicans have so far failed to deliver on their promises to repeal and replace the Affordable Care Act.

It’s not just the fact that millions of Americans now rely on the law and its programs for coverage. And it’s not the rise in Obamacare’s popularity, which has been relatively meager.

It’s also a fundamental shift in attitudes that has happened after the Affordable Care Act passed, where Americans became more accepting of a larger role for the government in health care. For all the attacks on the health law as a “government takeover” of health care, this polling suggests voters are kind of okay with that.

Video of the Day

The eclipse is not a health policy issue — but it is pretty stinking cool. Hopefully you won’t mind me recommending a video that has nothing at all to do with health care, but is the best thing I’ve watched all day. My colleague Joss Fong interviewed nine eclipse chasers who have spent decades now traveling the globe, searching for these brief moments. It is very worth a five-minute break from whatever you’re working on today — and might even make you a bit teary. Watch it here.

Kliff’s Notes

With research help from Caitlin Davis

Today’s top news

  • “Colorado’s Gardner faces blowback at home over Obamacare repeal”:Sen. Cory Gardner was hammered for supporting Obamacare repeal during a series of raucous town halls on Tuesday, where constituents repeatedly criticized his role in a closed-door partisan process to draft the failed GOP health bill.” —Rachana Pradhan, Politico
  • “Oregon approves sweeping bill expanding abortion access”: “Oregon Gov. Kate Brown (D) on Tuesday signed into law what advocates called the nation’s most progressive reproductive health policy, expanding access to abortion and birth control at a time when the Trump administration and other states are trying to restrict them.” —Sandhya Somashekhar, Washington Post
  • “Federal court: Arkansas can block Medicaid funds to Planned Parenthood”: “A federal appeals court ruled Wednesday that Arkansas can block Medicaid funding to Planned Parenthood. The court lifted an injunction a federal judge issued last year that blocked the state from cutting off funds to Planned Parenthood.” —Jessie Hellmann, the Hill

Analysis and longer reads

  • “A Start-Up Suggests a Fix to the Health Care Morass”: “Many primary care physicians — who often see themselves as a kind of quarterback who calls the shots on a patient’s care — have no easy way to monitor a patient’s meandering path through the health care system. Aledade’s software addresses that by collecting patient data from a variety of sources, creating a helicopter view.” —Farhad Manjoo, New York Times
  • “Doctors Warm to Single-Payer Health Care”: “Single-payer health care is still a controversial idea in the U.S., but a majority of physicians are moving to support it, a new survey finds. Fifty-six percent of doctors registered either strong support or were somewhat supportive of a single-payer health system, according to the survey by Merritt Hawkins, a physician recruitment firm. In its 2008 survey, opinions ran the opposite way — 58 percent opposed single-payer.” —Rachel Bluth, Kaiser Health News
  • “CMS cancels mandatory episode payment models, cuts participation in joint replacement model”: “The Centers for Medicare and Medicaid Services on Tuesday officially announced it is pulling back from mandatory bundled payment models set up under the Obama administration. CMS is proposing to cancel the episode payment models and the cardiac rehabilitation incentive payment model, which were scheduled to begin on January 1, 2018.” —Susan Morse, Healthcare Finance

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