Medicare-For-All: The Public’s Opinion
While change will occur in the political and policy arenas between now and next November, one thing is certain — healthcare will play a leading role in the 2020 election. The healthcare issue set is vast and includes costs, reproductive rights, the opioid epidemic, and data privacy to name a few; however, it will be Medicare-For-All at the heart of the discussion. Reflective of a broader debate over the future of healthcare in the U.S., Medicare-For-All has received considerable attention from both the media and politicians alike. Yet despite the publicity, there are diverging opinions on where Americans truly stand on the issue.
Through a review of twenty-eight national surveys conducted over the last two years, we can begin to uncover how Americans feel about Medicare-For-All. An in-depth examination of the data reveals what they understand, what they don’t understand, and how public opinion shifts when the discussion moves beyond a campaign slogan and into the practical implications of a policy that could fundamentally alter U.S. healthcare.
- Top line support for Medicare-For-All is high, but Americans don’t understand what it entails.
- Support drops when Americans learn about the details and its potentially adverse effects, especially the elimination of private insurance coverage.
- There is, however, support for other pathways to expand coverage.
History Suggests Significant Healthcare Legislation Is Forthcoming
Recent history suggests major healthcare legislation should be expected within the next few years. Since Medicare and Medicaid were created in 1965, significant healthcare legislation has passed every seven years on average, and the pace has accelerated over the last two decades (of note, not all of the below expanded coverage).
Top Line Support For Medicare-For-All Is Strong
At first glance, it would appear Medicare-For-All will be that next piece of significant healthcare legislation. A majority of Americans have expressed support for Medicare-For-All in nearly every survey over the last two years (a complete list of surveys can be found at the end).
As we dig deeper, this initial support for Medicare-For-All makes sense. The policy invokes ‘Medicare’ in the name –a ubiquitously popular program, even among those who are not covered by it. A Kaiser Family Foundation survey from November 2017 found 80 percent of all Americans have a favorable perception of Medicare. A more recent Kaiser Family Foundation survey from April reveals even some of those who are not supportive of Medicare-For-All as a policy view the term itself positively.
It is important to point out that the ways in which Medicare-For-All questions have been asked over the last two years vary substantially. (I counted at least 11 different ways across the surveys.) This makes it difficult to measure changes in support over time. Question wording in surveys is critical and the range of results is reflective of the many ways this has been measured.
Significant Challenges For Medicare-For-All
While surveys have shown Americans respond favorably to the Medicare-For-All concept, many of those same surveys reveal the policy faces significant challenges:
Americans Have A Murky Picture Of What It Entails
For now, Medicare-For-All is something of a “choose your own adventure” policy. Americans do not fully understand what it entails — a sentiment aided by the assortment of Medicare-For-All policies across the Democratic Presidential panel. Earlier this month, a Kaiser Family Foundation survey found 39 percent of respondents believed they would no longer pay health insurance premiums under a Medicare-For-All model. 27 percent indicated that they would no longer be on the hook for deductibles and co-pays (premiums and cost sharing would be eliminated by Senator Bernie Sanders’ plan, which has received support from several other Democratic Presidential Primary candidates).
Separately, a December survey by NORC/University of Chicago found that 55 percent of respondents believed enrollment in a Medicare-For-All plan would be optional (the Sanders plan would not), while only 51 percent thought all Americans would be eligible to participate.
These surveys (and others) reveal a considerable lack of knowledge among Americans about Medicare-For-All.
Support Weakens When Americans Learn About Undesirable Effects
While survey respondents have largely been supportive of the goals of Medicare-For-All (e.g., universal coverage and the elimination of cost sharing), they do not respond well to the potential tradeoffs. A January survey from the Kaiser Family Foundation revealed an erosion in support when respondents were told Medicare-For-All would lead to increased taxes, delays in treatment, and would threaten Medicare in its current form.
A December NORC/University of Chicago survey found that 47 percent of respondents believed Medicare-For-All would increase U.S. healthcare spending, while 29 percent believed the policy would decrease U.S healthcare spending.
Americans With Private Coverage Like Their Coverage
Perhaps the most profound challenge for Medicare-For-All lies in its impact on private coverage. Roughly 180 million Americans currently have private health insurance coverage and for the most part, they like their coverage. In politics it is often said that taking benefits away from people is good way to lose your job — this certainly applies to the Medicare-For-All discussion. Since 2001, Gallup has asked Americans to rate healthcare coverage in the U.S. as well as their own coverage. Consistently, a majority rate coverage in the U.S. poorly while rating their own coverage positively.
A recent national Public Opinion Strategies survey posed a similar question, finding just 41 percent satisfied with the U.S. healthcare system, but 84 percent satisfied with their own healthcare (90 percent among those with private insurance coverage). Furthermore, even 76 percent of respondents who expressed support for a Medicare-For-All policy indicated satisfaction with their own healthcare.
One of the highest points of unpopularity forthe Affordable Care Act was in the Fall of 2013, when approximately 4 million insurance plan cancellation letters went out across the country (contrary to the claim that individuals could “keep their coverage if they liked it”). Despite arguments that Medicare-For-All would lead to the elimination of premiums and cost sharing, cancelling the policies of 180 million Americans will be highly unpopular.
Support for Medicare-For-All plummets when invoking raised taxes and the loss of private coverage. A 2017 NBC News-Wall Street Journal survey found Americans divided on support (“single payer health care system” was used instead of Medicare-For-All) at 47–46. The 47 percent in favor received a follow-up question in which they were asked if they would still support the policy if it led to a loss of employer provided health plans. 20 percent of those respondents moved in opposition of a single payer system, leaving the recalculated number at 36 percent in support and 55 percent in opposition. (A Politico-Harvard survey from October 2018 found a very similar result).
Stronger Support Exists For Other Policies That Expand Coverage. Despite challenges for Medicare-For-All, Americans do express stronger support for coverage expansion. And while the impact of potential trade-offs to those policies has not yet been measured, there is evidence that Americans support expanding coverage. Surveys from Gallup and Pew demonstrate a majority of Americans believe it is the responsibility of the federal government to make sure all Americans have healthcare coverage.
Further, a Kaiser Family Foundation survey from January found 74 percent of Americans favor the federal government doing more to help provide health insurance to more Americans. That same survey found support for other policies that resulted in coverage expansion. Support for a public option (that preserves the ability of Americans to keep their own coverage) was 74 percent, while support for Medicare buy-in for individuals between the ages of 50 and 64 was 75 percent. Support for allowing individuals who lacked employer-sponsored insurance to buy coverage through the Medicaid program was 77 percent. Separately, a majority of respondents in a March Quinnipiac survey suggested it is a good idea to allow adults the option to buy into the Medicare program.
The Bottom Line
Health Management Academy Executive Chairman Gary Bisbee, Ph.D. recently summed up the process of policy reform:
Policy reform typically follows a distinct pattern. It begins with a rhetorical phase where political consensus is established. Then, a statutory phase follows where the tough work of navigating line-item subtleties and drafting legislation takes place. Finally, there is the regulatory phase where the agencies promulgate the rules that bring statutory language to life.
Rhetorically, Medicare-For-All is a political strategist’s dream. It is simple, straightforward, and, at least for now, allows voters to define it on their own terms. However, upon closer inspection, most Americans are not ready for such a seismic change to their own healthcare. They crave lower costs and support an expansion of coverage; ultimately though, as a detailed review of these surveys reflect, Medicare-For-All is not the solution they want at this moment.
An accompanying slide deck to this brief can be found here.
Jarrett Lewis is a partner at Public Opinion Strategies, one of the nation’s leading public opinion research firms specializing in political, public affairs, public policy, and corporate positioning research. His work is focused in the healthcare industry.
Gallup national surveys, 2000–2017
Gallup national surveys, 2001–2018
NBC News/Wall Street Journal national survey, September 2017
Politico/Harvard national survey, August-September 2017
Quinnipiac University national survey, September 2017
Kaiser Family Foundation national survey, November 2017
Gallup national survey, November 2017
Reuters/Ipsos national survey, June-July 2018
Kaiser Family Foundation national survey, July 2018
NBC News/Wall Street Journal national survey, September 2018
Pew Research Center national survey, September 2018
Kaiser Family Foundation national survey, September-October 2018
CBS News national survey, October 2018
Politico/Harvard national survey, October 2018
NORC/University of Chicago national survey, December 2018
Kaiser Family Foundation national survey, January 2019
Politico/Harvard national survey, January 2019
CBS News national survey, January 2019
Kaiser Family Foundation national survey, February 2019
Kaiser Family Foundation national survey, March 2019
Politico/Harvard national survey, March 2019
Fox News national survey, March 2019
Quinnipiac University national survey, March 2019
CNN national survey, April 2019
Kaiser Family Foundation national survey, April 2019
Fox News national survey, April 2019
RealClearPolitics national survey, April-May 2019
Public Opinion Strategies national survey, April 2019
Kaiser Family Foundation national survey, May-June 2019