Public Opinion on Single-Payer, National Health Plans, and Expanding Access to Medicare Coverage

For many years, Kaiser Family Foundation has been tracking public opinion on the idea of a national health plan (including language referring to Medicare-for-all since 2017). Historically, our polls have shown support for the federal government doing more to help provide health insurance for more Americans, though support among Republicans has decreased over time (Figure 1). Polling from the late 1990s through late 2000s found fewer than half the public was in favor of a national health plan in which all Americans would get their insurance from a single government plan (Figure 2).  Since 2017, once the phrase “Medicare-for-all” was used in most public discussions of a national health plan and included in KFF question wording, majorities have favored a national health plan, though the level of support has narrowed in recent months (Figure 3). Overall, a majority of Democrats and about half of independents favor a national Medicare-for-all plan while most Republicans oppose (Figure 4). Yet, how politicians discuss different proposals does affect public support (Figure 5 and Figure 6). In addition, when asked why they support or oppose a national health plan, the public echoes the dominant messages in the current political climate (Figure 7). A common theme among supporters, regardless of how we ask the question, is the desire for universal coverage (Figure 8).

Yet, it is unclear how much staying power this support has once people become aware of the details of any plan or hear arguments on either side. Current KFF polling finds that Americans know little about how the leading Medicare-for-all proposals would reshape the way all Americans get and pay for health care (Figure 9), and public support for Medicare-for-all shifts significantly when people hear arguments about potential tax increases or delays in medical tests and treatment (Figure 10). KFF polling also shows many people falsely assume they would be able to keep their current health insurance under a single-payer plan (Figure 11), suggesting another potential area for decreased support especially since most supporters (67 percent) of such a proposal think they would be able to keep their current health insurance coverage (Figure 12).

Medicare-for-all, an issue which really gained traction during Bernie Sanders’ run during the 2016 presidential primary, does seem to be on the minds of Democrats and Democratic-leaning independents at the beginning of the 2020 primary season. But KFF polling finds more Democrats and Democratic-leaning independents would prefer voting for a candidate who wants to build on the ACA in order to expand coverage and reduce costs rather than replace the ACA with a national Medicare-for-all plan (Figure 13). Recently, we have found broad support for proposals that expand the role of public programs like Medicare and Medicaid as well as a government-administered public option (Figure 14). And while partisans are divided on a Medicare-for-all national health plan, there is robust support among Democrats, and even support among Republicans, for an expansion of the Medicare program through a Medicare buy-in or a Medicaid buy-in proposal (Figure 15).  So while the general idea of a national health plan (whether accomplished through an expansion of Medicare or some other way) may enjoy fairly broad support in the abstract, it remains unclear how this issue will play out in the 2020 election and beyond.