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Ten years after its enactment, public support for the Affordable Care Act (ACA) still only reaches a scant majority. Candidates for the presidency-and the sitting president-have endorsed health reforms that would radically transition US health care away from the current system upon which the ACA was built. Few opinion surveys to date have captured dominant preferences among alternative health reform policies or characterized attitudes and experiences that might be associated with policy preferences. Using a 2019 nationally representative telephone survey, this article considers how variations in political values, attitudes toward government, and experiences with the health care system relate to competing health reform preferences. Differences between those who favor Medicare for All over building on the ACA largely reflect different levels of satisfaction with the status quo and views of private health insurance. By contrast, differences between ACA supporters and those who would favor replacing it with a state-based alternative reflect sharply different political values and attitudes. Key differences remain significant after controlling for demographic, health, and political characteristics. Overwhelming public support still eludes the ACA, and reaching consensus on future directions for health reform will remain challenging given differences in underlying beliefs., (Copyright © 2020 by Duke University Press.)

Importance: The 2016 US presidential election brought national visibility to prominent economic issues affecting rural America, yet little has been done to examine serious health or economic problems in rural communities from the perspectives of rural US adults themselves., Objective: To examine views on the most serious health and economic concerns and potential solutions in rural communities., Design, Setting, and Participants: This survey study used 2 cross-sectional probability-based telephone (cellular and landline) surveys of adults living in the rural United States. The first survey was conducted June 6 to August 4, 2018, and the second survey was conducted January 31 to March 2, 2019. All results were weighted to be nationally representative of rural US adults. Data analysis was conducted in April 2019., Main Outcomes and Measures: The primary study outcomes were the prevalence of rural adults reporting their biggest community problems, problems with health care access and costs, ratings of the local economy, views on opioid addiction, and views on solving major community issues., Results: The 2018 survey included 1300 respondents (response rate, 12%; completion rate, 70%), and the 2019 survey included 1405 respondents (response rate, 8%; completion rate, 76%). Rural adults primarily identified as non-Hispanic white (78%), and more than half of respondents were 50 years or older (survey 1: 55%, survey 2: 53%). Rural adults identified opioid or other drug addiction or abuse (25%; 95% CI, 22%-28%) and economic concerns (21%; 95% CI, 19%-24%) as the most serious problems facing their local communities. Opioid or other drug addiction or abuse was reported as a serious problem in their local community by 57% (95% CI, 53%-60%) of rural adults, while 49% (95% CI, 46%-53%) of rural adults said they personally know someone who has had opioid addiction. Problems paying medical bills were reported by 32% (95% CI, 29%-36%) of rural adults, and recent issues with accessing health care were reported by 26% (95% CI, 23%-30%) of rural adults. Regarding financial and economic issues, 55% (95% CI, 52%-59%) of rural adults rated their local economy as only fair or poor, and 49% (95% CI, 44%-54%) of rural adults said they would have difficulty paying off an unexpected $1000 expense. On solving major community problems, 58% (95% CI, 54%-62%) of rural adults saw a need for outside help to solve major community problems, and among those who reported needing outside help, 61% (95% CI, 57%-66%) identified a major role for government., Conclusions and Relevance: These findings suggest that in today's economically stretched rural United States, opioid or other drug addiction or abuse has emerged as an equal problem with economic concerns. One in 3 rural adults still have problems paying their medical bills even after the passage and implementation of the Patient Protection and Affordable Care Act. Although rural communities have traditionally been self-reliant, more than half of rural adults are open to outside help to solve serious problems facing their communities, including major help from government.

In this analysis of data from 27 public opinion polls, the authors examine the role of the Affordable Care Act in the 2014 congressional elections. The outcome of the elections is likely to influence implementation of the ACA and future U.S. health care policy.

Expansion of Medicaid under the Affordable Care Act to millions of low-income adults has been controversial, yet little is known about what these Americans themselves think about Medicaid. We conducted a telephone survey in late 2013 of nearly 3,000 low-income adults in three Southern states--Arkansas, Kentucky, and Texas--that have adopted different approaches to the options for expansion. Nearly 80 percent of our sample in all three states favored Medicaid expansion, and approximately two-thirds of uninsured respondents said that they planned to apply for either Medicaid or subsidized private coverage in 2014. Yet awareness of their state's actual expansion plans was low. Most viewed having Medicaid as better than being uninsured and at least as good as private insurance in overall quality and affordability. While the debate over Medicaid expansion continues, support for expansion is strong among low-income adults, and the perceived quality of Medicaid coverage is high., (Project HOPE—The People-to-People Health Foundation, Inc.)

This analysis of national opinion polls shows that a majority of Americans support increased spending on public health in general and that they see public health interventions as saving money in the long term. At the same time, many do not favor increased federal spending in a number of areas that public health officials deem important. In addition, polls show striking partisan differences, with Republicans much less supportive than Democrats of additional spending on public health. This split may have political implications for the public health component of the new health reform law if there is a change in party control of one or more houses of Congress after the November 2010 elections. As a result, in order to sustain public support for increased spending, it will be critically important to give examples of cost savings from public health programs and to highlight how they have reduced mortality from major chronic illnesses, such as cancer, heart disease, and HIV/AIDS.

The partisan split in Congress over health reform may reflect a broader divide among the public in attitudes toward the uninsured. Despite expert consensus over the harms suffered by the uninsured as a group, Americans disagree over whether the uninsured get the care they need and whether reform legislation providing universal coverage is necessary. We examined public perceptions of health care access and quality for the uninsured over time, and we found that Democrats are far more likely than Republicans to believe that the uninsured have difficulty gaining access to care. Senior citizens are less aware than others of the problems faced by the uninsured. Even among those Americans who perceive that the uninsured have poor access to care, Republicans are significantly less likely than Democrats to support reform. Thus, our findings indicate that even if political obstacles are overcome and health reform is enacted, future political support for ongoing financing to cover the uninsured could be uncertain.

An individual mandate is an important feature of many recent plans to achieve universal health insurance coverage in the United States, without radically changing the way most Americans get health care and coverage. Using national public opinion data, we find that on its own, an individual mandate does not have broad support across partisan and sociodemographic groups. Policymakers who choose to pursue an individual mandate for policy reasons may expand the base of supporters by incorporating it into a "shared-responsibility" plan that includes requirements for employers, government, and insurers.

This study examines public opinion about the new health reform law in Massachusetts at four stages, from the beginning of the debate in September 2003 through June 2008, two years into implementation. We find that the favorable political environment in Massachusetts likely encouraged leaders to act and also contributed to the shape of the legislation as a "shared responsibility" compromise plan. Despite perceptions by some that the law is not helping the uninsured, support for it remains high-even for the individual mandate, the law's most controversial feature. There is little interest in repealing this legislation.

We report the results of a national survey conducted to help public health officials understand the public's response to community mitigation interventions for a severe outbreak of pandemic influenza. Survey results suggest that if community mitigation measures are instituted, most respondents would comply with recommendations but would be challenged to do so if their income or job were severely compromised. The results also indicate that community mitigation measures could cause problems for persons with lower incomes and for racial and ethnic minorities. Twenty-four percent of respondents said that they would not have anyone available to take care of them if they became sick with pandemic influenza. Given these results, planning and public engagement will be needed to encourage the public to be prepared.

Background: Fifteen years ago, public opinion surveys in Spain showed substantial dissatisfaction with the health-care system. Since that time, health-care in Spain has undergone significant changes, including a decentralization of the system, an increase in spending and a change in the way the system is financed., Objective: This study examines how Spanish citizens rate the performance of their health system today, both as compared with other sectors of society and as compared with earlier time periods., Methods: Data are drawn from nationally representative telephone surveys of the non-institutionalized adult Spanish population (age 18 years and over). The study was carried out in two phases: October-November 2005 (n = 3,010) and January 2006 (n = 2,101)., Results: The majority of the Spanish population thinks the health system needs to be changed. The problems cited relate mostly to long wait times to get health-care. Nevertheless, over the last 15 years, the proportion of people who have very negative views about the health system has decreased by half. The majority believes that not enough money is spent on health-care, but few people would support an increase in taxes to provide additional funding. The survey finds the National Health System's institutions and health professionals to be more highly trusted than other institutions and professional groups in the country., Conclusions: Government policy-makers in Spain face a dilemma: the public wants more health spending to decrease wait times, but there is substantial resistance to increasing taxes as a means to finance improvements in the system's capacity.

Opinion surveys conducted in 2006 show that health care is an important but second-tier issue in terms of priorities for government action. Americans' top health care concerns are mostly related to economic insecurity: rising costs and the problems of the uninsured. The biggest perceived health threats are cancer, HIV/AIDS, and avian flu. Although most Americans do not think that the health system is in crisis, the public remains dissatisfied with both the country's health care and public health systems. These attitudes are likely to create a climate that is supportive of increased health spending and substantial policy changes.

Countries worldwide face the threat of emerging infectious diseases. To understand the public's reaction to the use of widespread quarantine should such an outbreak occur, the Harvard School of Public Health, with the U.S. Centers for Disease Control and Prevention, undertook a survey of residents of Hong Kong, Taiwan, Singapore, and the United States. A sizable proportion of the public in each country opposed compulsory quarantine. Respondents were concerned about overcrowding, infection, and inability to communicate with family members while in quarantine. Officials will need specific plans to deal with the public's concerns about compulsory quarantine policies.

For more than two decades, polls have shown that Americans are dissatisfied with their current health care system. However, the public's views on how to change the current system are more conflicted than often suggested by individual poll results. At the same time, Americans are both dissatisfied with the current health care system and relatively satisfied with their own health care arrangements. As a result of the conflict between these views and the public's distrust of government, there often is a wide gap between the public's support for a set of principles concerning what needs to be done about the overall problems facing the nation's health care system and their support for specific policies designed to achieve those goals.

An important question for physicians in the aftermath of the Terri Schiavo case is whether the effort of elected officials to intervene was a one-time anomaly or signals a future trend of elected officials being involved in cases where patients are in a vegetative or long-term comatose state. To try to answer this question, we used results from 12 national opinion surveys conducted in March and April 2005, when the Schiavo case was being debated. A review of these survey results showed that efforts by elected politicians to intervene in the Schiavo case were opposed by the majority of Americans. However, the public was more divided on the question of whether Schiavo's feeding tube should be removed. Opposition to removing Schiavo's feeding tube was associated with opposition to abortion. The results suggest that issues involved in cases like Schiavo's are not likely to disappear from the political agenda.

Polling taken during the 2004 influenza vaccine shortage found a high level of public concern but no consensus on who should be responsible for solving the problem. A substantial minority questioned whether the vaccine should be reserved for high-risk groups, while a majority thought that care providers should be responsible for allocating it. Many people did not seek vaccination for reasons beyond the shortage, including concerns about safety and efficacy and the perceived low risk from influenza. Although some have suggested that this might have been a successful case of health care rationing, it might not be generalizable to shortages of vaccines for other diseases.

In response to the possibility of a bioterror attack using smallpox, many states have updated and revised their current public health laws in line with the Model Act, which would effectively give states the right to invoke mandatory state health powers, such as quarantine or vaccine. Previous studies have supported the importance of allying with the public in creating and implementing effective bioterror response policies. Historical case studies and recent research suggest that when the public is not supportive of government health policies, they may be less willing to comply. In this study we analyze a recent survey to determine the effects of a set of variables, including aspects of trust in government that have been found in previous studies to influence public opposition to compulsory government health policies, on opinions about compulsory vaccination and quarantine.

Exit polls showed that health care was a second-tier issue in the 2004 presidential race and that it was more important to Democratic than Republican voters. Those who considered health care the most important issue in their voting decision voted over-whelmingly for John Kerry. An analysis of national opinion surveys and exit polls shows that Republican and Democratic voters expressed dramatically differing views on key health policy issues. With the exception of malpractice reform and reducing federal health spending, health care is not likely to be a top issue for the Bush administration's second term.

Background: We examined the importance for voters of health care as an issue in the presidential election of 2004, how this ranking compares with the importance of health care in past elections, and which issues voters regard as the most important health care issues in the months before the election., Methods: We studied data from 22 national opinion surveys, 9 of them conducted as telephone surveys during the 2004 presidential campaign, 10 conducted as telephone surveys during the previous three presidential elections, and 3 conducted as national exit polls of voters., Results: Voters ranked health care as the fourth most important issue in deciding their vote for president in 2004. The top health care issues for voters were the costs of health care and prescription drugs, prescription-drug benefits for the elderly, the uninsured, and Medicare. Bioterrorism and abortion were also important issues for voters. The voters most concerned about health care were older persons and those who identified themselves as Democrats. Four issues less salient to voters were racial disparities in health care, aid to developing countries to prevent and treat human immunodeficiency virus infection and the acquired immunodeficiency syndrome, medical malpractice, and the quality of care., Conclusions: Although health care ranks higher in importance among voters than most other domestic issues, it is only fourth in importance in deciding their vote for president. The health care issues of greatest concern are the affordability of health care and health care insurance. Health care issues do not appear likely to play a decisive role in the presidential election in 2004, but they might make a difference in some swing states if the race is close., (Copyright 2004 Massachusetts Medical Society)

Data drawn from ten recent public opinion polls show that the issue of the uninsured is likely to become more visible on the U.S. agenda, although not as prominent as it was in the early 1990s. Although there is no public consensus on any single approach, a hybrid plan--which leaves workplace insurance in place and includes elements of several proposals now being discussed to cover more of the uninsured--offers the possibility of public support. The critical issue is whether or not there will be public support in the future for raising revenues to pay for major expansions in coverage.

In the competition for African American voters in the 2004 elections, health policy is likely to be an important issue. Blacks are about twice as likely as whites to say that health care issues are important in their vote choice. Using national survey data, this paper shows that candidates will have to have well-developed proposals on the uninsured, protecting Medicaid, aiding neighborhood health centers, and expanding funding for AIDS, to appeal to black voters. However, in responding to black voters, candidates will have to be careful not to alienate white voters by proposing health policies that involve sizable increases in taxes or government regulation.

To communicate effectively with the public during an emergency, health officials need to find out in real time what Americans know and believe, whom they trust, and what actions they are taking in response to the crisis. Short-duration surveys can provide vital information to guide public officials in their response to events and their communication efforts. Prior research has shown that such surveys, when statistically re-weighted, can offer timely results without unacceptable risk of bias. Using examples from public opinion surveys during the anthrax attacks of 2001, this article examines the role such surveys can play during a public health crisis.

Background: In response to the report by the Institute of Medicine on medical errors, national groups have recommended actions to reduce the occurrence of preventable medical errors. What is not known is the level of support for these proposed changes among practicing physicians and the public., Methods: We conducted parallel national surveys of 831 practicing physicians, who responded to mailed questionnaires, and 1207 members of the public, who were interviewed by telephone after selection with the use of random-digit dialing. Respondents were asked about the causes of and solutions to the problem of preventable medical errors and, on the basis of a clinical vignette, were asked what the consequences of an error should be., Results: Many physicians (35 percent) and members of the public (42 percent) reported errors in their own or a family member's care, but neither group viewed medical errors as one of the most important problems in health care today. A majority of both groups believed that the number of in-hospital deaths due to preventable errors is lower than that reported by the Institute of Medicine. Physicians and the public disagreed on many of the underlying causes of errors and on effective strategies for reducing errors. Neither group believed that moving patients to high-volume centers would be a very effective strategy. The public and many physicians supported the use of sanctions against individual health professionals perceived as responsible for serious errors., Conclusions: Though substantial proportions of the public and practicing physicians report that they have had personal experience with medical errors, neither group has the sense of urgency expressed by many national organizations. To advance their agenda, national groups need to convince physicians, in particular, that the current proposals for reducing errors will be very effective., (Copyright 2002 Massachusetts Medical Society)

Policy PointsA decade after failing to make it into the Affordable Care Act, the public option reemerged as a health reform goal at both the national and state levels, with polls reporting strong, bipartisan support.A 2020 poll that probed both support for one public option approach (Medicare "buy‐in") and attitudes toward government suggests that differences in these attitudes could plague reform advocates' efforts.Although the COVID‐19 pandemic viscerally highlighted the need for a more coherent health care system—including universal coverage—other recent evolutions in the broader US political context could undermine reform. [ABSTRACT FROM AUTHOR]