What kind of health care do Americans want? They don't even know

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What kind of health care do Americans want? They don't even know

By Hanna Horvath, Myles Ma & Jeanine Skowronski

Voters in the 2018 midterm elections named health care as the most important issue facing the country. But a Policygenius survey suggests Americans are divided on the fix.

In fact, public opinion is almost evenly split: 51% of Americans support privatized health care, while 49% support a fully government-funded option.

Clear lines emerge when you break the survey data down by demographic. People without health insurance are more likely to support public health care, as are younger Americans.

These responses aren’t surprising, given younger people and lower-income people stand to benefit the most from government-funded health care.

“If we did have universal health care like some of the European countries or Canada, I think that would honestly better suit our nation as a whole,” says Melissa Penton, 31.

Penton is a full-time student in an accelerated nursing program in Dallas. She quit her job in August to pursue her degree and can’t afford any of the plans on Healthcare.gov. In other states, she might qualify for Medicaid, the federal-and-state-funded health insurance program for low-income, needy Americans and their families, but Texas declined to expand the program to cover all low-income people. Penton's school requires she has health coverage and she’s considering buying a short-term health plan.

“I, right now, don’t feel like it works for the people who are low-income,” she says of the American health care system.

Notably, low-income Americans collectively weren’t more likely to support public health care.

There could be a number of reasons why.

Low-income residents in Medicaid expansion states can get subsidized health insurance and are worried changes to the system will cause them to lose coverage, says Timothy Jost, professor of law at Washington and Lee University.

Other low-income Americans may be politically opposed to government-provided health care.

“They don’t think the government has done anything for them,” he says.

Why are Americans divided?

Health care has been a point of public contention in the U.S. for decades, as accessibility to private plans — which a plurality of Americans still rely on — narrowed and the cost of medical services climbed. But the partisan divide over solutions widened since the passage of President Barack Obama’s signature health care law in 2010. And tensions came to a fever-pitch in 2017 when Republicans took over all three branches of government and pushed to overturn it.

The heightened political climate — and the various media narratives driven by partisan bickering — clearly influenced Americans’ opinion. Support for various health care systems mirror the more common political party log lines, with Republicans most likely to get behind fully privatized health care and Democrats most likely to support a public program akin to Sen. Bernie Sanders’ Medicare-for-all.

It’s also left many Americans ... confused.

Case in point: 52% of survey respondents who said they don’t support Obamacare said they would most support a private health care system with a safety net for old, sick and poor — an albeit simplistic descriptor for what the law actually is.

Meanwhile, just over 28% of Americans in favor of public health care weren’t willing to pay anything to fund the program. About one-third would only pay up to $2,000 a month.

Sanders has made it clear that his social insurance program — like Medicare itself — won’t come free. His plan includes a 2.2% income-based premium and an income tax increase on households making more than $250,000.

Part of the confusion stems from how complex health care is in America compared to other countries, said Ed Weisbart, a physician and chairman of the Missouri chapter of Physicians for a National Health Program.

Penton, shopping for health insurance on her own for the first time, needed to research what different plans offer, even as a future nurse.

“I don’t know much about insurance even being in the health care industry,” she said.

Most Americans are shielded from the cost of health care.

“They pay a small part out of their paycheck,” Jost says. “They pay when they have to get services. Most of the cost is invisible to them.”

Universal health coverage makes these costs painfully transparent, he says.

Fixing a broken system

Expect the divide to persist for years. Voters may have gone to the polls with health care in mind, but the outcome of the last election — a split Congress — doesn’t lend itself to fast solutions.

Due to the divided government, Jost doesn't expect many changes at the national level any time soon, but “I could see us expanding coverage in the states,” he says.

Legislators in New York are considering a bill to establish single-payer health care, and California Gov.-elect Gavin Newsom called for such a system during his campaign.

For now, Americans in need of health insurance should check to see if they qualify for subsidized care. Federal open enrollment for a 2019 health care plan ends Dec. 15, but some state exchanges close later and eligible Medicaid recipients can apply all year. Our state-by-state guide to health insurance has more details on your options.

Graphics: Hanna Horvath

Image: Cn0ra