Healthcare will be one of the central issues of the 2020 election and Medicare-For-All will drive much of that debate. In a review of twenty-eight national surveys conducted over the last two years, I have attempted to decipher how voters view the issue of Medicare-For-All.

1. JUNE 2019
Medicare-For-All:
THE PUBLIC’S OPINION
By: Jarrett Lewis, Partner, Public Opinion Strategies
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 drug pricing,
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.
KEY TAKEAWAYS
Topline 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, wide-ranging
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).

2. June 2019
TOPLINE 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).
Would you support or
oppose the following? A
policy of Medicare For All.
Reuters/Ipsos,
June-July, 2018
Please tell me whether you
would be more likely/less
likely to vote for a
candidate for Congress
who takes this position, or
would it not make a
difference to you?...Favors
Medicare for all, a single
payer health care system in
which all Americans would
get their health insurance
from one government plan
that is financed in part by
taxes.
NBC-WSJ,
September 2018
Do you (favor) or (oppose)
having a national health
care plan, sometimes
called Medicare-for-all, in
which all Americans would
get their insurance from a
single government plan?
Kaiser Family Foundation,
April 2019
Do you support or oppose
Medicare for All, which is a
system where all
Americans – not just older
ones – get health insurance
through the government’s
Medicare system?
Real Clear Politics,
April-May, 2019

3. June 2019
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.
Please tell me if you have a positive or negative reaction to each
term…Medicare-For-All…do you have a positive or negative
reaction to this, or not?
Kaiser Family Foundation,
April 2019
Do you favor or oppose having a national health plan, sometimes
called Medicare-for-All, in which all Americans would get their
health insurance from a single government plan?
Kaiser Family Foundation,
April 2019
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:
1.
Americans have a murky picture
of what it entails.
2.
The adverse effects cause an
erosion in support.
3.
Individuals with private coverage
(largely) like
their coverage.
Americans Don’t Understand It
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).

4. June 2019
Conversely, most Americans are unaware that Medicare-For-All would eliminate private insurance (the Sanders
plan would). A Kaiser Family Foundation survey from January found 55 percent of Americans believe they would be
able to keep their current insurance plan, while 37 percent (correctly) stated they would not.
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.
Would You Favor/Oppose a Medicare For All Plan if You Heard It Would:
Guarantee health
insurance as a
right
Eliminate all
premiums &
reduce out-of-
pocket costs for
most
Eliminate private
insurance
companies
Requires most
Americans to pay
higher taxes
Threaten the
current
Medicare
program
Lead to delays
in people
getting some
treatments
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.

5. June 2019
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.
Now thinking about health care in the country as a
whole…overall, how would you rate health care coverage
in this country… as excellent, good, only fair, or poor?
Gallup
Overall, how would you rate your healthcare coverage…as
excellent, good, only fair or poor?
Gallup
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 peaks of unpopularity of the 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.

6. June 2019
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).
Would you favor or oppose a single payer
health care system in which all Americans
would get their health insurance from one
government plan that is financed by
taxes?
NBC-WSJ, Sep. 2017
And, if you learned that virtually all health
care costs would be covered, but it would
eliminate employer provided health plans
and there would be only one government
plan, would you favor or oppose a single
payer health care system?
NBC-WSJ, Sep. 2017
Total Favor/Oppose
Recalculated Among All Adults
NBC-WSJ, Sep. 2017
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.
Do you think it is the responsibility of the federal government to make sure that all Americans have healthcare
coverage, or is that not the responsibility of the federal government? (Gallup)

7. June 2019
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.
Do you favor or oppose…
Creating a national
government administered
health plan similar to
Medicare open to anyone,
but allow people to keep
the coverage they have if
they prefer.
Kaiser Family Foundation,
April 2019
Allowing people between
the ages of 50 and 64 to
buy insurance though the
Medicare program.
Kaiser Family Foundation,
April 2019
Allowing people who don't
get health insurance at
work to buy health
insurance through their
state Medicaid program
instead of purchasing a
private plan.
Kaiser Family Foundation,
April 2019
Do you think that keeping
the current health care
system but allowing all
adults the option of buying
into Medicare is a good
idea or a bad idea?
Quinnipiac,
March 2019
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.

8. June 2019
SOURCES
Gallup national surveys, 2000-2017
Gallup national surveys, 2001-2008
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