U.S. Secretary of Health and Human Services Alex Azar speaks on prescription drugs for the market during the 2018 National Academy of Medicine Annual Meeting on Oct. 15, 2018 at the National Academy of Sciences in Washington, D.C. Forty-three percent of voters trust federal agencies like HHS to lower health care costs. (Alex Wong/Getty Images)

As Democratic frontrunner candidate Joe Biden attempts to combat the building enthusiasm for “Medicare for All” with his proposal to build on the Affordable Care Act without disrupting the private insurance market, a new Morning Consult poll finds less than a quarter of voters trust private insurers to keep the cost of health care low. And despite pushback from moderate Democratic lawmakers against plans that would dramatically expand the government’s role in health care, voters place more faith in federal health agencies than in either Congress or the insurance industry to fight for affordable health care. In the July 8-10 poll of 1,988 registered voters, more than four in 10 said they had “a lot” or “some trust” in government regulators, such as the Health and Human Services Department and the Centers for Medicare and Medicaid Services, to keep the costs of health care low. That’s compared to 23 percent who said the same of the private insurance market. Still, 47% said they didn’t have much or any faith in the government agencies to lower health care costs, and other entities drew even worse numbers.

The survey comes as lawmakers and industry stakeholders scramble to earn Americans’ confidence that affordability is their priority. With Congress in gridlock and with little hope for substantive reform, trade groups representing insurers, providers and pharmaceutical companies have doubled down on working with leaders on Capitol Hill to churn out piecemeal solutions to Americans’ ballooning health costs. But in spite of their best efforts, and millions of dollars spent on advertising, Americans aren’t betting on the myriad entities with power over the health care market to contain their costs. The pharmaceutical industry in particular is the subject of intense ire among the public. Three in 4 voters say they have little or no confidence in drug companies to reduce costs; over half say they don’t trust pharmaceutical companies at all.

In recent weeks, two of the Trump administration’s major drug pricing priorities — forcing drugmakers to disclose list prices in direct-to-consumer advertisements and prohibiting pharmacy benefit managers from pocketing any negotiated discounts on prescription drugs — have hit setbacks. Senate Finance Committee Chairman Chuck Grassley (R-Iowa) said he expects to finalize a deal to lower drug prices soon, though GOP lawmakers have expressed concern about a provision that would give the government power to set price caps on drugs covered under Medicare Part D. The distrust of the pharmaceutical industry is one area where the parties find common ground. Republicans are only slightly more likely to trust the private health insurance market than Democrats, by a margin of 5 points (28 percent vs. 23 percent). The survey’s margin of error is 2 percentage points. Just months into primary election season, support for enshrining the role of private insurers is the clear fault line on health care among Democratic candidates vying for the nomination, with advocates of a public option, which would allow people to buy into government health coverage like Medicare, leaning heavily into the argument that the 150 million people with employer-sponsored coverage shouldn’t be forced off the insurance they like. Advocating for his plan at a presidential forum in Iowa this week, Biden echoed the infamous phrase from former President Barack Obama vis-à-vis the Affordable Care Act: “If you like your health care plan, your employer-based plan, you can keep it. If you like your private insurance, you can keep it.”