PRINCETON, NJ -- More Americans now say it is not the federal government's responsibility to make sure all Americans have healthcare coverage (50%) than say it is (47%). This is a first since Gallup began tracking this question, and a significant shift from as recently as three years ago, when two-thirds said ensuring healthcare coverage was the government's responsibility.

Gallup has asked this question each November since 2001 as part of the Gallup Poll Social Series, and most recently in its Nov. 5-8 Health and Healthcare survey. There have been some fluctuations from year to year, but this year marks the first time in the history of this trend that less than half of Americans say ensuring healthcare coverage for all is the federal government's responsibility.

"Both Republicans and Democrats since 2006 have become less likely to choose the 'government responsibility' option, though Democrats' views have remained steady over the past year while Republicans' support has declined further."

The high point for the "government responsibility" viewpoint occurred in 2006, when 69% of Americans agreed. In 2008, this percentage fell to 54%, its previous low reading. This year, in the midst of robust debate on a potentially imminent healthcare reform law, the percentage of Americans agreeing that it is the government's responsibility to make sure everyone has health insurance has fallen even further, by seven points, to 47%. Half of Americans now say this is not the government's responsibility.

The reason behind this shift is unknown. Certainly the federal government's role in the nation's healthcare system has been widely and vigorously debated over the last several months, including much focus on the "public option." These data suggest that one result of the debate has been a net decrease in Americans' agreement that ensuring all Americans have healthcare coverage is an appropriate role for the federal government.

There are major differences in views on this issue by partisanship, as would be expected given the major partisan differences on most issues relating to the role of government in the U.S. today. The views of Republicans and independents who lean Republican about the government's healthcare role are almost a precise mirror image of the views of Democrats and independents who lean Democratic.

More than 7 out of 10 Republicans say it is not the responsibility of government to see that all Americans have healthcare coverage, while more than 7 out of 10 Democrats say it is.

A look at the trends on this question shows that both Republicans and Democrats since 2006 have become less likely to choose the "government responsibility" option, though Democrats' views have remained steady over the past year while Republicans' support has declined further.

The percentage of Republicans choosing the "government responsibility" option fell 20 percentage points between 2006 and the current survey, compared to a 13-point drop among Democrats. From a longer-range perspective, however, Democrats' views today reflect essentially a return to the sentiment seen early in the decade, while Republicans now express significantly lower support.

Replace the Current System?

A second question Gallup tracks each November asks Americans directly about "replacing the current healthcare system with a new government-run health care system."

Throughout this decade, a plurality of Americans have consistently favored maintaining the current system, although support has fluctuated. In November 2007, the edge for the private system over the government-run system was just 7 points, vs. a 31-point gap in 2004. The current 29-point gap is thus at the high end of the historical range.

Almost 9 out of 10 Republicans and Republican leaners favor maintaining the current healthcare system based mostly on private health insurance. Democrats and Democratic leaners favor the concept of replacing the current system with a government-run system, but Democratic opinion is less monolithic than Republican opinion; more than a third of Democrats would favor maintaining the current system.

The alternatives outlined in this question are not directly a part of the current debate; there has been no serious discussion on the part of those advocating healthcare reform of the possibility of dismantling the current system and turning it into one run completely by the government. Still, the trend line gives a good perspective on the larger issue of shifting to a more European-style healthcare system, something that the majority of Americans at this point would clearly oppose.

Bottom Line

The wording of the healthcare bill the House passed last Saturday explicitly states that one of the bill's purposes is to provide "affordable, quality healthcare for all Americans."

The current poll results indicate that, with the renewed healthcare debate since President Obama took office, Americans have become less convinced that it is an appropriate goal for the federal government to take on the responsibility of ensuring that all Americans have healthcare coverage. It is possible that the current debate has increased the average American's awareness as to the nuances of the various roles the government could play in the healthcare system, helping make the generic "make sure all Americans have healthcare coverage" sound less appealing. Plus, the current debate may have produced more skepticism among Americans that the government's role in healthcare could or should be this broad.

Most polling shows that Americans tend to favor a "public option" in which the government would provide a healthcare plan that would not be mandatory but one of several options for those seeking healthcare insurance. Americans apparently do not equate this with government's guaranteeing that all Americans have healthcare coverage.

Finally, the current data confirm the basic premise that all in all, Americans do not support the idea of a government-run system as a full replacement for the current system based on private insurance.

Survey Methods

Results are based on telephone interviews with 1,008 national adults, aged 18 and older, conducted Nov. 5-8, 2009. For results based on the total sample of national adults, one can say with 95% confidence that the maximum margin of sampling error is ±3 percentage points.

Interviews are conducted with respondents on land-line telephones (for respondents with a land-line telephone) and cellular phones (for respondents who are cell-phone only).

In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.