Republicans Once Wanted Government out of Health Care. Trump Voters See It Differently, KFF Health News, Feb. 27, 2025, by Noam N. Levey
Government regulation of health care prices used to be heresy for most Republicans. GOP leaders fiercely opposed the 2010 Affordable Care Act, which included government limits on patientsâ costs.
But as Trump begins his second term, many of the voters who sent him back to the White House welcome more robust government action to rein in a health care system many Americans perceive as out of control, polls show.
Republican voters strongly back federal limits on the prices charged by drug companies and hospitals, caps on patientsâ medical bills, and restrictions on how health care providers can pursue people over medical debt.
Even Medicaid, the state-federal insurance program that Republican congressional leaders are eyeing to dramatically cut, is viewed favorably by many GOP voters.
Skepticism about government lingers among rank-and-file Republicans. And ideas such as shifting all Americans into a single government health plan, akin to âMedicare for All,â are still nonstarters for many GOP voters.
But as tens of millions of Americans are driven into debt by medical bills they donât understand or canât afford, many are reassessing their inclination to look to free markets rather than the government.
In a recent national survey, Fabrizio Ward and Hart Research, which for decades has polled for Democratic candidates, found that Trump voters were more likely to blame health insurers, drug companies, and hospital systems than the government for high health care costs.
Three-quarters of Trump voters back government limits on what hospitals can charge, Wardâs polling found.
Mike Perry, whoâs convened dozens of focus groups with voters about health care in recent years, said the support for government price caps is all the more remarkable since regulating medical prices isnât at the top of most politiciansâ agenda. âIt seems to be like a groundswell,â he said. âTheyâve come to this decision on their own, rather than any policymakers leading them there, that something needs to be done.â
Other forms of government regulation, such as limits on medical debt collections, are even more popular. About 8 in 10 Republicans backed a $2,300 cap on how much patients could be required to pay annually for medical debt.
As Trump and his allies in Congress begin shaping their health care agenda, many Republican leaders have expressed more interest in cutting government than in expanding its protections.
âThere is oftentimes a massive disconnect,â Ward said, âbetween what happens in the caucuses on Capitol Hill and whatâs happening at family tables across America.â
Comment:
By Don McCanne, M.D.
The important message here is that it is not only Democrats who are concerned about health care costs so much that they want the government to take actionâit is Republicans as well, including those who voted for Trump in 2024. In fact, many Trump supporters think he would do a better job in controlling their health care costs.
Yet there is still significant opposition to single payer / Medicare for All. This is despite numerous studies showing that such a model would be more effective in controlling costs while ensuring access to comprehensive, high quality care for all, affordable for each one of us. They want the government to help, but they remain uncomfortable with the single payer model. So what is going on here?
Most of all, the private insurance industry has been very effective in marketing their products. A predominant example: people on Medicare believe that private Medicare Advantage plans will provide greater benefits at a lower cost than traditional government-managed Medicare. When the insurance product is marketed to them, it seems like that is true. They get a few additional, nominal benefits that are not offered in traditional Medicare, and the up-front costs are lower than premiums in the traditional program especially if including Medigap plans needed to fill coverage holes.
But the financial advantage is illusory. The purpose of health insurance is to provide better access to necessary health care while controlling costs that they would otherwise be exposed to when they need to access that care. Is that the way private Medicare Advantage plans work? No. When beneficiaries need to use their plans, they usually have a limited choice of providers because of the narrow networks covered; they face prior authorization requirements; and they often have greater out-of-pocket expenses because of the deductibles and copays required by the plans, often creating financial hardship. At that point, they might want to return to the greater choices and more affordable coverage of traditional Medicare, but the Medigap plan may no longer be available because of pre-existing conditions (which are ignored at the time of original enrollment).
Actually, what patients want at the time of medical need would be choice of providers, truly comprehensive benefits, with elimination of cost-sharing at the time of service. The way you would get that is through a single payer system, an improved Medicare for All.
Paying for it? This would happen via a public insurance program which would be progressively financed through taxes with those in poverty paying nothing, and increasing with income, with the billionaires paying significantly more than the actual costs. This would be the most equitable method, with no person suffering a financial hardship (when unaffordable costs happen to be one of the greatest sources of dissatisfaction with todayâs health care system).
Of course, Republicans have heavily opposed single payer since they greatly favor further reduction in taxes for the billionaires while having the masses fund care through reduced benefits and greater financial contributions. They currently support a privatized Medicare Advantage for All that would do this: fewer paid benefits for lower income individuals and greater cost sharing at the time of service â the opposite of what our system should be providing.
We see that the public broadly does want the government to be involved in fixing our system, providing better care at lower costs. But we really need to do this through the more humanitarian single payer model, rather than through tweaking a system designed to shift our health care dollars to wealthy private investors and away from care.
Our task now is to explain to everyone (including Trump voters!) that they can have the government controls that they want, but that the system needs to be designed so that it works for the people, all of us, rather than being designed to increase the wealth of the private investors at a cost to the average citizen of affordability and access to the care that they need.
Once they understand the system, thatâs what theyâll want.
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