This report draws on a Public Agenda/USA TODAY/Ipsos Hidden Common Ground nationally representative survey of American adults as well as four focus groups exploring the views and values of the American public on health care, including how much change people think the health care system needs, their goals and priorities for changing it, and their views on various proposals for doing so.

The research finds that nearly all Americans across the political spectrum want the health care system to change. Even people who currently have what they consider to be satisfactory health insurance nonetheless think the system needs substantial change. Americans across party lines also largely agree on what the goals for the health care system ought to be—starting with making it more affordable and ensuring that people are not penalized for pre-existing conditions.

Republicans and Democrats differ from each other on how to achieve those goals somewhat, while people who identify as Independents and those who have no political affiliation typically fall somewhere in between. Few of these differences involve huge or unbridgeable gaps. Moreover, for each of the four approaches to health care reform that this survey asked people to consider (see Finding 3), around a quarter of Americans say they do not have enough information to give an opinion, suggesting that there is substantial room for public opinion to evolve as people learn more.

The main findings from this research are:

  1. Americans across political affiliations are calling for substantial changes to the health care system, including those who are satisfied with their current insurance.
  2. Americans across the political spectrum share many of the same goals for health care, beginning with making it more affordable for ordinary people — perhaps because half of Americans have experienced serious financial difficulties due to health care or know someone who has. Other important shared goals include covering pre-existing conditions and covering long-term care.
  3. The survey asked people to consider four approaches to health care reform. Of those, a public option-type plan is supported by a majority of Democrats while Republicans are split on it. A Medicare for All-type plan is also popular with Democrats but opposed by most Republicans. A market-based approach appeals to about half of Republicans and a plurality of Democrats. Giving states more responsibility for health care garners the least support overall.
  4. As people grapple with the four approaches, common ground on protecting people with pre-existing conditions emerges strongly. Democrats are more comfortable with using tax increases to fund health care and with a larger role for the federal government than Republicans are, while Republicans particularly value consumer choice.

Given the public’s desire for substantial change in health care, findings from this survey suggest that leaders should focus pragmatically on achieving the many goals that attract strong cross-partisan agreement. While partisanship plays a role in influencing how people believe these goals should be achieved, findings from this research provide an outline for a workable public conversation about improving health care in the United States. It is our hope that this report, along with the other Hidden Common Ground activities that accompany it, can help focus, frame, stimulate, and contribute to that conversation.

Methodology in Brief

This report summarizes findings from a nationally representative survey of 1,020 adult Americans 18 years and older. The survey was fielded December 19-26, 2019 by Ipsos using the probability-based web-enabled KnowledgePanel®. Respondents completed the survey in English or Spanish. The survey was weighted to match Census figures to ensure full representation of the American people.

The research also draws from four demographically diverse focus groups that Public Agenda conducted in October 2019 in Baltimore, Maryland; Dallas, Texas; Earth City, Missouri; and New Rochelle, New York.

Click here for a complete survey methodology, the topline with full question wording and cross tabulations by political affiliation.