Support for expanding Medicare into a government-run health plan for everyone swings by nearly 20 percentage points depending on how the idea is described to voters, according to new polling that arrives as the ACA marketplace is deteriorating and employer healthcare costs continue a seemingly never-ending upward climb.
The poll, conducted by Tavern Research on behalf of the Searchlight Institute, tested three versions of a Medicare-like federal plan on three separate groups of 1,493 likely voters surveyed June 24-26.
One polled version, which drew net support of 28 percentage points, would let people opt in to Medicare and would be funded partly by monthly payments from enrollees. The second version saw net support of 33 points and described an automatic enrollment system, with no funding mechanism mentioned. The last version pitched a single plan that would replace private and employer-based insurance outright, funded by higher federal taxes. That drew net support of just 11 points.
The survey sample included 52% women to 48% men, a split between 40% approve to 57% disapprove of President Trump’s job performance, and a near-even split on how respondents said they voted in 2024 (49% Harris, 50% Trump). Thirty-eight percent of respondents received health coverage through their employer, 31% through Medicare and 14% from their state’s Medicaid program.
The same poll found voters draw sharp lines around what they want the government to cover. Support for federal coverage of cancer treatment and other serious illnesses hit 47 points net; emergency care, 45; surgery, 43; and prescription drugs and primary care at 42 each. Cosmetic procedures and plastic surgery fell to negative 31, and coverage of weight loss drugs like Ozempic was negative four. When pollsters asked what would happen if voters actually had to give up their current health plan to join a Medicare-like one, 70% said they’d stay put. Only 29% said they had any confidence in the federal government to successfully run such a program.
In late May, a survey of 2,002 registered voters by the Century Foundation found that two in three said they want either new public insurance options or a complete overhaul of the system. The uncertainty among voters around a path forward is unfolding against a health insurance market that has been getting measurably worse for consumers on at least two fronts.
On the ACA marketplaces, enrollment has fallen in 49 of the 50 states since last February, landing at nearly 19.2 million, or a decline of 12%. This year alone, eight insurers have already announced that they will stop offering marketplace plans nationally or in specific states after the 2026 plan year amid the declining enrollment, a deteriorating risk pool and the expiration of the enhanced subsidies at the end of 2025. So far, insurers offering coverage next year have pitched a median rate increase of 14% for 2027, the second year in a row of double-digit premium hikes.
On the employer front, PwC has projected a 9% medical cost trend for the group market in 2027, the steepest single-year cost increase in 17 years. That comes after the Milliman Medical Index put 2026’s total cost increase at 7.9%, itself the sharpest jump in more than a decade (besides the pandemic). In its 2027 projection, PwC cited provider adoption of AI documentation and coding tools, provider reimbursement pressure and consolidation, pharmacy spend, behavioral health utilization, and out-of-network payment disputes under the No Surprises Act as the main factors driving costs up.
The financial pressures facing the commercial market join a swirling storm of negativity around the healthcare system as the impact of H.R. 1’s roughly $1 trillion in Medicaid cuts paired with work requirements loom large, fewer than half of the country now saying it can consistently afford necessary care and medications, and what is sure to be a headline-grabbing start to Luigi Mangione’s New York state murder trial in early September.
But despite the mounting challenges for the private market and a souring mood on healthcare among Americans, none of it has translated into a political path toward anything resembling Medicare for All, particularly in a Republican-controlled Congress. And heading into the midterms, Democrats have remained caught between their progressive and centrist wings, including when it comes to healthcare policy.
Sen. Bernie Sanders’ annual pitch for a universal system remains stuck in committee, as it has every Congress since he first introduced it. A more active track has come from the centrist flank, running through the CHOICE Act that would add a public option to the exchanges, to a March letter from Senate Democrats that pushed a policy framework to expand “Medicare-type choices” as part of broader coverage reform.
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