Approval of the ACA recently climbed to a new high of 57% — driven largely by a surge in support among independents — even as pandemic‑era enhanced subsidies are set to expire Dec. 31 unless Congress acts, according to a survey published Dec. 8 by the West Health-Gallup Center on Healthcare in America.
Seven things to know:
1. Sixty-three percent of independents now approve of the ACA, up 10 points from last year, according to Gallup, which has tracked ACA approval since 2012. That rise helped push overall approval to 57%. Support among Democrats remains high at 91%; among Republicans, it stays at 15%.
2. The 57% approval today is among the highest levels recorded, marking a shift from the 37-48% range seen in earlier years. Approval has hovered at or above 50% since 2017, according to the report.
3. Among those who approve of the ACA:
- 45% want to keep it largely as is
- 49% favor keeping it but with significant changes
Those who disapprove are much more likely to support complete repeal (72%) than significant modifications (24%). That marks the widest margin between repeal versus reform among disapprovers in the survey’s history.
4. With enhanced ACA subsidies set to expire Dec. 31, many Americans face premium hikes or loss of coverage. That could drive patients to delay care or seek services in emergency departments, a risk for health systems already under financial pressure.
5. A separate nationwide Gallup panel found 73% of adults believe the government should help fund hospital bills for uninsured patients. Among them: 78% of independents and 93% of Democrats agreed; among Republicans, 53% disagreed.
When asked whether such funding should cover all uninsured patients or only legal residents, 51% of U.S. adults preferred limiting federal help to uninsured legal residents; only 33% said all uninsured patients should be covered regardless of legal status.
6. As public sentiment rises and coverage instability looms, payers may overhaul plan offerings, potentially withdrawing from certain markets. Health systems will need to adapt, whether by expanding safety‑net services, strengthening charity/financial assistance programs or adjusting payer mix strategies.
7. Americans broadly support the ACA — especially independents — but remain divided over how the law should evolve, according to the survey. Those divisions match the broader policy tensions heading into subsidy expiration and suggest that how lawmakers respond could dramatically reshape the coverage and care landscape for 2026 and beyond.
Click here for more details on the Gallup survey.
