As the next round of the Democratic presidential debates approaches, Democrats are largely united in the belief that the federal government has a responsibility to make sure all Americans have health care coverage. However, they are internally divided over how this should be achieved.

Overall, 53% of Americans say it is the responsibility of the federal government to make sure all Americans have health care coverage, while 44% say the government does not have this responsibility. The share saying the government is responsible for ensuring all Americans have health care coverage has declined from 60% in September 2018.

Republicans and Democrats continue to hold opposing views on whether or not it is the responsibility of the federal government to ensure health care coverage. While about eight-in-ten Democrats and Democratic-leaning independents (81%) say the federal government has a responsibility to make sure all Americans have health coverage, a similar share of Republicans and Republican leaners (77%) say the government does not have this responsibility.

Those who say the government is responsible for making sure all Americans have health coverage are divided over how health insurance should be provided. While 27% of adults support a single national government program, a similar share (24%) say universal health care should be provided through a mix of private insurance companies and government programs.

Among all Democrats and Democratic leaners, 44% say health insurance should be provided through a single national insurance system and 34% say it should be provided through a mix of private companies and government programs.

While Republicans overwhelmingly say it is not the government’s responsibility to ensure health coverage for all, most (64%) say the government “should continue to provide programs like Medicare and Medicaid for seniors and the very poor.” Only 12% of Republicans say the government should not be involved at all in providing health insurance.

Democrats ideologically divided on how health insurance should be provided

Wide majorities of Democrats and Democratic leaners across demographic groups say the federal government has a responsibility to ensure all Americans have health care coverage. However, there are sizable ideological differences over how health coverage should be provided.

A majority of liberal Democrats (57%) say the government has a responsibility to ensure health coverage for all and that it should be provided through a “single national health insurance system run by the government,” while 25% say insurance should be provided “through a mix of private insurance companies and government programs.”

Conservative and moderate Democrats are more divided: 42% favor a mix of government and private programs, while 33% favor a single government program.

About half of Democratic adults under age 50 (51%) say they would prefer a single national government program, while 28% say they would prefer a health care system with a mixture of government-run and private insurance programs.

By comparison, only about a third of Democrats ages 50 and older (35%) express a preference for a single national government program, while a slightly greater share (41%) say they would prefer a mixed system.

On balance, white Democrats are more likely to prefer a single government program to provide health insurance for all Americans over a mix of private insurance and government programs (47% vs. 32%). Black Democrats are roughly evenly split in their preferences: 38% back a single government program and 36% prefer a mix of government and private programs.

Shifting views on government’s responsibility to provide health coverage for all

In 2014, the public was divided over the role of the government in the health care system – 47% said the government was responsible for making sure all Americans have health care coverage, while 50% said it was not. The public subsequently grew more supportive of the government ensuring that all Americans had health care coverage. Since last fall, however, there has been a 7 percentage point drop (from 60% to 53%) in the share of Americans who say this.

The share of Republicans and Republican leaners holding the view that ensuring health care coverage is the government’s responsibility has decreased by 9 points since September 2018, from 29% to 20%. Democratic views have not changed significantly over the past year – in September 2018, 85% said making sure all Americans have health care coverage was the federal government’s responsibility; 81% say this today.

Note: See full topline results and methodology.