How Americans Think about Health Care and Insurance

Beatrice Ferrario and Stefanie Stantcheva

Tax Policy and the Economy, 2026, vol. 40, issue 1, 109 - 169

Abstract: This paper examines how Americans perceive and reason about health insurance policies using two large-scale surveys and experiments from 2019 and 2025. Across both, respondents consistently prioritize costs, affordability, and access. There is broad agreement that expanding coverage increases preventive care, reduces job-lock, and improves health, though views diverge on broader spillover benefits, which Democrats assess more favorably. Equity views are largely aligned—most recognize that health outcomes are not fully within individual control—but partisans differ on how strongly to prioritize helping low-income households. Partisan gaps are largest on policy preferences. Democrats favor single-payer systems and greater government involvement; Republicans prefer the status quo and limited government. These differences stem less from divergent efficiency or fairness beliefs than from fundamentally different views about government’s proper role. Experimental evidence highlights the power of concrete, program-specific information. Abstract efficiency or equity messages in 2019 had little effect, but in 2025, targeted information about Medicare and Medicaid significantly increased support for government-provided insurance—even among Republicans. The results suggest that detailed, positive program-based messaging can meaningfully shift public attitudes, potentially by addressing underlying skepticism about government itself.

Date: 2026
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