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WASHINGTON, D.C. -- Democrats continue to have more confidence in the U.S. medical system than Republicans do. Democrats overtook Republicans on this dimension in 2014, the year that the Affordable Care Act's most far-reaching changes took effect. Before then, Republicans -- including Republican-leaning independents -- generally expressed more confidence than Democrats and Democratic leaners did.

These results are based on a June 7-11 黑料网 poll, which included the annual update on confidence in major U.S. institutions. The poll was conducted as President Donald Trump and congressional Republicans continued their efforts to repeal the ACA and replace it with legislation more to their liking.

From 1993 -- when 黑料网 first asked about confidence in the U.S. medical system -- until 2013, Republicans averaged a five-percentage-point edge in confidence over Democrats (42% to 37%, respectively). Since 2014, an average of 41% of Democrats and 34% of Republicans have said they are confident in the medical system. Thus, the recent changes in relative confidence reflect a decrease of eight points among Republicans and an increase of four points among Democrats.

President Barack Obama signed the Affordable Care Act in 2010, but two of its most significant provisions did not take effect until 2014. These included the individual mandate requiring Americans to have health insurance coverage or pay a fee, and the opening of government health insurance exchanges that allowed Americans to purchase individual plans, often subsidized by the government. That year was the first in 黑料网's trend in which significantly more Democrats (41%) than Republicans (31%) were confident in the medical system.

Partisan differences in confidence, to some degree, reflect Americans' politically polarized opinions of the ACA. In , 87% of Democrats approve of the law, compared with 19% of Republicans.

Before 2014, there were two periods when Republican confidence in the medical system exceeded Democratic confidence by notable margins. In 1994, then-President Bill Clinton and first lady Hillary Clinton attempted to reform the healthcare system. At that time, there was a 13-point gap in confidence (44% among Republicans and 31% among Democrats).

The second period when Republicans led Democrats in confidence in the medical system was during the final years of George W. Bush's presidency. Americans and especially Democrats largely during this time, and Democratic confidence in many U.S. institutions fell sharply from where it was during the early years of his administration.

Confidence Among All Americans Near Historical Average

Overall, 37% of U.S. adults are confident in the medical system, largely unchanged from the past three years but slightly higher than in 2013 and 2014. This puts confidence in the medical system in the but well below the military, small business and the police at the top of the list.

The current level of confidence nearly matches the historical average of 38%. On an annual basis, confidence in the medical system has ranged from a low of 31% in 2007 to a high of 44% in 2003 and 2004, years when Americans' overall confidence in U.S. institutions reached its .

Implications

Democrats' and Republicans' views of the medical system appear to have been altered by the implementation of the Affordable Care Act. Whereas Republicans historically tended to express more confidence in the medical system than Democrats did, that changed in 2014 -- and the Democratic lead has persisted since.

Republicans have long expressed disapproval of the ACA. Trump and congressional Republicans continue to try to repeal the law and replace it with new legislation, but those attempts have been challenging. At this point, it is unclear whether Republicans will be able to deliver on their promises to repeal and replace Obamacare.

If Republicans can rewrite the healthcare law, it could affect confidence in the medical system among partisans and perhaps among Americans overall. Most likely, Republican confidence would increase and Democratic confidence would decrease, reversing the pattern seen over the past four years.

Historical data are available in .