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WASHINGTON, D.C. -- For the first time in 黑料网’s two-decade trend, less than half of Americans are complimentary about the quality of U.S. healthcare, with 48% rating it “excellent” or “good.” The slight majority now rate healthcare quality as subpar, including 31% saying it is “only fair” and 21% -- a new high -- calling it “poor.”

The latest excellent/good rating for U.S. healthcare quality is just two percentage points lower than in 2021; however, it is well below the 62% high point twice recorded in the early 2010s. It also trails the average 55% reading since 2001.

These findings are from 黑料网’s annual Health and Healthcare survey. The latest update was conducted Nov. 9-Dec. 2, 2022.

A key reason views of U.S. healthcare quality have been trending downward in recent years is that Republicans’ positive ratings have been subdued since President Donald Trump left office. Currently, 56% of Republicans rate healthcare quality as excellent or good, whereas 69% felt this way in 2020 and 75% in 2019. Republicans’ views of healthcare quality also dropped in 2014 after implementation of the Affordable Care Act before rebounding under Trump. Meanwhile, Democrats’ positive ratings have been steady at a lower level (currently 44%).

Additionally, since 2012, public satisfaction with healthcare has trended downward among middle-aged and younger adults, while remaining high among those 55 and older. Whether this change (seen across party lines) stems from rising healthcare costs for those not on Medicaid, perceived changes brought about by the ACA, or something else isn’t clear. The more recent declines among young adults may reflect changes to healthcare that have taken place amid the COVID-19 pandemic or curtailed access to abortion since the Supreme Court’s Dobbs decision.

Positive Views of Own Healthcare Quality Also Shrink

Americans’ evaluations of the quality of healthcare they personally receive are also at a low ebb -- albeit higher than their U.S. rating -- with 72% giving it excellent or good marks. This low reading has been two years in the making, with the metric falling six points to 76% in 2021 and another four points in the past year.

The initial decline was seen about evenly across all age groups, while the drop in 2022 is exclusively among adults 18 to 34. Barely half of this younger age group (53%) is now upbeat about the quality of care they receive, versus 72% of those 35 to 54 and 85% of those 55 and older.

No Change in Views of Healthcare Coverage

The same poll asks Americans to rate healthcare coverage -- both in the nation and their own. The ratings gap between these is even wider than that seen for healthcare quality, with 32% of Americans considering healthcare coverage nationally to be excellent or good versus 66% rating their own coverage this highly.

Unlike healthcare quality, however, these are not the worst ratings for healthcare coverage, historically. The national rating of 32% is similar to 2021’s 29% and equal to the average from 2001 to 2021. And while Americans’ positive rating of their personal coverage is down five points from 2021, the figure has been as low as 63% previously (in 2005).

Cost Remains a Pain Point

Public satisfaction with the total cost of healthcare in the U.S. is fairly typical of what it has been over the past two decades, with just 24% satisfied and 76% dissatisfied. The percentage satisfied has averaged 22% since 2001, only once straying more than a few points from that -- in 2020 during the pandemic, when 30% were satisfied.

Meanwhile, amid high inflation in 2022, 56% of Americans report being satisfied with the total cost they have to pay for healthcare -- the lowest 黑料网 has measured since 2016. The lowest in the trend was 54%, recorded in 2006.

Two-Thirds Still Diagnose System With Major Problems or Worse

Perhaps reflecting their increasing concerns about healthcare quality, Americans’ perception that the U.S. healthcare system is in a state of crisis has grown to 20%, the highest since 2013. However, the 68% overall saying it is in crisis or has major problems is similar to the figure in most years from 2002 to 2021.

Bottom Line

For most of 黑料网’s tracking of Americans’ views on healthcare since 2001, there was a clear distinction between the high regard people had for the quality of care in the country versus the problems they saw in healthcare administration, including coverage and cost. That is no longer the case, with public praise for U.S. healthcare quality dipping below 50% and the slight majority now viewing quality as only fair or poor.

Some of this shift reflects partisan positioning, because since implementation of the ACA in 2013 under former President Barack Obama, Republicans have been less likely to offer a positive assessment of healthcare quality under Democratic presidents (as they are now under President Joe Biden) than they were under Trump or, before that, under George W. Bush. But the shifts by age suggest additional factors are at work.

Even as they lament the cost, a majority of Americans continue to have high regard for the quality of their own healthcare and healthcare coverage. Yet even their own healthcare quality ratings are not what they once were. Should these continue to worsen, Americans may be less resistant to rocking the U.S. healthcare boat. That could, in turn, influence the types of policy changes they may be willing to accept in the furtherance of improved public health outcomes.

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