60 percent of Americans believe it’s the government’s responsibility to provide universal health coverage, representing a major shift in opinion since 2013, according to an analysis published in the New England Journal of Medicine.

Harvard researchers Robert Blendon, ScD and John Benson analyzed 27 national opinion polls conducted by 12 survey organizations. They found support for universal health coverage went from 42 percent in 2013 (with 56 percent saying it’s not the federal government’s responsibility to ensure all Americans have coverage) to 60 percent in 2017, with 39 percent still opposed. A partisan split, remains, however, with 85 percent of self-identified Democrats believing universal coverage is the federal government’s responsibility, with only 30 percent of Republicans in agreement.

The increased support for guaranteeing coverage factored into the Republican attempts to repeal the Affordable Care Act being unpopular (24 percent approved vs. 56 percent disapproved, according to the analysis) and failing to pass.

“When confronted with millions losing coverage, the public became more supportive of the principle that the federal government should ensure coverage for these people,” Blendon said in a statement. “This substantial change likely impacted the outcome of the Senate debate.”

Attitudes towards the ACA have also appeared to have changed, though not as drastically. When the law was passed in 2010, 42 percent approved of the law while 45 percent disapproved, with the split narrowing slightly to 44-45 by 2012. In 2017, however, 49 percent approved of the ACA while 44 percent disapproved. However, identical percentages of Republicans and Democrats (60 percent each) also said the law hadn’t affected them directly.

“This suggests that most people’s views about the ACA debate were not based on personal experience but on their beliefs and values about the role of the federal government in extending insurance coverage to those who do not have it,” Blendon and Benson wrote.

Other findings from the analysis included:

• 57 percent said the federal government should play a major role in improving the healthcare system, another answer with a heavy partisan split, with 87 percent of Democrats but only 28 percent of Republicans favoring a major role.. Overall, 26 percent said the government should play a minor role and 15 percent said it should play no role at all.
• 63 percent said lawmakers should make changes to expand coverage, even if it meant increasing government spending, which was also preferred by 89 percent of Democrats. 27 percent favored reducing government spending even if it means fewer people are insured, a stance shared by 56 percent of Republicans.
• 72 percent preferred keeping Medicaid coverage at current levels, while 22 percent wanted it reduced to its pre-ACA state. A slight majority of Republicans (52 percent) favored maintaining Medicaid coverage.
• 50 percent were opposed to eliminating the ACA’s individual mandate, while 48 percent supporting getting rid of it.
• Less than 25 percent believed insurers should be able to charge more for people with pre-existing conditions.