Mary Catherine Johnson is a retired small-business owner from outside Rochester, New York. She voted for Donald Trump three times.

Lexy Mealing, who used to work in a physician’s office, is from Long Island. She’s a Democrat.

But the women share a common bond. They both survived breast cancer.

And when the American Cancer Society Cancer Action Network organized its annual citizen lobby day in Washington last month, Johnson and Mealing were among the more than 500 volunteers pushing Congress to keep cancer research and support for cancer patients at the top of the nation’s health care agenda.

The day is something of a ritual for groups like the cancer organization.

This year, it came as Democrats and Republicans in Washington slid toward a budget impasse that shut down the federal government. But these volunteers transcended their political differences and found common ground.

“Not one person here discussed if you’re a Democrat, if you’re a Republican,” said Mealing, one of 27 volunteers in the New York delegation. “Cancer doesn’t care.”

Every one of the volunteer lobbyists had been touched in some way by the deadly disease, which is expected to kill more than 600,000 people in the U.S. this year.

Johnson said each of her mother’s 10 siblings died from cancer, as did a lifelong friend who died at age 57, leaving behind his wife and two young daughters.

Like many of the New York volunteers, Johnson also said she’s worried about the state of politics today.

“I think we’re probably the most divided that we’ve ever been,” she said. “That scares me. Scares me for my grandchildren.”

Katie Martin, a cancer volunteer from outside Buffalo, also worries. She and her daughter recently drove past political protesters screaming at one another on the street.

 “My daughter is silent and then starts asking, ‘What is this?’ And I don’t know how to explain it, because it doesn’t even make sense to me,” she said. “It’s very heartbreaking.”

Mealing said she can barely watch the news these days. “A lot of Americans are very stressed out. There’s a lot of things going on.”

Americans are indeed split over many issues — immigration, guns, President Trump. But helping people with cancer and other serious illnesses retains broad bipartisan support, polls show.

In one recent survey, 7 in 10 voters said it’s very important for the federal government to fund medical research. That included majorities of Democrats and Republicans.

“It’s rare in today’s environment to see numbers like that,” said Jarrett Lewis, a Republican pollster who conducted the survey for patient groups. “But almost everybody in this country knows somebody who’s had cancer.”

Similarly, a recent KFF poll found that three-quarters of U.S. adults, including most Republicans who align with the Make America Great Again, or MAGA, movement, want Congress to extend subsidies that help Americans buy health insurance through Affordable Care Act marketplaces.

These subsidies, which are critical to people with chronic illnesses such as cancer, are among the main sticking points in the current budget impasse in Congress.

As the cancer volunteers gathered in a conference hotel in Washington, they focused on their shared agenda: increasing funding for cancer research, retaining insurance subsidies, and expanding access to cancer screening.

“We may not see eye to eye politically. We might not even see eye to eye in social circumstances,” said Martin, the Buffalo-area volunteer. “But we can see beyond those differences because we’re here for one cause.”

The state delegations practiced the pitches they would make to their members of Congress. They ran through the personal stories they would share. And they swapped tips for how to deal with resistant staff and how to ask for a photo with a lawmaker.

On the morning of their lobby day, they reconvened in a cavernous ballroom, decked out in matching blue polo shirts and armed with red information folders to leave at each office they would visit.

They got a pep talk from a pair of college basketball coaches. Then they headed across town to Capitol Hill.

The army of volunteers — from every state in the country — hit 484 of the 535 Senate and House offices.

Not every visit was an unqualified victory. Many Republican lawmakers object to extending the insurance subsidies, arguing they’re too costly.

But lawmakers from both parties have backed increased research funding and support for more cancer screening.

And the New Yorkers felt good about the day. “It was amazing,” Mealing said as the day wrapped up. “You could just feel the sense of, ‘Everybody stronger together.’”

When evening came, the volunteers met on the National Mall for a candlelight vigil. It was raining. Bagpipes played.

Around a pond near the Lincoln Memorial, some 10,000 tea lights glimmered in little paper bags. Each luminary had a name on it — a life touched by cancer.

John Manna, another New Yorker, is a self-described Reagan Republican whose father died from lung cancer. He reflected on the lessons this day could offer a divided nation.

“Talk to people,” he said. “Get to know each other as people, and then you can understand somebody’s positions.  We have little disagreements, but, you know, we don’t attack each other. We talk and discuss it.”

Manna said he would be back next year.

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President Donald Trump rode to reelection last fall on voter concerns about prices. But as his administration pares back federal rules and programs designed to protect patients from the high cost of health care, Trump risks pushing more Americans into debt, further straining family budgets already stressed by medical bills.

Millions of people are expected to lose health insurance in the coming years as a result of the tax cut legislation Trump signed this month, leaving them with fewer protections from large bills if they get sick or suffer an accident.

At the same time, significant increases in health plan premiums on state insurance marketplaces next year will likely push more Americans to either drop coverage or switch to higher-deductible plans that will require them to pay more out-of-pocket before their insurance kicks in.

Smaller changes to federal rules are poised to bump up patients’ bills, as well. New federal guidelines for covid-19 vaccines, for example, will allow health insurers to stop covering the shots for millions, so if patients want the protection, some may have to pay out-of-pocket.

The new tax cut legislation will also raise the cost of certain doctor visits, requiring copays of up to $35 for some Medicaid enrollees.

And for those who do end up in debt, there will be fewer protections. This month, the Trump administration secured permission from a federal court to roll back regulations that would have removed medical debt from consumer credit reports.

That puts Americans who cannot pay their medical bills at risk of lower credit scores, hindering their ability to get a loan or forcing them to pay higher interest rates.

“For tens of millions of Americans, balancing the budget is like walking a tightrope,” said Chi Chi Wu, a staff attorney at the National Consumer Law Center. “The Trump administration is just throwing them off.”

White House spokesperson Kush Desai did not respond to questions about how the administration’s health care policies will affect Americans’ medical bills.

The president and his Republican congressional allies have brushed off the health care cuts, including hundreds of billions of dollars in Medicaid retrenchment in the mammoth tax law. “You won’t even notice it,” Trump said at the White House after the bill signing July 4. “Just waste, fraud, and abuse.”

But consumer and patient advocates around the country warn that the erosion of federal health care protections since Trump took office in January threatens to significantly undermine Americans’ financial security.

“These changes will hit our communities hard,” said Arika Sánchez, who oversees health care policy at the nonprofit New Mexico Center on Law and Poverty.

Sánchez predicted many more people the center works with will end up with medical debt. “When families get stuck with medical debt, it hurts their credit scores, makes it harder to get a car, a home, or even a job,” she said. “Medical debt wrecks people’s lives.”

For Americans with serious illnesses such as cancer, weakened federal protections from medical debt pose yet one more risk, said Elizabeth Darnall, senior director of federal advocacy at the American Cancer Society’s Cancer Action Network. “People will not seek out the treatment they need,” she said.

Trump promised a rosier future while campaigning last year, pledging to “make America affordable again” and “expand access to new Affordable Healthcare.”

Polls suggest voters were looking for relief.

About 6 in 10 adults — Democrats and Republicans — say they are worried about being able to afford health care, according to one recent survey, outpacing concerns about the cost of food or housing. And medical debt remains a widespread problem: As many as 100 million adults in the U.S. are burdened by some kind of health care debt.

Despite this, key tools that have helped prevent even more Americans from sinking into debt are now on the chopping block.

Medicaid and other government health insurance programs, in particular, have proved to be a powerful economic backstop for low-income patients and their families, said Kyle Caswell, an economist at the Urban Institute, a think tank in Washington, D.C.

Caswell and other researchers found, for example, that Medicaid expansion made possible by the 2010 Affordable Care Act led to measurable declines in medical debt and improvements in consumers’ credit scores in states that implemented the expansion.

“We’ve seen that these programs have a meaningful impact on people’s financial well-being,” Caswell said.

Trump’s tax law — which will slash more than $1 trillion in federal health spending over the next decade, mostly through Medicaid cuts — is expected to leave 10 million more people without health coverage by 2034, according to the latest estimates from the nonpartisan Congressional Budget Office. The tax cuts, which primarily benefit wealthy Americans, will add $3.4 trillion to U.S. deficits over a decade, the office calculated.

The number of uninsured could spike further if Trump and his congressional allies don’t renew additional federal subsidies for low- and moderate-income Americans who buy health coverage on state insurance marketplaces.

This aid — enacted under former President Joe Biden — lowers insurance premiums and reduces medical bills enrollees face when they go to the doctor or the hospital. But unless congressional Republicans act, those subsidies will expire later this year, leaving many with bigger bills.

Federal debt regulations developed by the Consumer Financial Protection Bureau under the Biden administration would have protected these people and others if they couldn’t pay their medical bills.

The agency issued rules in January that would have removed medical debts from consumer credit reports. That would have helped an estimated 15 million people.

But the Trump administration chose not to defend the new regulations when they were challenged in court by debt collectors and the credit bureaus, who argued the federal agency had exceeded its authority in issuing the rules. A federal judge in Texas appointed by Trump ruled that the regulation should be scrapped.

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GLOBE, Ariz. — Like many residents of this copper-mining town in the mountains east of Phoenix, Debbie Cox knows plenty of people on Medicaid.

Cox, who is a property manager at a real estate company in Globe, has tenants who rely on the safety-net program. And at the domestic violence shelter where she volunteers as president of the board, Cox said, staff always look to enroll women and their children if they can.

But Cox, who is 65, has mixed feelings about Medicaid. “It’s not that I don’t see the need for it. I see the need for it literally on a weekly basis,” she said. “I also see a need for revamping it significantly because it’s been taken advantage of for so long.”

It wasn’t hard to find people in Globe like Cox with complicated views about Medicaid.

Gila County, where Globe is located, is a conservative place — almost 70% of voters went for President Donald Trump in November. And concerns about government waste run deep.

Like many rural communities, it’s also a place where people have come to value government health insurance. The number of Gila County residents on Medicaid and the related Children’s Health Insurance Program has nearly doubled over the past 15 years, according to data from the Georgetown University Center for Children and Families. Today, almost 4 in 10 residents are on one of the plans for low- and moderate-income people or those with disabilities.

So as congressional Republicans consider plans to cut more than $700 billion from Medicaid, the debate over the program hits close to home for many Globe residents, even as some welcome the prospect of tighter rules and less government spending.

For Heather Heisler, the stakes are high. Her husband has been on Medicaid for years.

“We’re ranchers, and there’s not much money in ranching,” said Heisler, who gets her own health care from the Indian Health Service. “Most people think there is, but there isn’t.”

Heisler was selling handicrafts outside the old county jail in Globe on a recent Friday night when the town hosted a downtown street fair with food trucks and live music.

She said Medicaid was especially helpful after her husband had an accident on the ranch. A forklift tipped over, and he had to have part of his left foot amputated. “If anything happens, he’s able to go to the doctor,” she said. “Go to the emergency room, get medicines.”

She shook her head when asked what would happen if he lost the coverage. “It would be very bad for him,” she said.

Among other things, proposed tax legislation written by House Republicans would require working-age Medicaid enrollees to prove they are employed or seeking work. The bill, which passed the House and has advanced to the Senate, would also mandate more paperwork from people to prove they’re eligible.

Difficult applications can dissuade many people from enrolling in Medicaid, even if they’re eligible, researchers have found. And the nonpartisan Congressional Budget Office estimates more than 10 million people will likely lose Medicaid and CHIP insurance under the House Republican plan.

That would reverse big gains made possible by the 2010 Affordable Care Act, which has allowed millions of low-income, working-age adults in places like Globe to get health insurance.

Nationally, Medicaid and CHIP have expanded dramatically over the past two decades, with enrollment in the programs surging from about 56 million in 2005 to more than 78 million last year, according to federal data.

“Medicaid has always played an important role,” said Joan Alker, who runs the Georgetown University Center for Children and Families. “But its role has only grown over the last couple of decades. It really stepped in to address many of the shortcomings in our health care system.”

That’s particularly true in rural areas, where the share of people with disabilities is higher, residents have lower incomes, and communities are reliant on industries with skimpier health benefits such as agriculture and retail.

In Globe, former mayor Fernando Shipley said he’s seen this firsthand.

“A lot of people think, ‘Oh, those are the people that aren’t working.’ Not necessarily,” said Shipley, who operates a State Farm office across the road from the rusted remains of the Old Dominion copper mine. “If you’re a single parent with two kids and you’re making $20 an hour,” he added, “you’re not making ends meet. You’ve got to pay rent; you’ve got to feed those kids.”

Not far away, at the local hospital, some low-wage workers at the registration desk and in housekeeping get health care through Medicaid, chief financial officer Harold Dupper said. “As much as you’d like to pay everyone $75,000 or $80,000 a year, the hospital couldn’t stay in business if that was the payroll,” he said, noting the financial challenges faced by rural hospitals.

The growing importance of Medicaid in places like Globe helps explain why Republican efforts to cut the program face so much resistance, even among conservatives.

“There’s been a shift in the public’s attitude, and particularly voters on the right, that sometimes government plays a role in getting people health care. And that’s OK,” said pollster Bob Ward. “And if you take away that health care, people are going to be angry.” Ward’s Washington, D.C., firm, Fabrizio Ward, works for Trump. He also polls for a coalition trying to protect Medicaid.

At the same time, many of the communities where Medicaid has become more vital in recent years remain very conservative politically.

More than two-thirds of nearly 300 U.S. counties with the biggest growth in Medicaid and CHIP since 2008 backed Trump in the last election, according to a KFF Health News analysis of voting results and enrollment data from Georgetown. Many of these counties are in deep-red states such as Kentucky, Louisiana, and Montana.

Voters in places like these are more likely to be concerned about government waste, polls show. In one recent national survey, 75% of Republicans said they think waste, fraud, and abuse in Medicaid is a major problem.

The actual scale of that waste is hotly debated, though many analysts believe relatively few enrollees are abusing the program.

Nevertheless, around Globe, Republican arguments that cuts will streamline Medicaid seemed to resonate.

Retiree Rick Uhl was stacking chairs and helping clean up after lunch at the senior center. “There’s a lot of waste, of money not being accounted for,” Uhl said. “I think that’s a shame.” Uhl said he’s been saddened by the political rancor, but he said he’s encouraged by the Trump administration’s aggressive efforts to cut government spending.

Back at the street fair downtown, David Sander, who is also retired, said he doubted Medicaid would really be trimmed at all.

“I’ve heard that they really aren’t cutting it,” Sander said. “That’s my understanding.”

Sander and his wife, Linda, were tending a stall selling embroidery that Linda makes. They also have a neighbor on Medicaid.

“She wouldn’t be able to live without it,” Linda Sander said. “Couldn’t afford to have an apartment, make her bills and survive.”

This article first appeared on KFF Health News and is republished here under a Creative Commons license.

When congressional Republicans in 2017 pushed to repeal the Affordable Care Act and slash Medicaid, dozens of physician groups, patient advocates, hospitals, and others rallied to defend the law and the safety-net program.

Eight years later, two industry groups have been notably restrained as GOP lawmakers consider sweeping new Medicaid cuts: the American Medical Association and the American Health Care Association, which represents nursing homes.

At the same time, the two groups are lobbying Republicans, seeking support on other priorities.

The AMA is lobbying lawmakers to reverse a nearly 3% cut in Medicare’s fees for physicians. And the AHCA has pushed Congress to roll back regulations enacted under President Joe Biden that mandate better staffing ratios at nursing homes.

Representatives of the two groups declined to comment on the record about any connections between the Medicaid fight and their other legislative priorities.

But AHCA spokesperson Rachel Reeves said the nursing home group, which has issued a statement defending Medicaid, is communicating with lawmakers about the importance of the program for people with low incomes and disabilities. “We will make sure that the voices of our community are heard and that the message is loud and clear: Congress must protect our seniors who rely on Medicaid,” she said. Medicaid is the primary payer for nursing home care, covering more than 6 in 10 nursing home residents.

Nevertheless, other advocates and congressional Democrats said they’re frustrated by the two groups. “The time to speak out is now,” Sen. Ron Wyden, the senior Democrat on the Senate Finance Committee, told KFF Health News. “Americans will know which organizations stood up against harmful cuts to Medicaid when this fight is over.”

Medicaid, a state-federal insurance plan that together with the related Children’s Health Insurance Program covers about 80 million Americans, is in the crosshairs as congressional Republicans seek to trim several trillion dollars in federal spending to offset the $4.5 trillion cost of extending tax cuts enacted in President Donald Trump’s first term.

Medicaid cuts on the scale being contemplated would put coverage for millions of Americans at risk. That has alarmed advocates who work with people covered by the program, including children, Americans with disabilities, and low-income older adults. Other advocacy organizations who work with these patients have been much more active.

Last week, more than 400 pediatricians traveled to Washington, D.C., to speak to members of Congress about the importance of Medicaid. More than 100 leaders of safety-net hospitals that serve low-income patients around the country did the same.

Patients’ advocates such as the American Cancer Society Cancer Action Network have defended Medicaid. Last month, state medical societies sent a letter to congressional leaders warning of dire consequences if Medicaid cuts are enacted. And this week, more than 750 members of the American College of Obstetricians and Gynecologists are expected in Washington, where the group says they’ll be lobbying to preserve Medicaid funding.

“Slicing hundreds of billions of dollars from federal funding will force states to cut the care children and families depend on or raise taxes on hard-working Americans,” said Chip Kahn, chief executive of the Federation of American Hospitals, another trade group fighting to defend Medicaid.

Building coalitions was critical in previous health care debates, said Ron Pollack, the former head of patient advocacy group Families USA. Pollack helped lead the push for the 2010 Affordable Care Act. “We succeeded in the past because we stuck together,” he said.

Eight years ago, the AMA and AHCA were key members of the coalition that turned back Republican efforts to repeal the Affordable Care Act, often called Obamacare.

The AMA, the nation’s largest physician group, sent multiple letters to Congress throughout 2017, warning lawmakers in a March 17, 2017, letter that they should “keep upmost in your mind the potentially life altering impact your decisions will have on millions of Americans.”

And the AHCA’s president was a leading voice opposing repeal, which at one point he called “the biggest threat that the sector has faced in at least 20 to 25 years.”

This year, the AMA hasn’t sent a single letter or issued any news releases opposing Medicaid cuts. By contrast, the group has issued seven news releases since January on the lack of congressional action on physician fees.

The AHCA issued its first public defense of Medicaid in this year’s debate — a document it called a fact sheet — only the day after House Republicans adopted a budget resolution that threatens the program’s funding. When the group issued its 2025 policy priorities last week, “Priority #1” focused on staffing, including repealing the Biden-era staffing mandate. “Protecting Medicaid” was “Priority #2.”

The Medicaid debate will likely drag on for months as GOP leaders in the House and Senate try to cobble together a bill to extend tax cuts.

Medicaid’s defenders say they’re still looking for more voices to speak up.

“Republicans have said outright that silence is consent,” Wyden said. “If health care organizations don’t speak out against the GOP’s plans to cut health care, Republican lawmakers are going to assume those organizations are on board with their agenda.”

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As President Donald Trump wrapped up his first term in 2020, he signed legislation to protect Americans from surprise medical bills. “This must end,” Trump said. “We’re going to hold insurance companies and hospitals totally accountable.”

But the president’s wide-ranging push to slash government spending, led by billionaire Elon Musk, is weakening the federal office charged with implementing the No Surprises Act.

Some 15% of those working at the federal Center for Consumer Information and Insurance Oversight, or CCIIO, were fired two weeks ago, according to the agency’s former deputy director in charge of operations, Jeff Grant.

And while the full impact of the cutbacks is still coming into focus, the retrenchment is threatening work at an agency already laboring to run an overstretched system for resolving sometimes very large bills from out-of-network medical providers.

“It’s a hot mess,” Grant said of the job cuts in an interview with KFF Health News. “The chaos has put everyone in a tailspin.”

The cuts, which affected 82 of the federal office’s employees, also risk delaying critical new rules designed to speed the process of adjudicating disputes over surprise bills between health plans and medical providers.

Grant, who was the top career official at CCIIO, retired last week after 41 years in government. He blasted the layoffs as a “grievous error” in a strongly worded letter to the acting human resources director, criticizing him for cutting jobs without regard for the qualifications of employees or the needs of the agency.

Health insurers have also raised concerns about maintaining the agency’s work on surprise bills.

A spokesperson for the federal Centers for Medicare & Medicaid Services, which oversees the CCIIO, said the federal agency is doing that. “CMS is committed to enforcing the No Surprises Act, and the agency continues to move forward with that important work,” Catherine Howden said.

The CCIIO, a small part of the federal health agency, was created by the 2010 Affordable Care Act and charged with ensuring that health insurance plans meet standards established by the law to protect patients.

After Congress passed the No Surprises Act in 2020, the office assumed additional responsibility for setting up and administering the complex process for protecting patients from surprise bills.

The work drew support from Democrats and Republicans, who’d been inundated with stories of patients hit by huge bills from emergency physicians, anesthesiologists, and other providers who were not in patients’ insurance networks, even when patients received care at in-network hospitals.

“We will end surprise medical billing,” Trump promised on the campaign trail in 2020. “The days of ripping off patients are over.”

The law barred medical providers in most cases from pursuing patients over surprise bills. This prohibition is not directly affected by the recent job cuts ordered by Musk’s Department of Government Efficiency, created by Trump through an executive order.

But the CCIIO had been working to streamline a system established by the No Surprises Act to resolve disagreements between health plans and medical providers over out-of-network bills. This key protection was put in place so patients would not be caught in the middle of billing disputes.

The system, known as independent dispute resolution, or IDR, has been inundated with hundreds of thousands of cases. In 2023, more than 650,000 new disputes were filed, according to a recent analysis published in the journal Health Affairs.

“The No Surprises Act has protected millions of Americans from receiving surprise medical bills,” said Jennifer Jones, who directs legislative policy at the Blue Cross Blue Shield Association, an insurance trade group. “But issues with the independent dispute resolution process,” she added, “are driving up costs for patients and employers.”

Also overwhelmed has been a consumer reporting system designed to allow patients to lodge complaints if they feel they have been unfairly targeted with a surprise bill.

Under former President Joe Biden, the CCIIO had been working on new rules to make dispute resolution more efficient, which experts said would make a difference.

“If this rule becomes final and works as well as intended, it should help more out-of-network claims get resolved,” said Jack Hoadley, an emeritus research professor at Georgetown University, who has studied surprise medical billing.

But the new rules weren’t finished before Biden left office. And the senior official overseeing this work left his job in January. The recent cuts hit the remaining CCIIO staffers working on the No Surprises Act, according to Grant and other sources familiar with the layoffs, who asked not to be identified out of fear of professional retaliation.

Grant said senior CCIIO officials were since able to shift some employees around and got permission to recall some of the 82 people let go. But he said there is no guarantee that all of them will want to come back to the diminished agency.

Even more concerning, Grant said, are deeper cuts that the White House has told federal agencies to prepare for by March 13.

“These cuts were pretty bad,” Grant said. “What happens next will be even more important.”

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Like many Americans who voted for Donald Trump, Jason Rouse hopes the president’s return will mean lower prices for gas, groceries, and other essentials.

But Rouse is looking to the federal government for relief from one particular pain point: high health care costs. “The prices are just ridiculous,” said Rouse, 53, a retired Michigan firefighter and paramedic who has voted for Trump three times. “I’d like to see a lower cap on what I have to pay out-of-pocket.”

Government regulation of health care prices used to be heresy for most Republicans. GOP leaders fiercely opposed the 2010 Affordable Care Act, which included government limits on patients’ costs. More recently, the party fought legislation signed by former President Joe Biden to cap prescription drug prices.

But as Trump begins his second term, many of the voters who sent him back to the White House welcome more robust government action to rein in a health care system many Americans perceive as out of control, polls show.

“That idea that government should just keep its hands off, even when things are tough for people, has kind of lost its sheen,” said Andrew Seligsohn, president of Public Agenda, a nonprofit that has studied public attitudes about government and health care.

“We’re wandering around the country with a set of old, outdated frameworks about what ordinary Democrats and ordinary Republicans like,” he said.

Republican voters strongly back federal limits on the prices charged by drug companies and hospitals, caps on patients’ medical bills, and restrictions on how health care providers can pursue people over medical debt.

Even Medicaid, the state-federal insurance program that Republican congressional leaders are eyeing to dramatically cut, is viewed favorably by many GOP voters, like Ashley Williamson.

Williamson, 37, a mother of five in eastern Tennessee who voted for Trump, said Medicaid provided critical assistance when her mother-in-law needed nursing home care. “We could not take care of her,” Williamson said. “It stepped in. It made sure she was taken care of.”

Williamson, whose own family gets coverage through her husband’s employer, said she would be very concerned by large cuts in Medicaid funding that could jeopardize coverage for needy Americans.

For years, Republican ideas about health care reflected a broad skepticism about government and fears that government would threaten patients’ access to physicians or lifesaving medicines.

“The discussions 10 to 15 years ago were all around choice,” said Christine Matthews, a Republican pollster who has worked for numerous GOP politicians, including former Maryland governor Larry Hogan. “Free market, not having the government limit or take over your health care.”

Matthews and fellow pollster Mike Perry recently convened and paid for several focus groups with Trump voters, including Rouse and Williamson, which KFF Health News observed.

Skepticism about government lingers among rank-and-file Republicans. And ideas such as shifting all Americans into a single government health plan, akin to “Medicare for All,” are still nonstarters for many GOP voters.

But as tens of millions of Americans are driven into debt by medical bills they don’t understand or can’t afford, many are reassessing their inclination to look to free markets rather than the government, said Bob Ward, whose firm, Fabrizio Ward, polled for Trump’s 2024 campaign.

“I think most people look at this and say the market is broken, and that’s why they’re willing for someone, anyone, to step in,” he said. “The deck is stacked against folks.”

In a recent national survey, Fabrizio Ward and Hart Research, which for decades has polled for Democratic candidates, found that Trump voters were more likely to blame health insurers, drug companies, and hospital systems than the government for high health care costs.

Sarah Bognaski, 31, an administrative assistant in upstate New York, is among the many Trump voters who say they resent profiteering by the health care industry. “I don’t think there is any reason a lot of the costs should be as high as they are,” Bognaski said. “I think it’s just out of pure greed.”

High health care costs have had a direct impact on Bognaski, who was diagnosed four years ago with Type 1 diabetes, a condition that makes her dependent on insulin. She said she’s ready to have the government step in and cap what patients pay for pharmaceuticals. “I’d like to see more regulation,” she said.

Charles Milliken, a retired auto mechanic in West Virginia, who said he backed Trump because the country “needs a businessman, not a politician,” expects the new president to go even further.

“I think he’s going to put a cap on what insurance companies can charge, what doctors can charge, what hospitals can charge,” said Milliken, 51, who recently had a heart attack that left him with more than $6,000 in medical debt.

Three-quarters of Trump voters back government limits on what hospitals can charge, Ward’s polling found.

And about half of Trump voters in a recent KFF poll said the new administration should prioritize expanding the number of drugs whose price is set through negotiation between the federal Medicare program and drug companies, a program started under the Biden administration.

Perry, who’s convened dozens of focus groups with voters about health care in recent years, said the support for government price caps is all the more remarkable since regulating medical prices isn’t at the top of most politicians’ agenda. “It seems to be like a groundswell,” he said. “They’ve come to this decision on their own, rather than any policymakers leading them there, that something needs to be done.”

Other forms of government regulation, such as limits on medical debt collections, are even more popular.

About 8 in 10 Republicans backed a $2,300 cap on how much patients could be required to pay annually for medical debt, according to a 2023 survey by Perry’s polling firm, PerryUndem. And 9 in 10 favored a cap on interest rates charged on medical debt.

“These are what I would consider no-brainers, from a political perspective,” Ward said.

But GOP political leaders in Washington have historically shown little interest in government limits on what patients pay for medical care. And as Trump and his allies in Congress begin shaping their health care agenda, many Republican leaders have expressed more interest in cutting government than in expanding its protections.

“There is oftentimes a massive disconnect,” Ward said, “between what happens in the caucuses on Capitol Hill and what’s happening at family tables across America.”

NOW READ: That Trump 'backlash' may not be real — here's why

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Among the biggest-grossing films in America in February 2002 were a war drama about American troops in Somalia (“Black Hawk Down”), an Arnold Schwarzenegger action movie (“Collateral Damage”), and a future Oscar winner about a brilliant mathematician struggling with schizophrenia (“A Beautiful Mind”).

But none of these films topped the box office that month. That title went to “John Q.,” a movie about health insurance.

Or, more precisely, a story about a desperate father — played by Denzel Washington — who takes a hospital emergency room hostage at gunpoint when his HMO refuses to cover a heart transplant for his young son.

John Q.’s violent quest for justice was, of course, fictional. And even in the film, no one ends up dead.

Tragically, that wasn’t the case on the streets of New York City on Dec. 4 when a gunman fatally shot Brian Thompson, CEO of health insurance giant UnitedHealthcare.

But there was nothing new about the anger at health insurers that Thompson’s shooting unleashed online — and which suspect Luigi Mangione expressed in a document he allegedly wrote.

In fact, eruptions of public rage have shadowed the American health care system for decades.

In the late 1990s and early 2000s, as “John Q.” was hitting movie screens, Americans were revolting against HMOs, whose practice of denying care to plan members to pad their bottom lines made them public enemy No. 1.

Just a few years later, health insurers stoked new ire for rescinding coverage after people were diagnosed with expensive illnesses like cancer. More recently, insurers’ widening use of cumbersome prior authorization procedures that slow patients’ access to care has provoked yet another round of fury.

The cycle of outrage periodically turns on others in the health care industry as well. Exorbitant bills and aggressive collection tactics, such as garnishing patients’ wages, are sapping public trust in hospitals and other medical providers.

And drug companies — perennial poster children for greed and profiteering — have enraged Americans since at least the 1950s, when new “wonder drugs” like steroids were fueling a growing industry.

When Sen. Estes Kefauver, a Tennessee Democrat who had led an investigation of the Mafia, convened hearings in 1959 to probe high prescription prices, his committee received mountains of mail from Americans who reported being fleeced by drugmakers. One retired rail worker told of having to spend more than a third of his retirement income on medicines for himself and his wife.

All this public outcry has occasionally sparked change. President Barack Obama and congressional Democrats leveraged anger at spiking insurance premiums in California to get the Affordable Care Act over the finish line in 2010, a landmark achievement that expanded health coverage to millions of Americans.

But more often, cycles of rage have been so much sound and fury, producing only modest reforms. In some cases, public anger has yielded more headaches for patients.

The HMO backlash in the late 1990s and early 2000s, for example, prompted employers — from whom about half of Americans get their health coverage — to embrace high-deductible health plans. Many employers saw these plans as a way to hold down costs if they couldn’t limit patients’ choice of medical providers through HMOs. These deductibles, which can reach thousands of dollars a year, are driving tens of millions of Americans into debt.

To many on the left who have long argued for a single-payer, government-run health system, the obstacle to more meaningful relief has been the political power of the same industries — health insurers, drug companies, hospitals — that fuel patient anger.

These industries have indeed proven adept at resisting change that threatened their bottom lines. They’ve also benefited from a paradox in how Americans think about their health care.

Patients may get angry. They may even lose faith in the system. This year, public views of health care quality fell to the lowest point since Gallup began asking about it in 2001, with 44% of Americans rating quality as excellent or good, down from a high of 62%.

Yet more than 70% said their own health care is excellent or good.

There is much debate about what accounts for this paradox. Are Americans just grateful to have the health protections they do? Are they satisfied because most don’t have to use the health care system on a regular basis? Do they simply like their doctor, in the way that voters routinely say they like their own member of Congress but hate Washington politicians? Or do they worry that no matter how frustrating the current system can be, any change risks making the situation worse?

The answer is probably a bit of all of this. Together, such sentiments represent a major challenge for those who hope the current wave of anger at health insurers will drive big improvements.

Could that change? Maybe. These are volatile and unpredictable political times. And the pressure of big medical bills is real. Medical debt, in particular, is exacting a fearsome toll on millions of Americans, KFF Health News’ reporting has shown.

But to drive change, advocates looking to harness public anger at the health care industry probably need to rethink their favored solutions. Old ideas like “Medicare for All,” long cherished on the left, or a deregulated health care market, long championed by the right, haven’t swayed Americans so far, no matter how angry they’ve been.

I don’t know when we’ll see meaningful alternatives. One thing that’s almost certainly on the way: Hollywood’s spin on the death of a health insurance executive gunned down in Midtown Manhattan.

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This article first appeared on KFF Health News and is republished here under a Creative Commons license.