According to a June 2017 poll, Americans agree by a 60-to-39 margin that the federal government bears a responsibility to ensure health care for all Americans; 33% said that they favored a “single-payer” health system, 12% more than in 2014.1 The prevailing belief that the government should actively promote broader health insurance coverage contrasts strikingly with the nearly successful effort this year to repeal the Affordable Care Act (ACA), executive orders that threaten to destabilize ACA marketplaces, and repeated calls by the majority party in Congress to slash Medicaid spending.