Less than half of respondents in a new Gallup survey have favorable opinions of the U.S. health care system, with a majority saying it is only fair or poor.

It is the first time since 2001, when the survey giant started recording feedback on health care in the U.S., that less than half of respondents (48 percent) said the system was excellent or good. It continues a worrying trend of declining faith in health care in the country, pollsters noted.

Views on health care in the U.S. have degraded since their peak in 2012, when 62 percent of respondents had praise for the system. Since then, these positive views have hovered around 55 percent, dipping to 50 percent last year and falling below the threshold of half of respondents this year.

The new survey found that one of the key reasons that attitudes toward health care have been on a downward trend is that the faith of Republicans in the system has deteriorated since former President Trump left office. In 2019, 75 percent of Republicans held a positive view of health care — now only 56 percent share the viewpoint. Democrats have always had a generally lower level of satisfaction, sitting currently at 44 percent.

The price of obtaining health care in the U.S. is another sticking point for respondents, with just 24 percent saying that they were satisfied with the total cost of health care in the country. And 56 percent of them said that they were satisfied with the price that they personally pay for health care, which is the lowest mark since 2016.

Gallup’s survey of 1,020 adults was conducted in November and December and has a margin of error of 4 percentage points.