Poll finds deep divisions on health-care reform

President Obama and the Democrats are still struggling to win the battle for public opinion.
President Obama and the Democrats are still struggling to win the battle for public opinion. (Jim Young - Reuters)
By Dan Balz and Jon Cohen
Washington Post Staff Writers
Tuesday, November 17, 2009

As the Senate prepares to take up legislation aimed at overhauling the nation's health-care system, President Obama and the Democrats are still struggling to win the battle for public opinion. A new Washington Post-ABC News poll shows Americans deeply divided over the proposals under consideration and majorities predicting higher costs ahead.

But Republican opponents have done little better in rallying the public opposition to kill the reform effort. Americans continue to support key elements of the legislation, including a mandate that employers provide health insurance to their workers and access to a government-sponsored insurance plan for those people without insurance.

Over the past few months, public opinion has solidified, leaving Obama and the Democrats with the political challenge of enacting one of the most ambitious pieces of domestic legislation in decades in the face of a nation split over the wisdom of doing so. In the new poll, 48 percent say they support the proposed changes; 49 percent are opposed.

With the bill through the House, Senate Democrats are now looking for the votes to enact their version of the legislation and keep the reform effort moving forward. Whatever the outcome of the health-care debate, it will have a powerful influence in shaping the political climate for next year's midterm elections.

The House bill contains a highly controversial provision prohibiting abortion coverage for those insured under a new public insurance plan as well as those who received federal subsidies to purchase private insurance. In the poll, 61 percent say they support barring coverage for abortions for those receiving public subsidies, but if private funds were used to pay for abortion expenses, the numbers flipped. With segregated private money used to cover abortion procedures, 56 percent say insurance offered to those using government assistance should be able to include such coverage.

The new poll provides ammunition for both advocates and opponents of reform. For opponents, a clear area of public concern centers on cost -- 52 percent say an altered system would probably make their own care more expensive, and 56 percent see the overall cost of health care in the country going up as a result.

Few see clear benefits in exchange for higher expenses. Rather, there has been a small but significant increase in the number (now 37 percent) who anticipate their care deteriorating under a revamped system, putting that number in line with opinion in July 1994, just before President Bill Clinton's health-care reform efforts fizzled.

Among those with insurance, three times as many continue to see worse rather than better coverage options ahead (39 to 13 percent), and fewer than half of those who lack insurance see better options under a changed system. Six in 10 see it as "very" or "somewhat" likely that many private insurers would be forced out of business by a government-sponsored insurance plan, a potential result that GOP leaders frequently warn about.

But reform proponents have other findings to bolster their case. Two-thirds of those surveyed support one of the basic tenets of the reform plan, a new requirement that all employers with payrolls of $500,000 or more provide health insurance coverage for their employees or face fines.

As in previous polls, a majority supports a government-sponsored heath insurance plan to compete with private insurers, although the percentage supporting the general idea has slipped slightly over the past month to 53 percent. Support for the scheme jumps to 72 percent when the public plan is limited to those who lack access to coverage through an employer or the Medicare or Medicaid systems.

While Americans overall are divided on reform legislation, the Democrats have made some progress among at least one key group. Support among senior citizens, while still broadly negative, is up 13 points since September to 44 percent.

Seniors have also tilted back toward Obama when matched head to head with congressional Republicans on dealing with health-care reform, helping the president to a 13-point advantage over the GOP on this issue.

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