Deep divisions linger on health care
But poll finds support for key provisions of reform effort

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.

Republicans appear to be hampered by a widespread perception that they have not offered clear choices: 61 percent of those polled say the GOP is "mainly criticizing" without presenting alternatives to Democratic proposals.

Looking toward next year's midterm elections, 25 percent say they more apt to back a candidate who supports the proposed health-care changes; 29 percent are less likely to do so. More, 45 percent, say the vote will not make much of a difference. Independents are nearly twice as likely to be swayed away from rather than toward a candidate who supports the changes (31 percent to 17 percent).

Beyond health care, Obama continues to garner broadly positive ratings from the public. His overall approval rating stands at 56 percent, holding steady in Post-ABC polls since the late summer. More, 61 percent, say they have an overall favorable impression of him, and a slim majority continues to see him as "about right" ideologically (four in 10 consider him "too liberal."

The president, who is on a 10-day visit to Asia, gets his top mark on handling international affairs, and also picks up majority approval on dealing with the threat of terrorism. But Americans are more divided over his performance on other key issues, with nearly even splits in satisfaction with his work on health care, the economy and the situation in Afghanistan. On each of these three issues, intensity runs against the president, with significantly higher numbers expressing "strong" disapproval as strident approval. Obama receives generally negative reviews on his handling of the federal budget deficit, with 53 percent disapproving of his actions on that front.

Obama continues to be lifted by weakness in the opposition. In addition to his double-digit lead over congressional Republicans on health care, the president has a 15-point advantage on handling the nation's still-struggling economy. More broadly, Democrats continue to have the edge as the party more trusted to deal with the country's main problems over the next few years and when it comes to being more empathetic and more in tune with people's values.

But there are also evident signs of an anti-incumbent mood in the new survey, which would disproportionately hurt the majority Democrats next fall should they hold. Most see the country as headed pretty seriously off on the wrong track and half of all Americans say they are inclined to look around for someone new to support for Congress; just 38 percent are inclined to reelect their member of Congress. These numbers are similar to those from November 1993, one year before Republicans took back control of the House and Senate and close to those from May 2006, six months before Democrats re-captured the Congress.

Among independents, nearly two-thirds say they are inclined to seek new representatives. Independents also about evenly divided over which party better represents their personal values and give Democrats a narrow advantage on being more in tune with "needs of people like you." More than a quarter of independents do not trust either party to adequately deal with the country's primary concerns in the coming years.

The poll was conducted Nov. 12-15 by conventional and cellular telephone among a random national sample of 1,001 adults. The margin of sampling error is plus or minus three percentage points.

Polling analyst Jennifer Agiesta contributed to this report.

© 2009 The Washington Post Company