Senate Republicans attempted to pass a "skinny repeal" bill that would undo some portions of the Affordable Care Act on July 28, but the bill failed after three GOP senators voted against it. (The Washington Post)

The immediate cause of Republicans’ failure to repeal and replace the Affordable Care Act early Friday morning was the opposition of three Republican senators. But the persistent unpopularity of Republican repeal efforts has weighed heavily on GOP plans, suggesting that Americans’ skepticism has jelled over months of debate.

On average, 55 percent of Americans opposed the GOP proposals to replace Obamacare while 22 percent supported them, according to an average of health-care polls tracked by PollingReport, which we compiled starting in March.

Negative reactions to Republican repeal efforts have been strikingly consistent. Polls have asked about GOP proposals using a wide range of wordings, but every single poll tracked by the PollingReport found opposition outweighing support by more than 20 percentage points. Web-based polls not tracked by PollingReport found narrower margins, though support has consistently trailed opposition.

Beyond overall support, repeal proposals had only tepid majority support among Republicans, according to polls tracked by the Kaiser Family Foundation. Polls conducted this month find Republican support ranging from 49 to 60 percent. The same polls showed clear opposition from independents (18 to 30 percent) and overwhelming opposition among Democrats (5 to 9 percent).

The GOP efforts have not gotten more or less popular over time. Polls from March through May found opposition outpacing support by an average of 32 percentage points, overlapping the House’s passage of a repeal bill. The margin was negative 35 points in June, and negative 31 points in July as the Senate debated varying proposals.

Trump supporters represent an exception to that. In May, Kaiser found that 69 percent of Americans who approved of Trump’s job performance had a favorable view of Republican plans to repeal the ACA, but that fell to 54 percent in July. The drop was even more pronounced in Fox News’ polling tracking Trump voters, from 79 percent in May to 52 percent in July.

Was the “skinny repeal” more popular?

No polls tested Republicans’ “skinny repeal” legislation, which was drawn up Thursday and voted down early Friday morning, and past polling suggests it might have been more popular than previous plans. For one, it focused on repealing the individual mandate to purchase insurance — the part of the ACA that over 6 in 10 people disliked in a November Kaiser survey. It also skirted major federal cuts to future Medicaid spending included in previous bills that were widely unpopular.

At the same time, the Senate’s scaled-back repeal had several unpopular components, such as suspending the employer mandate, temporarily blocking funding for Planned Parenthood and allowing states flexibility in deciding which health benefits insurers should be required to cover. Congressional Budget Office forecasts found that the law would result in more people lacking insurance and lead to higher premiums for people purchasing insurance, which also may have sapped public support.

As Republicans hammered out new legislation, support for the Affordable Care Act grew. Some 50 percent rated it favorably in the last Kaiser Family Foundation poll earlier this month, up from 43 percent last December and a far cry from its low of 33 percent favorable in November 2013.

Americans still support changes to the Affordable Care Act

Whatever their skepticism for Republican repeal efforts, polls show many are not happy with the status quo. A Gallup poll from earlier this month found that 44 percent of Americans want to keep the Affordable Care Act but “make significant changes,” nearly twice as many who want to keep the law “as is” and higher than the 30 percent who wanted to repeal it.

And the public is lopsided in favoring a bipartisan approach to changes, a route pushed in a speech earlier this week by Sen. John McCain (Ariz.), one of the three Republicans who voted down the skinny-repeal bill. A 77 percent majority of Americans in a CNN poll this month said Republicans should work with Democrats to pass a health-care bill, while 12 percent preferred continuing attempts to pass a bill that has only Republican support. The strategy — which in practice would require compromises from Democrats as well — was also favored by 69 percent of Republicans.