In Health Care Debate, Public Attitudes Remain Unchanged

Six months of heated debate and messy legislative sausage-making have shifted almost no one's mind on health care reform: Bottom-line public attitudes today, tilting negative but not broadly so, are essentially the same as they've been since August.

Fifty-one percent of Americans oppose the proposed changes to the health care system being developed by the Obama administration and Congress. Forty-four percent are in favor, with the rest undecided. That's identical to what it was a month ago.

Click here for PDF with charts and questionnaire.

Indeed, despite the changing components of the plan, opposition has hovered in a narrow 3-point band in each of six ABC News/Washington Post polls since August, and support's been between 44 and 48 percent. At 51-44 percent, each today is a single point from its average, 50-45 percent.

Nonetheless, in the last two readings more Americans have opposed than supported the measure, something that couldn't be said, giving polling tolerances, in the earlier polls. And what clearly has lost ground is the intensity of sentiment among supporters. At its peak, in September and again in November, 30 percent of Americans "strongly" backed the proposed changes. With the plan still going through its many iterations, that's dropped to 22 percent, a new low. Substantially more, 39 percent, are strongly opposed, a number that's held steadier.

With the Senate returning to Washington today, the intensity of opposition is one factor that may weigh on lawmakers up for re-election next fall. Twice as many Americans say they'd be much more apt to oppose a candidate who backed the plan, 24 percent, as to support one, 12 percent. Independents – swing voters in many contests – split about the same, 26 percent vs. 10 percent.

CHANGES and CONCERNS – Changes in the hopper as House and Senate Democrats hammer out their differences may not help. While there's reportedly a compromise on taxing high-benefit health plans, Americans by 58-22 percent prefer higher income taxes on wealthier Americans instead. And a public option, widely reported as dead, gets slightly more support than the alternative, private plans with terms negotiated by the government – a 47-41 percent split.

The public divides evenly on a third point of contention, the level of restrictions on abortion coverage in health plans in which the government's involved.

Like the bottom-line support, concerns about the plans are steady as well. Fifty-six percent think the new system would end up costing more than the current health care system – the opposite of its intended effect. Fifty-three percent think their own health care costs would be higher. And just 38 percent think the quality of their care would improve. (Other elements of reform have been more attractive, such as covering the uninsured and prohibiting limitations on coverage for pre-existing conditions.)

STABLE – It appears that bottom-line views have been so stable since August because they're based heavily on factors such as partisanship, ideology and attitudes on the appropriate role of government – all basic beliefs that tend not to change quickly.

Support for the plan peaks at 74 percent of Democrats, 71 percent of liberals and 70 percent of people who favor a larger government that provides more services. Opposition stands at 85, 74 and 67 percent, respectively, among Republicans, conservatives and people who favor a smaller, less active government. Nothing in the debate has changed these fundamentals.

Nonetheless, attitudes on reform do reflect a missed opportunity for President Obama. When he raised it as a top priority in April – at his peak of popularity overall – 57 percent of Americans approved of his handling of health care. That quickly subsided as details were advanced and the debate was engaged – 53 percent approval in June, 49 percent in July, 46 percent in August.

Today, it's 44 percent, matching its low last month, with 52 percent disapproving – numbers almost precisely matching views on the plan itself. And again intensity is against him: Many more strongly disapprove than strongly approve of the president's work on health care reform. 43 percent vs. 24 percent.

METHODOLOGY – This ABC News/Washington Post poll was conducted by telephone Jan. 12-15, 2010, among a random national sample of 1,083 adults, including landline and cell phone-only respondents, with an oversample of African-Americans (weighted to their correct share of the population) for a total of 153 black respondents. Results for the full sample have a 3.5-point error margin. Click here for a detailed description of sampling error. Sampling, data collection and tabulation by TNS of Horsham, Pa.