POLL: Obama Approval Shows Durability

It's similar on health care, an issue on which Obama has just 47 percent approval overall and, as noted, several specifics produce significant levels of public concern. For all those, Obama leads the Republicans in Congress in trust to handle health care by 13 points, 50 percent to 37 percent.

HEALTH – The "public option" component of reform is an example of how details matter. Overall 53 percent in this poll favor a government-backed alternative to private insurance in general, a modest majority down a bit from 57 percent last month. But support rises sharply, to 72 percent, if the option is limited to people who do not receive insurance from an employer or through the existing Medicare or Medicaid programs, as called for in the House-passed version.

Another popular element of the plan is the employer mandate – that is, requiring all companies with a payroll of at least $500,000 either to offer health insurance to their employees or pay money into a government fund that would provide assistance buying insurance to people who can't get it from work. Sixty-six percent of Americans like the idea.

These are among the elements that counter some significant concerns about reform. Six in 10 think it's at least somewhat likely that a government plan would force many private insurers out of business because they couldn't compete, although fewer, 30 percent, think this is "very" likely. It matters: Support for reform overall is 34 points lower among those who think a public option would damage private carriers.

Concerns about impacts on cost, in particular, are substantial. As noted 54 percent of Americans who currently have insurance think changes in the system will raise their costs, and among all adults 56 percent think reform will boost the costs of the health system overall. Both are strong predictors of opposition to the current reform plans. (Cost concerns peak among seniors.)

Abortion Coverage and Health Care Reform

Moreover, 37 percent think changes in the system will make their own care worse – a new high, up 5 points from September – while many fewer, 19 percent, think their care will improve. And there's an even broader division on the impact on health insurance coverage – 13 percent think it'll improve, 39 percent worsen.

These, however, leave substantial numbers, 42 and 46 percent, respectively, who think their quality of care and extent of coverage will be unchanged, and in those groups support for reform is substantial, 63 and 67 percent. There's also a fairly even split on whether support for reform will make care for "most people" better or worse (34 percent vs. 38 percent), another factor that mitigates some of reform's negatives.

Views on abortion coverage also underscore how details matter. Sixty-one percent say insurance policies bought using government assistance should not be allowed to include coverage for abortions. But if the insurance companies use private funds, not public money, in providing abortion coverage – the workaround some Democrats have proposed – support for allowing that coverage gains very sharply, up 21 points to 56 percent.

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