Public doubt about health care reform has grown as the debate's raged this summer, with a rise in views it would do more harm than good, increasing opposition to a public option – and President Obama's rating on the issue at a new low in ABC News/Washington Post polls.
Fewer than half of Americans, 45 percent, support reform as it's been explained to date, while 50 percent are opposed – with many more "strongly" opposed than strongly in favor, 40 percent vs. 27 percent. Support's at just 36 percent among independents, the crucial political center.
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Obama's approval rating for handling health care has fallen steadily from 57 percent in April to 46 percent today, led by a steep 17-point slide among independents. And expectations he can successfully accomplish reform have dropped further – from 68 percent shortly before he took office to 49 percent now.
Support for a public option, currently the most contentions element of reform, has fallen from 62 percent in June to 52 percent now; 46 percent are opposed, up 13 points. Like much of the debate, it's an intensely partisan issue, with support ranging from three-quarters of Democrats to half of independents and 24 percent of Republicans. The drop in support, though, has occurred equally among independents and Republicans alike.
In a similar trend, two months ago Americans by 58-39 percent said reform was "necessary to control costs and expand coverage" rather than believing it would "do more harm than good." Today that's narrowed to a close 51-46 percent split.
Health care reform overall, a political sand trap when last attempted in 1993, looks much the same in 2009. In a cautionary note for proponents of reform in marginal congressional districts, more people say they'd be inclined to vote against a candidate who supported reform than to vote for one. That may conjure memories of the Democratic rout of 1994.
LETDOWNS – It's not Obama's only letdown. While pessimism about the economy's future has eased, fewer than half give him credit for improving it. Americans disapprove of his handling of the deficit by a record 12-point margin, 53-41 percent. And after sharp gains following last fall's election, views of the country's direction have soured; 55 percent say it's seriously off on the wrong track.
One additional figure shows the extent to which the Obama star has faded: At his 100-day mark in April, 60 percent of Americans expressed confidence in him "to make the right decisions for the country's future." Today, just past 200 days into his presidency, it's 49 percent.
Obama Approval Anchored by Democrats
Yet, buoyed by vast loyalty in his own party, Obama retains a 57 percent job approval rating overall, creditable albeit slightly below the average for all first-term presidents at seven months since 1945, 63 percent. And while Republican opposition to health care reform has shown traction, the party itself has not: Just 21 percent express confidence in the Republicans in Congress to make the right decisions for the country, unchanged from April, lower than its level last winter and less than half Obama's standing on this same question. (Obama also far outpoints confidence in congressional Democrats, 35 percent.)
Tellingly, in a result that's been steady since spring, even among Republicans, fewer than half – 46 percent – have confidence in their own party to make "the right decisions" for the country. And just 25 percent of Americans identify themselves as Republicans, vs. 35 percent Democrats – roughly steady since 2007, as disapproval of George W. Bush pushed the country away from what had been political parity a few years earlier.
Obama gets 52 percent approval for handling the economy, unchanged from July and down from his peak, 60 percent, in February and late March. Nonetheless perhaps the best result for him is in economic expectations: Fewer than half, 48 percent, now think the recession will last more than another year, down very sharply from 70 percent last winter.
Obama's best hope is that a less gloomy economic outlook could leaven the public's mood more generally. One risk is that economic expectations can improve long before current conditions follow suit. Another is that when economic discontent eventually does ease, other contentious issues may simply supplant it. Such is politics.
One example is the war in Afghanistan; as reported separately, while Obama still retains 60 percent approval for handling it, dangers lurk. For the first time more than half call the war not worth fighting. Support for a reduction in U.S. troops has grown sharply. And barely more than four in 10 think the United States is winning.
HEALTH – Another risk, clearly, is health care. The decline in support for a public option and rise in suspicion that reform will do "more harm than good" are no surprise; ABC/Post polling earlier this summer showed the continued vulnerability of health care reform to pushback. That's because broad concerns about the system overall are tempered by individual satisfaction with current care, coverage and even costs – things people don't want to see worsened.
There are such concerns: Anywhere from 33 to 41 percent in this poll think reform will worsen their own quality of health care, insurance coverage and health care costs, while far fewer, 14 to 19 percent, think any of these would be improved.
Countering those views, 37 percent think health care for "most people" would be improved – essentially as many as say most people would receive worse care (38 percent), but no more. Among uninsured adults, moreover, 56 percent think reform would improve their ability to get coverage – but that leaves many, even in this group, in doubt about the benefits of reform.
Health Care Reform and Your Own Care
These views strongly inform positions on reform. It's supported by 84 percent of those who think it would improve their own care, and also by 84 percent of those who think it'd improve care for most people. But support falls to 57 percent of those who see no change in their own care and 50 percent who see no change for most people – and drops further, to 6 percent of those who think it'd worsen their care, and 5 percent of those who think it's worsen care for most people.
Sociologists – and polling data – long have demonstrated how concerns about impacts on society often trump personal self-interest in attitudes on political issues. Health care reform, though, is one issue on which self-interest does matter. Views on reform's personal impact, as well as on its impact on "most people," both independently predict attitudes on the proposal overall.
REFORM GROUPS – The 45-50 percent division in overall support vs. opposition to reform, reported above, is not statistically significant at the customary 95 percent confidence level. But it's 88 percent probable that more people oppose than support the reform package as this question asked it.
Differences among groups are telling. Beyond the partisan divisions reported above, support for reform is considerably higher among uninsured Americans (57 percent) than among the 85 percent who do have insurance (43 percent support reform). Reform's supported by 58 percent of adults under age 30, but 44 percent of 30- to 64-year-olds and just 34 percent of seniors, apparently concerned about its potential impact on Medicare. And support's 8 points higher among women (who are more apt to be Democrats) than it is among men.
Changes among groups in views on a public option also are informative. Opposition has increased by 17 points among Republicans, from 59 percent in June to 76 percent now; but it's also risen by 15 points among independents, from 32 percent then to 47 percent now. (It's essentially unchanged among Democrats). Opposition has increased by 16 points among conservatives, to 67 percent, but also by 11 points among liberals and by 9 points among moderates, albeit to much lower levels, 22 and 38 percent, respectively.
Proponents of a public option can argue that it still has more support than opposition, at 52 percent vs. 46 percent. Nonetheless that 6-point gap has narrowed substantially from a 29-point advantage in favor of a public option in June.
ANGER – Another result shows rough balance on an emotional scale; 15 percent of Americans are "enthusiastic" about reform, but 18 percent are "angry" about it. Some of that anger has boiled over at so-called town hall meetings held by Congress members in recent weeks; given what they've heard, 51 percent of Americans think such protests have been appropriate overall, while 45 percent call them inappropriate.
Views on reform make the difference: Health reform opponents overwhelmingly see the protests as appropriate (71 percent say so); supporters, as inappropriate (64 percent). Similarly, among people who are angry about reform, 85 percent call the town half protests appropriate; among those who are enthusiastic about reform, just 31 percent agree.
Health Care and the Congressional Election
VOTE IMPACT – Measurements of potential impacts on voting are somewhat speculative; few voters are propelled by a single issue, and congressional elections are far distant. Nonetheless, by 32 percent to 23 percent, more Americans say they'd be inclined to vote against rather than for a congressional supporter of health care reform.
Narrowing down to those who say it'd make a strong difference, the vote effect is negative by a 12-point margin: Twenty-six percent say they'd be much more apt to oppose such a candidate, compared with 14 percent much more apt to support one. It's not predictive, but it hardly makes reform a political slam-dunk.
The issue is a bigger negative motivator for Republicans than a positive one for Democrats: Four in 10 Democrats say they'd be more likely to support a candidate who favors reform, but 65 percent of Republicans say they'd be more likely to oppose such a candidate. Most crucial in election equations are independents, and by 2-1 they say they'd be more likely to oppose than to support such a candidate, 31 percent to 16 percent. Narrowing to independents who'd be "much" more likely to support or oppose a candidate on these grounds, supporting reform is a negative for 25 percent, vs. a positive factor for 10 percent.
OBAMA OVERALL – Obama's overall approval rating remains better than his approval specifically for handling the top issues of the day, the economy and health care. But its course tells a similar story: down 11 points from his initial mark of 68 percent in February, which exceeds the average seven-month decline, 5 points, for first term-presidents since 1945.
Obama remains far more popular among young adults than old – 71 percent approval among 18- to 29-year-olds vs. 47 percent among seniors, albeit down about equally in both groups since February. But the biggest gap is partisan: He's moved not at all among Democrats – 90 percent approval in February, 90 percent now. But he's gone from 37 percent approval among Republicans to 19 percent now; and, among independents, from 67 percent approval in February to 50 percent now.
That's a difficult trend for Obama, more so given his 36 percent approval among independents specifically on health care. In Congress he can make do with Democrats, who control both houses. But in public opinion, on health care and much else – and letting go of the chimera of post-partisanship – he needs independents as well.
METHODOLOGY – This ABC News/Washington Post poll was conducted by telephone Aug. 13-17, 2009, among a random national sample of 1,001 adults, including landline and cell-phone-only 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.