Sept. 14, 2009 -- Bottom-line views on health care reform have stabilized but failed to improve since President Obama addressed the nation, leaving him with a continued challenge in selling his plan to a public that remains skeptical about its benefits and costs alike.
Obama shows some improvement. He's stanched his losses, shored up his base and gained on a few specifics. But his speech was no game-changer: Americans in this ABC News/Washington Post poll divide by 48-48 percent on his handling of the issue and by 46-48 percent on the reform package itself, both essentially the same as their pre-address levels.
More continue to think reform will worsen rather than improve their own care, costs and coverage. There's still a nearly even split on whether it'll improve care for most people in general. More think it'll weaken rather than strengthen Medicare. And nearly two-thirds think it'll boost the already vast federal deficit.
Perhaps worst for the president, in interviews following his nationally televised address to a joint session of Congress, Americans by 54-41 percent say that the more they hear about health care reform, the less they like it. And while he still leads the Republicans in Congress in trust to handle reform, he's lost 7 points in this measure, and they've gained 9, since June.
Still, Obama has possibilities. He's cut into suspicions that reform will force change on people who don't want it – albeit just to an even split. And if the much-debated "public option" is dropped, support for reform inches ahead, albeit to a still-tepid 50 percent, while opposition slips to 42 percent.
In making their case, both parties face a fundamental challenge: Democratic allegiance has slipped to a two-year low in this poll and Republican affiliation is back near its lowest ever; instead 43 percent of Americans now identify themselves as independents, the most since ABC/Post polls began 28 years ago.
HEALTH CARE: SPLIT – The results do not show wholesale opposition to health care reform; rather, on the most basic measures, essentially an even division. Given the level of concerns, that underscores the extent of dissatisfaction with the current system, the vein Obama has sought to mine. Indeed more still say reform is necessary (53 percent, though down from 58 percent in June) than say it'll do "more harm than good" (44 percent).
On the plus side for Obama, this is the first ABC/Post poll since April in which his support for handling of health care did not lose ground. There's been a slight gain in his "strong" support. In addition to the president's continued if diminished lead over the Republicans in trust to handle the issue, he has a large advantage in being seen as trying to cooperate on it.
Obama and Support for Health Care
Bill Clinton took an immediate but short-lived 13-point bounce in support out of his health care address Sept. 22, 1993. Obama shows no such gain. The questions now are whether the current division holds – and if so whether it's enough for the arm-twisting in Congress that lies ahead.
OTHER RATINGS – Most broadly, the president now has a 54 percent overall job approval rating, with 43 percent disapproving, continuing the erosion in his support since April as the inaugural honeymoon's faded and he's taken ownership of the country's problems.
His overall approval has slipped to 49 percent among independents, not significantly different from last month but his first mark under 50 percent in this quintessential swing group. It's 87 percent among Democrats vs. 15 percent among Republicans, a vast partisan gap.
Nearly as many Americans now "strongly" disapprove of the president, 31 percent, as strongly approve, 35 percent. From his best in February, his strong approval is down by 8 points; his strong disapproval, up by 14. It's risen sharply among moderates and independents (by 15 and 16 points, respectively) as well among conservatives and Republicans (by 23 and 29 points).
With 9.7 percent unemployment, the economy is critical. Obama gets a tepid 51 percent approval rating for handling it. In an especially weak rating, just 39 percent approve of his handling of the deficit, a new low, while 55 percent disapprove. And most notably, his advantage in trust to handle the economy has contracted from 61-24 percent in April, the record for a president over the opposition party in polls since 1991, to a much narrower 48-37 percent now.
The number of Americans who say Obama's doing a better job than they expected has subsided from 54 percent in April to 42 percent now; those who say he's doing worse, meanwhile, has grown from 18 percent then to 31 percent now.
Nonetheless, while 39 percent call Obama "too liberal," up 10 points from the pre-inauguration level, that's no higher than it was just before the election, and about the same as the number who, at the peaks, saw John McCain, and George W. Bush before him, as "too conservative."
And Obama has a potentially important ace in the hole: his personal popularity. Sixty-three percent of Americans have a favorable opinion of him overall, 40 percent "very" favorable. That's well down from its peak, 79 percent in January, but still quite positive. His favorable rating among Republicans, though, has dived from 54 percent then to 24 percent now.
Democrats, Republicans and Health Care
Instead, as noted, the number identifying themselves as Democrats has slipped to 32 percent, compared with averages of 35 percent this year and 36 percent in 2008. The previous high for independents, now 43 percent, was 41 percent in July and in an early 1996 poll. The number of independents wasn't so high last month (34 percent), leaving the durability of these readings unclear. But it certainly doesn't make the task of partisan persuasion easier for either side.
The Democrats still do retain the upper hand; Americans trust them over the Republicans to handle the nation's main problems by a substantial 48 percent to 28 percent – although less broad than the 56-23 percent Democratic advantage in December, a 27-year record.
Testing Obama vs. the Republicans in Congress, the president leads in trust to handle health care reform by 48-36 percent. That's down, though, from 55-27 percent in June and, like many other basic health care measures, puts him under 50 percent. Obama also leads in trust to handle the deficit, and, as noted, the economy, but again by smaller margins than previously.
Also, specific to health care, the president and his party far outpoint the Republicans in being seen as making a "good-faith effort" to cooperate – 50 percent say Obama and the Democrats in Congress are trying to cooperate on reform, vs. 31 percent who say the same of the Republicans. And many more chiefly blame the Republicans for the negative tone of the debate, 31 percent, than the Democrats, 17 percent. But a plurality, 49 percent, blames both sides equally.
There's a challenge for Obama and the Democrats embedded in these views: Even as the Republicans are seen as less cooperative, 71 percent say the president and his party should try to change their reform proposals to win Republican support, rather than pushing ahead without it.
PUBLIC OPTION – On specifics in the health care plan, 55 percent support a so-called public option, with 42 percent opposed – slightly less opposition than in last month's 52-46 percent division, but still shy of the initial reaction in June, 62-33 percent support.
That June poll found that support for a public option drops dramatically if it would put many private insurers out of business, as critics claim. This poll shows a flip side: Support for a public option swells to 76 percent if it were available only to people who can't get coverage from a private insurer. The increase is most dramatic among Republicans, a 32-point gain to 59 percent support; and seniors, a 33-point gain to 68 percent. Something like this was suggested by Obama, who said in his address the option would be available only to people who "don't have" insurance; herein may be a path to compromise.
Medical Malpractice and Medicare
OTHER ELEMENTS – Another element of reform, limiting medical malpractice awards, is popular, with 63 percent support, up from 57 percent in June. On the other hand it's back to a split on taxing insurance companies when they sell high-end, so-called Cadillac insurance policies – 45 percent in favor, 48 percent opposed. And if the insurance companies passed on the tax by raising the prices of those policies, opposition soars to 71 percent.
Some of the compunctions are considerable. Sixty-five percent think reform would increase the deficit. Forty percent think it'd weaken Medicare, about twice the 22 percent who think it'd strengthen that popular program. Among seniors, 56 percent think reform would weaken Medicare, explaining why opposition to reform peaks in their ranks.
Perhaps most basic are these: Americans divide, 35-38 percent, on whether reform would make the quality of care for most people better or worse (the rest expect no change). More think it would make their own care worse rather than better, by 32-16 percent; their own costs worse, by 40-20 percent; their own coverage worse, by 37-11 percent. Even among the uninsured, just 51 percent think reform would improve their own coverage. And none of these advanced after the president's address.
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.