POLL: Obama Holds Steady on Health Reform

Oct. 19, 2009— -- President Obama's holding the line at an even division in public views on health care reform, boosted by support for two key elements – a personal mandate and a public option – and aided by continued weakness in the opposition party.

Americans divide about evenly on the reform plan and Obama's handling of health care alike – neither better nor worse for him since summer. But 57 percent support one of the plan's most contentious elements, a government-sponsored insurance option, and that soars to 76 percent if it's limited to those who can't get affordable private insurance.

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Indeed, Americans by 51-37 percent in this latest ABC News/Washington Post poll say they'd rather see a plan pass Congress without Republican support, if it includes a public option based on affordability, than with Republican backing but no such element.

That cuts to the GOP's basic challenges finding political footing: Only 20 percent of Americans now identify themselves as Republicans, the fewest in 26 years. Just 19 percent, similarly, trust the Republicans in Congress to make the right decisions for the country's future; even among Republicans themselves just four in 10 are confident in their own party. For comparison, 49 percent overall express this confidence in Obama, steady since August albeit well below its peak.

The Republican Party's difficulties are shown in another result as well; in an early assessment of preference for congressional candidates in 2010, the Democrats lead by 51-39 percent.

NINE MONTHS – Nine months into his presidency Obama faces his own threats, including the economy, concerns about the war in Afghanistan, continued doubts about the deficit and a sense his pace of accomplishment has slowed. Fewer than half, 49 percent, now say he's accomplished a great deal or good amount since taking office, down from 63 percent at the 100-day mark.

Obama's Job Approval Rating

Obama's rating is better in sum than on most individual issues, suggesting a continued boost from his personal appeal. Notably, his approval rating from independents, at 55 percent, is its best since July, while among Democrats he's slipped to a career-low – but still very high – 83 percent. (He's also at a new low, albeit 82 percent, among liberals.) With partisanship at full tilt, just 19 percent of Republicans approve.

While Obama's rated below the postwar average for a president at nine months, 63 percent, that covers a wide range; George W. Bush hit a record 92 percent approval in a post-9/11 rally, vs. Bill Clinton's 51 percent in October 1993. Ronald Reagan, the last president to take office in a recession, was at 59 percent at this point, very similar to Obama now. Reagan continued to lose ground as the economy foundered, perhaps the single greatest cautionary note for Obama today.

ISSUES – On individual issues, some of Obama's best ratings are unexpected: Fifty-seven percent approve of his work as commander in chief and on international affairs generally, two areas in which his credentials were questioned during the presidential campaign. Fifty-four percent approve of how he's handled winning the Nobel Peace Prize, making a mild net positive of that unexpected gift.

The president's ratings on domestic issues underscore their particularly contentious nature. Fifty percent approve of his handling of the economy, slipping beneath a majority for the first time (barely – it was 51 percent in the last ABC/Post poll). As has been the case since July, intensity is against him on the economy, with more strongly disapproving than strongly approving.

Just 45 percent approve of his handling of the deficit, but that's a bit of a respite, up a bit from 39 percent last month and the most since June. On health care, as noted, he gets an even split: 48 percent approve, 48 percent disapprove, again with more strongly disapproving, 38 percent, than strongly approving, 30 percent.

Health Care Reform

Whatever Obama's challenges, it's a far less bleak political picture than a year ago. Peering into the economic abyss, 90 percent in October 2008 said the country was seriously off on the wrong track, the most in 36 years of polling; it's 54 percent today – no smiley face, but still 36 points less grim. And then-President Bush, a year ago, had a career-low 23 percent job approval rating – a point away from the 70-year low set by Harry Truman in 1952. Obama's is 34 points better.

HEALTH REFORM – Perhaps a surprising result on health care is the fact that there's slightly more discontent among supporters of reform than among its opponents: While the differences aren't vast, more people say it doesn't go far enough either in expanding coverage or controlling costs as say it goes too far.

In any case enough take one of those two options ("too far" or "not far enough") to leave relatively few who say reform strikes about the right balance – one third on expanding coverage, 29 percent on controlling costs. That marks the sharp divisions the debate has produced.

Similarly, just 34 percent now say the plan creates the "right amount" of government involvement in the health care system. The biggest change has been a nine-point rise in the past month in the number who say it provides "not enough" change; still, now at 21 percent, this group remains far outnumbered by the 42 percent who see too much of a government role.

Overall, 45 percent support the proposed health care changes being developed by Obama and Congress, while 48 percent are opposed; that's been essentially steady in three ABC/Post polls since mid-August. Obama's own approval rating for handling health care has been more or less steady since July, after falling from 57 percent at his peak popularity in April.

As noted, 57 percent support a public option, up slightly from a low of 52 percent in August. Support ranges from 77 percent of Democrats and 57 percent of independents down to 26 percent of Republicans, and it's 76 percent among those who currently have no insurance vs. 53 percent among those who do.

Several proposals would limit public plans to people who don't have a choice of affordable private insurance; that sharply boosts support for the idea, notably by 30 points among Republicans, by 32 points who see reform creating too much government involvement in health care and by 33 points among those who worry about its impact on the deficit.

Similarly, 56 percent favor the concept of an individual mandate, a law requiring all Americans to have health insurance – and this likewise jumps, to 71 percent, if it includes financial assistance in obtaining insurance for families below a certain income line.

Among compunctions about reform, a prominent one is the so-called Cadillac tax on high-cost policies; given pro and con statements, 61 percent are opposed. Additionally, 43 percent continue to think reform will weaken Medicare – peaking at 51 percent of seniors, the group least supportive of reform efforts.

The deficit's another concern – but, this poll suggests, one with less teeth than might be supposed. Sixty-eight percent of Americans think reform would increase the federal budget deficit. But among those who say so, 46 percent say it'd be worth it.

METHODOLOGY – This ABC News/Washington Post poll was conducted by telephone Oct. 15-18, 2009, among a random national sample of 1,004 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.