As Democratic congressional leaders and White House officials work to shape health care bills that will go to the House and Senate floors, a new Washington Post-ABC News poll shows that support for a government-run health plan to compete with private insurers has rebounded from its summertime lows and now wins clear majority support from the public.
Americans remain sharply divided about both the overall health care package and President Obama's leadership on the issue, reflecting the intense partisan battle that has raged for months over the administration's top legislative priority. But majorities now back two key and controversial provisions: both the so-called public option and a new mandate requiring all Americans to carry health insurance.
Independents and senior citizens, two groups crucial to the debate, have warmed to the idea of a public insurance option, and are particularly supportive if it were administered by the states and limited to those without access to affordable private insurance, as stipulated in some versions of the legislation.
But in a sign of the fragile coalition politics that now influence the negotiations in Congress, Obama's approval ratings on health care are slipping among his fellow Democrats even as they are solidifying among independents and seniors. Among Democrats, strong approval of his handling of health care has dropped 15 percentage points since mid-September.
These numbers underscore the challenges ahead for the president and Democratic congressional leaders as they attempt to maintain support among liberals and moderates in their own party while continuing to seek approval from at least a few Republicans lawmakers.
Too far? Not far enough?
Overall, 45 percent of Americans favor the broad outlines of the proposals now moving in Congress, while 48 percent are opposed, about the same division as in August at the height of the angry town hall meetings over health care. Seven in 10 Democrats back the plan while almost nine in 10 Republicans oppose it. Independents divide 52 percent against, 42 percent in favor of the set of reforms.
There are also deep splits in the new poll over whether the proposed changes go too far or not far enough in expanding coverage and controlling costs. Twice as many see the plan as leading to too much, rather than too little, government involvement, but since last month there has been a nine-point increase in the number who say government should be more involved.
On the issue that has been a flash point in the national debate, 57 percent of all Americans now favor a public insurance option, while 40 percent are opposed. Support has risen since mid-August, when a bare majority, 52 percent, said they favored it. (In a June Post-ABC poll, support had been at 62 percent.)
If run by the states and available only to those who lack affordable private options, support for a public plan jumps to 76 percent. Under those circumstances, even a majority of Republicans, 56 percent, would be supportive, about double their level of support without such a limitation.
Fifty-six percent of all Americans favor a provision mandating all Americans to buy insurance, either through their employers or on their own or through eligibility for Medicare or Medicaid. That number rises to 71 percent should the government provide subsidies for many lower-income Americans to help them purchase insurance. With those qualifiers, a majority of Republicans say they backed the mandate.
Faced with a basic strategic choice that soon may confront the administration and Democratic congressional leaders, a slim majority of Americans, 51 percent, would prefer a reform plan that included some form of government insurance for people who cannot get affordable private coverage even if it had no GOP support in Congress. Thirty-seven percent would rather have a bipartisan plan without such a choice. Republicans and Democrats are on opposite sides of this question, with independents preferring legislation with a public option and without Republican support by 52 to 35 percent.
But if there is clear majority support for the public option and the mandate, there is even broader opposition to one of the major mechanisms proposed to pay for the bill. The Senate Finance Committee proposed a tax on the most costly private health insurance plans that would help offset the costs of extending coverage to millions more people. Sixty-one percent opposed the idea, while 35 percent favor it.
On another fiscal issue, nearly seven in 10 say they believe that any health care bill will enlarge the federal budget deficit, a possible point of concern for Obama. But in the context of the health care debate, nearly half of those who see the legislation as increasing the deficit also say that that would be "worth it."
Concerns over the implications for Medicare continue to cloud the debate. More than twice as many Americans (43 percent to 18 percent) say they believe new health care legislation will weaken rather than strengthen Medicare. Despite the dip in opposition to reform among seniors, most, 51 percent, still see reform as hurting the popular program.
Overall, 57 percent approve of the way Obama is handling his job as president and 40 percent disapprove. While those numbers have moved only marginally over the past few months, here too, there are fresh signs of issues among the party faithful: "strong approval" among liberal Democrats is down 16 percentage points over the past month.
On the economy, 50 percent approve of Obama's efforts, 48 percent disapprove.
Obama gets better marks from all Americans for his handling of international affairs and his performance as commander in chief (both 57 percent approve). Slim majorities also approve of how he is dealing the situation with Iran and his winning of the Nobel Peace Prize. The president continues to get majority disapproval for his work on the federal budget deficit.
Despite those mixed reviews on domestic priorities, Obama continues to hold a political advantage over Republicans, who have been unable to demonstrate widening public popularity.
The public is evenly divided when asked whether they have confidence in Obama to make the right decisions for the country's future, but just 19 percent express confidence in the Republicans in Congress to do so. Even among Republicans, only 40 percent express confidence in the GOP congressional leadership to make good choices.
Only 20 percent of adults identify themselves as Republicans, little changed in recent months, but still the lowest single number in Post-ABC polls since 1983. Political independents continue to make up the largest group, at 42 percent of respondents; 33 percent see themselves as Democrats.
The wide gap in partisan leanings and the lack of confidence in the GOP carries into early assessments of next year's midterm elections: 51 percent say they would back the Democratic candidate in their congressional district if the November 2010 election were held now, 39 percent would vote for the Republican. Independents split 45 percent for the Democrat, 41 percent toward the GOP.
The poll was conducted by conventional and cellular telephone from Oct. 15-19 among a random sample of 1,004 adults. The margin of sampling error for the full poll is plus or minus three percentage points.
Polling analyst Jennifer Agiesta contributed to this report.