Public option gains support

By:  Dan Balz and Jon Cohen
Washington Post

Americans still divided on overall packages

A new Washington Post-ABC News poll shows that support for a government-run health-care plan to compete with private insurers has rebounded from its summertime lows and wins clear majority support from the public.

Americans remain sharply divided about the overall packages moving closer to votes in Congress and President Obama's leadership on the issue, reflecting the partisan battle that has raged for months over the administration's top legislative priority. But sizable majorities back two key and controversial provisions: both the so-called public option and a new mandate that would require all Americans to carry health insurance.

Independents and senior citizens, two groups crucial to the debate, have warmed to the idea of a public option, and are particularly supportive if it would be administered by the states and limited to those without access to affordable private coverage.

But in a sign of the fragile coalition politics that influence the negotiations in Congress, Obama's approval ratings on health-care reform are slipping among his fellow Democrats even as they are solidifying among independents and seniors. Among Democrats, strong approval of his handling of the issue has dropped 15 percentage points since mid-September.

These numbers underscore the challenges ahead for the president and Democratic leaders in Congress as they attempt to maintain support among liberals and moderates in their own party while continuing to win over at least a few Republican lawmakers.

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 that existed in August, at the height of angry town hall meetings over health-care reform. 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 legislation.

There are also deep splits in the new poll over whether the proposed changes would go too far or not far enough in expanding coverage and controlling costs. Twice as many see the plan as leaning toward too much 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 perhaps the most pronounced flash point in the national debate, 57 percent of all Americans now favor a public insurance option, while 40 percent oppose it. Support has risen since mid-August, when a bare majority, 52 percent, said they favored it. (In a June Post-ABC poll, support was 62 percent.)

If a public plan were run by the states and available only to those who lack affordable private options, support for it jumps to 76 percent. Under those circumstances, even a majority of Republicans, 56 percent, would be in favor of it, about double their level of support without such a limitation.

Fifty-six percent of those polled back a provision mandating that all Americans buy insurance, either through their employers or on their own or through Medicare or Medicaid. That number rises to 71 percent if the government were to provide subsidies for many lower-income Americans to help them buy coverage. With those qualifiers, a majority of Republicans say they support the mandate.

The public option

Faced with a basic choice that soon may confront the administration and Democratic congressional leaders, a slim majority of Americans, 51 percent, would prefer a 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 that did not feature a public option. Republicans and Democrats are on opposite sides of this question, while independents prefer a bill that includes a public option but does not have Republican support, by 52 percent to 35 percent.

But if there is clear majority support for the public option and the mandate, there is broad opposition to one of the major mechanisms proposed to pay for the bill. The Senate Finance Committee suggested taxing the most costly private insurance plans to help offset the costs of extending coverage to millions more people. Sixty-one percent oppose the idea, while 35 percent favor it.

Nearly seven in 10 say they think that any health-care measure would increase the federal budget deficit, a possible concern for Obama. But nearly half of those who see the legislation as growing the deficit also say the increase would be "worth it."

Concerns about the implications for Medicare continue to cloud the debate. More than twice as many Americans (43 percent to 18 percent) say they think the legislation would weaken Medicare. Despite the dip in opposition to a health-care overhaul among seniors, most, 51 percent, still think reform would hurt 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, are fresh signs of restiveness 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, while 48 percent disapprove.

The president receives better marks from all Americans for his handling of international affairs and his performance as commander in chief (57 percent approval on each). Slim majorities also approve of how he is dealing the situation with Iran and his winning of the Nobel Peace Prize. A majority disapprove of his work on the federal budget deficit.

Partisan divide

Despite those mixed reviews on domestic priorities, Obama continues to hold a big political advantage over Republicans.

Poll respondents are 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 call themselves Democrats.

The wide gap in partisan leanings and the lack of confidence in the GOP carries into early assessments of the November 2010 midterm elections: Fifty-one percent say they would back the Democratic candidate in their congressional district if the elections were held now, while 39 percent would vote for the Republican. Independents split 45 percent for the Democrat, 41 percent for the Republican.

The poll was conducted by conventional and cellular telephone from Oct. 15 to 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.