By Jon Cohen and Dan Balz
Washington Post Staff Writer
Sunday, March 28, 2010

Americans overwhelmingly see the new health-care law as a major shift in the direction of the country, but they remain as deeply divided today over the changes as they were throughout the long congressional debate, according to a Washington Post poll.

In the days since President Obama signed the farthest-reaching piece of social welfare legislation in four decades, overall public opinion has changed little, with continuing broad public skepticism about the effects of the new law and more than a quarter of Americans seeing neither side as making a good-faith effort to cooperate on the issue.

Overall, 46 percent of those polled said they support the changes in the new law; 50 percent oppose them. That is virtually identical to the pre-vote split on the proposals and similar to the divide that has existed since last summer, when the country became sharply polarized over the president’s most ambitious domestic initiative.

The health-care debate galvanized the country to a remarkable extent. About a quarter of all adults say they tried to contact their elected representatives in Congress about health care in recent months, including nearly half of those who say they are “angry” about the changes. In general, opponents of the measure were more than twice as likely as supporters to say they had made the effort.

But there are signs that Democrats have started to rally, with the party’s base firming up after intense internal battles over a public insurance option and provisions covering abortion funding. Fifty-six percent of Democrats now “strongly support” the recently enacted health-care changes; last month, 41 percent were solidly behind the proposals. Eight in 10 Democrats now approve of the way Obama is handling health care, the most since last summer.

Obama’s overall approval rating is at 53 percent in the poll, about the same as it has been in Post-ABC polls in the past several months; 43 percent disapprove.

Obama has renewed his effort to sell the legislation to the public ahead of the November midterm elections, with more rallies planned this week. His success could be crucial to Democratic fortunes in this fall’s midterm elections, with about six in 10 saying the congressional votes on health care will be a factor in their choice at the ballot box.

At this point, Democrats hold a razor-slim edge (47 to 43 percent) on the “generic ballot,” the question about which party’s candidate people support in their local districts. Independents, who swung solidly for Democratic candidates in 2006 and 2008, now divide 42 percent for the GOP candidate and 39 percent for the Democrat.

Democratic officials have long argued that once the debate ended and health-care legislation was enacted, the public would begin to see the changes in a far-more-favorable light. The new poll suggests that the president and his party still face significant obstacles in this new phase of the debate.

Passions remain strongest among the plan’s detractors, as 26 percent of all adults said they are angry about the changes enacted by Congress, up from 18 percent in August. That includes 54 percent of all Republicans. Fewer Americans, 15 percent, said they are enthusiastic about the new measure, including 40 percent of liberal Democrats.

Among opponents, there is near-universal support (86 percent) for efforts to cancel the changes either through a new vote in Congress or through the courts. Since passage, Republican leaders have called for repeal of the new law and replacement with more modest changes.

Many key provisions of the new law have been highly popular in recent polling, particularly insurance changes such as extending coverage to young adults and eliminating exclusions based on preexisting conditions. But the intensity of the overall opposition adds to the Democrats’ challenge in pitching those benefits to voters, with just over seven months until the midterm elections.

More people see the changes as making things worse, rather than better, for the country’s health-care system, for the quality of their care and, among the insured, for their coverage. Majorities in the new poll also see the changes as resulting in higher costs for themselves and for the country.

Most respondents said reform will require everyone to make changes, whether they want to or not; only about a third said they believe the Democrats’ contention that people who have coverage will be able to keep it without alterations. And nearly two-thirds see the changes as increasing the federal budget deficit, with few thinking the deficit will shrink as a result. The Congressional Budget Office said the measure will reduce the deficit.

About half of all poll respondents said the plan creates “too much government involvement” in the health-care system, a concern that is especially pronounced among Republicans.

Senior citizens, who typically make up about one in five midterm voters, represent a particularly valuable but tough audience on this issue. More than six in 10 of those 65 or older see a weaker Medicare system as a result of the changes to the health-care system. Overall, seniors tilt heavily against the changes, with 58 percent opposed and strong opponents outnumbering strong supporters by a 2-to-1 ratio.

At the same time, seniors who say they understand the upcoming changes are much more apt to back the new law than those who say the plan is too complicated.

Support for the changes is significantly higher among Democrats and independents who say they understand the legislation than it is among those who do not. Republicans are solidly opposed, regardless of whether they think they understand the changes.

The overall political landscape continues to look favorable for Republicans to make gains in November, with six in 10 Americans seeing the country as pretty seriously off on the wrong track and that broad dissatisfaction likely to fall hardest on incumbents.

At this point, more poll respondents said they are likely to oppose a lawmaker who backed the president’s health-care initiative than said they would support such a candidate (32 percent to 26 percent), with more passion again on the negative side. Forty percent said the health-care vote will make no difference in their decision this fall.

The Democrats hold a 13-point advantage over the GOP when it comes to dealing with health care in general. That’s a significant, but far slimmer, lead than they carried into the 2006 elections, which returned them to the majority. Similarly, Democratic advantages on the economy, taxes, immigration and the deficit are all severely attenuated.

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