By Jon Cohen and Dan Balz
Washington Post Staff Writers
Monday, September 14, 2009, Washington Post

President Obama continues to face significant public resistance to his drive to initiate far-reaching changes to the country's health-care system, with widespread skepticism about central tenets of his plan, according to a new Washington Post-ABC News poll.

But after a summer of angry debate and protests, opposition to the effort has eased somewhat, and there appears to be potential for further softening among critics if Congress abandons the idea of a government-sponsored health insurance option, a proposal that has become a flash point in the debate. The gap in passion, which had shown greater intensity among opponents of the plan, has also begun to close, with supporters increasingly energized and more now seeing reform as possible without people being forced to give up their current coverage.

Obama continued his stepped-up effort to sell his health-care plan, appearing Sunday on CBS's "60 Minutes." He said that he wants a package that would deliver effective change and noted that he will bear the consequences of any public backlash against the result. "I'm the one who's going to be held responsible," he said. "I have every incentive to get this right."

Earlier, Sen. Olympia J. Snow (R-Maine), who has been seeking a bipartisan compromise, urged the president to abandon the so-called public option. "It's universally opposed by all Republicans in the Senate," she said on CBS's "Face the Nation." "And therefore, there's no way to pass a plan that includes the public option."

White House senior adviser David Axelrod, appearing on the same program, said he was "not willing to accept" the idea that a government option would not be in the final bill, but also reiterated the administration's position that the provision should not stand in the way of passing a reform measure.

The poll began on the evening after Obama delivered a speech to a joint session of Congress and concluded on the day tens of thousands of people demonstrated in Washington against the president and his plan. Obama's prime-time address last Wednesday came at the end of a summer in which both he and the effort steadily lost ground in public opinion polls, and it marked his most high-profile attempt to reframe the debate and prod his supporters to pass legislation by the end of the year.

As Congress begins its second week back from August recess, the playing field is virtually level: Americans remain almost deadlocked in their opinion of the Democrats' health-care initiative, with 46 percent in favor of the proposed changes and 48 percent opposed. There is also a clean split on Obama's handling of the issue, with 48 percent approving and the same number disapproving. But since mid-August, the percentage "strongly" behind the president on health care has risen to 32 percent, evening out the intensity gap that has plagued him on the subject.

The public also divides about evenly -- 51 percent in favor, 47 percent against -- on the question of whether people should be required to have health insurance, a central element of the plans under consideration.

But it is the public option that has become the major point of contention, with support for the government creation of an insurance plan that would compete with private insurers stabilizing in the survey after dipping last month. Now, 55 percent say they like the idea, but the notion continues to attract intense objection: If that single provision were removed, opposition to the overall package drops by six percentage points, according to the poll.

Without the public option, 50 percent back the rest of the proposed changes; a still sizable 42 percent are opposed. Independents divide 45-45 on a package without the government-sponsored insurance option, while they are largely negative on the entire set of proposals (40 percent support and 52 percent oppose). Republican opposition also fades 20 points under this scenario.

The decision to back away from the provision might hurt Obama among his base, but not dramatically so, as 88 percent of liberal Democrats support the reform plan as is, 81 percent without the public option.

The politics of the idea would also probably change dramatically depending on its scope: If it were limited to only those unable to get private insurance, support would rise to 76 percent.

The poll also carries a clear warning for both major political parties: Forty-three percent of respondents consider themselves independents, the most ever in a Post-ABC poll, and about a third of them say they do not trust either side to deal with the nation's biggest problems in the years ahead.

More than seven in 10 Americans, including majorities across party lines, say they think Obama and congressional Democrats should adjust the health-care legislation to appeal to some Republican lawmakers. Half credit the Democrats with making a good-faith effort to do so already, while most, 62 percent, say the GOP is not returning the favor.

Nearly half of all Americans, 45 percent, say the reform plan would create too much government involvement in the system, a number on par with polls taken during President Bill Clinton's doomed efforts at big health-care changes in 1993 and 1994. Just over half of independents say the current plan would amount to overreach, significantly more than said so in the early 1990s. About two-thirds say they think the reform plan would increase the federal budget deficit.

GOP insistence on placing new limits on medical malpractice lawsuits finds significant public backing: Nearly two-thirds support caps on the amount of money that can be collected as a result of medical errors, with support increasing since June.

There is, however, less backing for the idea of a new tax on insurance companies that offer high-cost, big benefit health plans; 45 percent of Americans favor such a levy, and support plummets if it is suggested that companies would have to raise fees for those policies as a result.

Above it all, the change in opinion on the broad question of whether government reform is necessary to control costs and expand coverage has been halted. Fifty-three percent now call government action essential, while 44 percent see it as doing more harm than good.

In his address to Congress, Obama made a direct appeal to the vast majority of Americans who have health insurance to try to reassure them about how his plan would affect them. "Nothing in our plan requires you to change what you have," he said, to opponents' jeers.

There is some evidence in the poll that this line of argument is working. Half of the insured now see the possibility for legislation that would allow individuals to keep their coverage without changes, up from 37 percent in June. But more still think changes would hurt their insurance coverage, their costs and their overall care.

Adding to the reservations about major reform is that a sizable number, 40 percent, think it would weaken Medicare, a figure that peaks at 56 percent among seniors.

Overall, seniors remain solidly opposed to health-care reform, and the number who think government involvement would do more harm than good continues to rise even as it has fallen among younger adults.

The loss of support among seniors has been a critical component of the issue. In June, seniors trusted Obama more than they did the Republicans in Congress by a margin of 62 to 24 percent; now, 44 percent side with the GOP, 39 percent with Obama.

Majorities of seniors approved of Obama's job performance consistently from his first months in office through mid-July, but his rating among seniors has since dropped to 38 percent, with 57 percent disapproving. Over all age groups, 54 percent approve of his performance, while 43 percent disapprove, the lowest marks of his presidency.

Among all Americans, Obama has lost ground to congressional Republicans over the summer on handling not only health care, but also the economy and the budget deficit. He still maintains double-digit leads on each, but the advantages are no longer commanding.

At the same time, what was a 56 percent to 30 percent advantage for Democrats in terms of public trust on the major issues facing the nation has slipped to 48 percent to 28 percent. Nineteen percent now consider neither party better able to cope with big problems, the most to say so in Post-ABC News polls dating to 1982.

When it comes to blame for the tone of the debate, about half say both sides are equally at fault; among the rest, about twice as many place primary culpability with the GOP as they do with the Democrats.

The telephone survey was conducted Thursday through Saturday among a random national sample of 1,007 adults. The margin of sampling error is plus or minus three percentage points.

Polling analyst Jennifer Agiesta contributed to this report.