As Washington lawmakers face renewed pressure to remedy the country's trillion-dollar budget deficit, fractured public opinion on where to make critical cuts—in health care and other major entitlement programs—could complicate political strategies in the run up to the 2012 presidential election, according to researchers from the Kaiser Family Foundation and the Harvard School of Public Health.
Most Americans favor the idea of closing the federal deficit through spending cuts—but they are also loath to choke off funding for some of the nation's costliest entitlement programs -- including Medicare (56 percent oppose) and Social Security (64 percent oppose), according to a poll
released by the researchers Tuesday. Medicare and Social Security account for a third of all federal spending.
A finding that nearly half of Americans—47 percent—oppose cuts to Medicaid, the public health insurance program for low-income families, came as a surprise, said Drew Altman, president and CEO of the Kaiser Family Foundation. The Medicaid program has become a major point of contention for states opposed to its expansion under the federal health care law, and a number of states have cited Medicaid as a principle cause of their budget problems.
"While we have always believed that Social Security and Medicare [are popular], the standing of the Medicaid program with the public … is actually very high," Altman said.
To make matters more complicated, half of Americans now oppose the health care law, but most aren't as enthusiastic about repealing, replacing or defunding it as GOP leaders are.
Researchers cited a lack of clear public consensus on federal spending, coupled with deeply partisan divides over the new health care law, as key findings.
The survey was completed in early January, just weeks prior to a vote by House Republicans to repeal the health law, a largely symbolic vote that fell along partisan lines. Public opposition of the health care law has swelled since December—half of Americans now oppose it, up from 41 percent. The survey also shows that the American public is almost as evenly divided about how Congress should proceed next—47 percent favor expanding the health law or keeping it the way it is now, while 43 percent favor repealing or repealing and replacing it with some other alternative.
Those results are hardly unexpected and haven't fluctuated much since the health care law was passed last March, according to Altman.
"In the bigger picture, given how stable public opinion on health reform has been … I would not expect big changes in public opinion from any strategy," Altman said.
"What will change things is the actual rollout of the law … that will be the real test."
Researchers also found that most Americans—62 percent—still oppose defunding the law, as Republicans in Congress have vowed to do.
"The public is really fed up with the contentious political environment that's happening and they want government to function," said Mollyann Brodie, director of KFF's public opinion and survey research. "They may simply be saying that defunding the law is not the way government should work." (note: KHN is a program of the foundation.)
In the months ahead, growing public aversion to "politics as usual" may signal a change in the tone of the health care debate. How politicians frame key issues of public interest—from reductions in federal spending to consumer protections in health insurance—will be key, said Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health.
Certain provisions of the health care law continue to carry public support—79 percent of Americans favor subsidies for low-income individuals to buy health insurance, and 85 percent support discounts on drugs in the Medicare doughnut hole, for example. Democrats will be challenged to convince a risk-averse public that the health care law's key provisions will be beneficial in the long run, while Republicans may focus on the importance of economic austerity in balancing the budget and creating new jobs, according to Blendon.
"I think we're going to see a shift from complete assault on health care to shifting the debate around reducing the deficit and spending," he said.
In order to have any effect, Blendon added, that debate will need to focus on individual costs and benefits.
"We have to get back to real people's lives … not, 'should we take 80 billion or 100 billion,'" he said.
Blendon and Altman said it is likely that neither Republicans nor Democrats will give ground on the health care law before the next presidential election in 2012. By then, many, but not all, of the health law's provisions will have gone into effect, and the public may be in a better position to judge its true effects, they say.
"Who's going to control the presidency and Congress?" said Blendon.
"I think there's not a middle ground until that election is resolved."
The telephone survey of 1,502 adults has a margin of sampling error of 3 percentage points.