Americans are getting focused on health care reform – and many don’t like what they see.

This article was co-authored by Bill McInturff and Alex Bratty.

A few weeks ago your faithful pollsters checked in to report what we were seeing in our data on the health care debate. Back then almost a third of the country (30%) said they did not know enough to have an opinion about the President’s health care plan. Just a few weeks later, we can tell you the public is now getting focused on this important issue (today just 17% say they don’t know enough to have an opinion), and not everyone – particularly those who already have private health insurance coverage – is happy with what they see.

In our latest NBC/WSJ poll* a plurality (42%) says from what they have heard about President Obama’s health care plan they think it is a bad idea. This is a ten-point jump from the 32% who said it was a bad idea in our June poll. Even more concerning is the shift in how the public perceives this plan will affect the quality of their care. In April, Americans were fairly evenly divided between those who thought Obama’s plan would mean their quality of care would get better (22%), get worse (24%), or stay about the same (29%). Today, the percentages saying it will get better or stay the same are basically unchanged (21% and 29% respectively), but 39% now say their quality of care will get worse – a whopping 15-point jump in just a few months. These numbers are even more striking among the 59% of the poll who have private coverage (15% say quality will get better, 44% say it will get worse).

More data from this poll helps explain why Congress has been struggling with the proposal to create a public health care plan administered by the federal government that would compete directly with private health insurance companies. The public is split on this idea – 46% favor it, 44% oppose it – with strong partisan lines drawn in the sand. Republicans oppose the plan by 78% to 18%, independents are divided (42% favor, 45% oppose), and Democrats favor it by 71% to 18%. However, it’s worth noting the internal conflict the Democratic Party is facing with Blue Dog Democrats (defined in this poll as White moderate and conservative Democrats) showing much softer support (56% favor, 31% oppose).

When presented with two different points of view on this public plan, a majority (52%) comes down on the side that it would limit access and choice of doctors/treatment while 41% believe it would lower costs and increase the number of people with coverage. Again, this is a significant shift in attitudes from our last poll when by five points Americans sided 47% to 42% with the argument in favor of the public plan. Of course, partisan attitudes are at play, but more importantly on this (and any other proposal related to health care reform) what matters most is health care coverage status. Last month privately insured Americans were fairly evenly split on these arguments, today by a margin of 16 points they are more concerned a public plan would limit access and choice. Those who are covered by Medicare, Medicaid, Tricare or some other plan switched from siding with the argument in favor of the public plan by 17 points to siding with the argument against it by a margin of 12 points. The 13% who do not have insurance continue to strongly favor President Obama’s health care proposal and the public plan.

The bottom line – that the Obama Administration is painfully discovering – is that you can not pass substantial care health reform unless the people who already have coverage see that there’s a benefit for them.

*National survey of 1,011 adults conducted July 24-27, 2009 (Public Opinion Strategies partners with Peter D. Hart Research Associates to conduct the NBC/WSJ polls. Neither Peter D. Hart Research Associates nor NBC/WSJ are responsible for these conclusions.)

Public Opinion Strategies