Something new is happening in a health care debate dominated for seven years by the twists and turns of Barack Obama's signature law. The focus has shifted to ideas from President Donald Trump and GOP lawmakers in Congress, and most people don't like what they see.
With Republicans in command, their health care proposals as currently formulated have generated far more concern than enthusiasm.
Even among rank-and-file Republicans, there's opposition to changes that would let insurers charge higher premiums to older adults, and many disapprove of cuts to Medicaid for low-income people, according to a recent poll by The Associated Press-NORC Center for Public Affairs Research. It also found more than half of Republicans at least somewhat worried about leaving more people uninsured, as the House plan is projected to do.
March polls by Fox News and Quinnipiac University showed overall margins of opposition to the GOP proposal nearing or even exceeding those of Obama's Affordable Care Act, or ACA, at its lowest points — such as when the HealthCare.gov website opened for business in 2013 and promptly crashed.
"Republicans are taking ownership of the health care issue, and all the pleasure and pain of health reform," said Drew Altman, president of the nonpartisan Kaiser Family Foundation, a clearinghouse for information about the health care system. "There has been a shift in focus from the ACA itself to the Republican plans, and who might lose benefits as a result."
Uninsured numbers tick up
Highlighting the stakes, the uninsured rate among U.S. adults rose slightly in the first three months of this year, according to an update Monday of a major ongoing survey. The Gallup-Healthways Well-Being Index found that 11.3 percent of adults were uninsured, an increase from 10.9 percent in the last two calendar quarters of 2016.
"Only time will tell" if the uptick means the U.S. is again losing ground on health insurance, said survey director Dan Witters. "A lot of uncertainty has been introduced into the marketplace through efforts to repeal," he said. "Plus premiums are now realizing a big jump for the first time in the ACA era."
Trump came into office with big, bold health care promises. In a Washington Post interview shortly before his inauguration, he declared his goal was "insurance for everybody," hand-in-hand with affordable coverage, "lower numbers, much lower deductibles." Although Trump said he'd soon release a plan, none appeared.
Instead, after weeks of laboring behind closed doors, House Republican leaders rolled out a proposal March 6 that the president enthusiastically embraced. But all the efforts of the White House and congressional leadership haven't convinced GOP lawmakers to pass it. Congress is on a two-week break with the health bill in limbo.
Frustrated, Trump is seeing his promise slip away to quickly repeal Obamacare and replace it with something better. Instead he could get left as the caretaker of the ACA, a law he's repeatedly called a "disaster" on account of rising premiums and insurer exits that diminish consumer choice in many communities.
Trump's personal image has taken a blow, with the AP-NORC poll finding that he gets his worst rating on health care. About 6 in 10 people disapprove of how the president has handled the issue.
"It is a major failure that a high priority of President Trump and the congressional Republican leadership leads to no bill, and the bill as proposed becomes unpopular even among their own voters," said Robert Blendon, a professor at the Harvard T.H. Chan School of Public Health, who follows opinion trends on health care. "It's a real leadership crisis issue."
Amid disapproval of the House GOP plan, some polls have shown improved ratings for the ACA. Gallup, for example, found Obamacare gained majority approval for the first time. But that does not change the fact that Republican voters remain overwhelmingly opposed to Obama's law and want it repealed.
What 'repeal' means
Nonetheless, there's recent evidence that Republicans differ among themselves about what "repeal" may mean.
A Quinnipiac poll last month found that 55 percent of Republicans said Trump and the Republican-led Congress should repeal "parts" of Obama's law, while 42 percent said "all" of it should go. Only 2 percent of Republicans said the ACA should not be repealed.
Republican views compare with 50 percent of the general public who say parts of the ACA should be repealed, 20 percent who say all of it should be repealed, and 27 percent who say it should remain.
The divisions among rank-and-file Republicans appear to mirror what's going on in the House, where disagreements among hardliners and moderates are keeping Speaker Paul Ryan, a Republican from Wisconsin, from putting together enough votes to take the bill to the floor.
Tim Malloy, assistant director of the Quinnipiac poll, said, "You have to figure a lot of people who voted for Trump are on Obamacare."