When the public debate over health care reform began in earnest in June, 50% of voters nationwide supported the legislative effort and 45% were opposed. By August, support had fallen to 43% and opposition had risen to 53%. Since then, opinions seem to have stabilized in advance of President Obama’s address to Congress tonight.

Not coincidentally, the president’s job approval ratings have fallen significantly.

All through the debate, it has been clear that those who oppose the plan feel more strongly about it than those who favor it. Currently, 43% are Strongly Opposed while just 23% Strongly Favor the health care reform plan proposed by the president and congressional Democrats.

Rasmussen Reports will be tracking this question daily for the next several days to measure the response to the presidential address intended to relaunch the troubled health care initiative.

Voters are concerned about a number of factors. Eighty percent (80%) believe passage of the current plan will likely lead to higher middle class taxes, and 68% believe it will increase the deficit. Fifty-two percent (52%) of those with health insurance say it’s likely they will be forced to change coverage. That’s a problem because voters with insurance overwhelmingly rate their own coverage as good or excellent.

Hardly anybody believes the proposed legislation will lead to lower costs or better quality of care. In fact, about half the nation’s voters believe just the opposite - that it will lead to higher costs and a lower quality of care.

Despite the decline in public support, the debate in Congress has changed little over the past months. Earlier in the year, a broad consensus emerged in Congress, but the points Congress ageed on received mixed reviews from the public. Just 222% believe Congress has a good understanding of the health care plan anyway. Voters also are skeptical about claims made by House leaders Nancy Pelosi and Steny Hoyer to encourage suppport for the plan.

As Congress wrestles with health care reform, voters place a higher priority on deficit reduction, However, those in the president’s party think health care reform is more important.

One major challenge is that while most voters oppose the legislation with or without a so-called “public option, that option is essential to supporters. In fact, without the inclusion of a government-run health insurance company to compete with private insurers, enthusiasm for the reform plan collapses among Democrats. A cautionary note should be issued on this topic: It’s likely that there is no common understanding of just what the public option is at this point in time.

It’s also important to recognize that most supporters of the current plan are also supporters of a single-payer system. Overall, nationwide, 32% of voters favor a single-payer health care system. But when it comes to health care, 51% fear the government more than they fear insurance companies.
These facts put the president in a difficult position. To reassure liberal voters in his base, he needs to signal that passage of this plan will eventually lead to single-payer coverage. To reassure those in the political center, he needs to signal exactly the opposite.

As for the political dynamics, just 24% say Democrats should pass health care reform without Republican votes. That may shift depending upon how the public views GOP participation in the debate. Still, there’s no doubt that the debate so far has been good politically for Republicans. The two parties are now trusted by equal numbers of voters on the health care issue. Prior to this year, Democrats had enjoyed a wide advantage on the issue.

A couple of items that have not made the congressional plan also attract support: 53% say limiting malpractice awards would reduce health care costs, and 83% say proof of citizenship should be required to get government health aid. Most also like the idea of providing free education to doctors who commit to serving those living in poverty.

August, of course, was a month of sound and fury in the health care debate. While the political types in Washington initially dismissed the town hall protesters, the general public gained a more favorable opinion of the protesters as time went on. One reason is that most voters viewed the town hall meetings as a time for members of Congress to listen, not speak.

Still, when all was said and done, little has changed since we compiled our list of recent health care polling at the end of July. Most Americans want reform, but they aren’t sold on the congressional reform plan. The president's challenge in his speech tonight is to begin reversing that view.