They may not like it, but they don't see it going away. About 7 in 10 Americans think President Barack Obama's healthcare law will go fully into effect with some changes, ranging from minor to major alterations, an Associated Press-GfK poll finds.
Just 12 percent say they expect the Affordable Care Act — "Obamacare" to dismissive opponents — to be repealed completely.
The law — covering 30 million uninsured, requiring virtually every legal U.S. resident to carry health insurance and forbidding insurers from turning away the sick — remains as divisive as the day it passed more than two years ago. After surviving a Supreme Court challenge in June, its fate will probably be settled by the November election, with Republican Mitt Romney vowing to begin repealing it on Day One and Obama pledging to diligently carry it out.
That's what the candidates say. But the poll found Americans are converging on the idea that the overhaul will be part of their lives in some form, although probably not down to its last clause and comma.
Forty-one percent said they expect it to be fully implemented with minor changes, while 31 percent said they expect to see it take effect with major changes. Only 11 percent said they think it will be implemented as passed.
Americans also prefer that states have a strong say in carrying out the overhaul. The poll found that 63 percent want states to run new health insurance markets called "exchanges." They would open for business in 2014, signing up individuals and small businesses for taxpayer-subsidized private coverage. With many GOP governors still on the sidelines, the federal government may wind up operating the exchanges in half or more of the states, an outcome only 32 percent of Americans want to see, according to the poll.
Finally, the poll found an enduring generation gap, with people 65 and older most likely to oppose the bill and those younger than 45 less likely to be against it.
"People are sort of averaging out the candidates' positions," said Harvard School of Public Health professor Robert Blendon, who tracks polling on healthcare issues. "The presidential candidates are saying there's a stark choice, but when you ask the voters, they don't believe that the whole bill will be repealed or implemented as it is today in law."
Republicans remain overwhelmingly opposed to the overhaul and in favor of repeal. But only 21 percent said they think that will actually come about.
Romney supporter Toni Gardner, 69, a retired school system nurse from Louisville, Ky., said that until a few weeks ago she was sure her candidate fully supported repeal, as she does.
But then Romney said in an interview there are a number of things he likes in the law that he would put into practice, including making sure that people with pre-existing medical problems can get coverage. The Romney campaign quickly qualified that, but the candidate's statement still resonates.
"If Romney gets in, he'll go with parts of it," Gardner said, "and there are parts of that he won't go with."
Gardner thinks expanding coverage will cost too much and may make it harder to get an appointment with a doctor. Besides, she doesn't believe the government can handle the job. She's covered by Medicare — a government-run health system — but says "that wasn't a choice that I had."
At 26, Santa Monica, Calif., web developer Vyki Englert has only bare-bones health insurance coverage. Her parents, a preschool teacher and a self-employed photographer, are uninsured. Englert says she thinks the law will largely go into effect as passed. (Among 18- to 29-year-olds, 60 percent think it will be implemented with only minor changes or none at all.)
Englert says that she supports guaranteeing coverage to people with health problems and that provisions such as broader coverage for birth control will help younger women such as her.
"I kind of see a day-to-day way where this law could benefit me," she said. Englert says the healthcare law dovetails with a trend toward consumerism in her generation. Older Americans "don't have the context of the young people," she added. "They are looking more at the theoretical impact on the budget and the country."
Overall, the poll found Americans divided on the question of repeal, with neither side able to claim a majority. Forty-nine percent said the healthcare law should be repealed completely, while 44 percent said it should be implemented as written.
The notion that the law will be implemented with changes, captured in the poll, mirrors a discussion going on behind the scenes in Washington, particularly among some Republicans.
"Whoever wins the election, the [healthcare law] is going to be modified," Mark McClellan, who ran Medicare under former President George W. Bush, said in a recent interview.
Congressional Republicans say if tax increases are on the table in a budget negotiation with a re-elected Obama next year, changes to the healthcare law — including possible delays in implementation — also must be considered. For now, White House officials refuse to be drawn in on that question.
Some parts of the law already are in effect; its big coverage expansion for the uninsured doesn't come until 2014.
Public opinion about the law itself has barely budged since the summer of 2010, soon after it passed. At the time, 30 percent supported the law. It's now 32 percent. And 40 percent opposed the overhaul. That's now 36 percent.
And misconceptions about the law that reigned two years ago continue to live on, including former Alaska Gov. Sarah Palin's widely debunked charge that it would create "death panels" to decide on care for the elderly and disabled.
In 2010, 39 percent believed the law would set up committees to review individual medical records and decide who gets care paid for by the government. Forty-one percent currently hold that view, according to the poll.
The poll asked people to say whether 18 different items were in the law or not and to rate how certain they were about their answers. Just 14 percent were right most of the time and sure of it.
Still, knowledge about what the law actually does is growing. More people are aware of provisions that allow adult children to stay on their parents' coverage until age 26, impose insurance mandates on individuals and businesses, and protect those with pre-existing medical conditions.
The poll was conducted Aug. 3-13 and involved interviews with 1,334 randomly chosen adults nationwide. It has a margin of sampling error of plus or minus 3.4 percentage points.
The survey was conducted online by GfK using its KnowledgePanel sample, which first chose people for the study using randomly generated telephone numbers and home addresses. Once people were selected to participate, they were interviewed online. Participants without Internet access were provided it for free.
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