PRINCETON, NJ -- Americans are skeptical that President Obama's healthcare plan will be able to accomplish all he intends -- to expand coverage to nearly all Americans without raising taxes on middle-class Americans or affecting the quality of care. Thirty-eight percent believe his plan will achieve all of these goals, while 60% do not think it will.

Republicans are nearly united in thinking the plan will not accomplish these stated goals (90% believe it will not), and most independents (64%) agree. Two in three Democrats (66%), on the other hand, express optimism that the plan will achieve these aims.

"The poll suggests that support could drop if Americans come to believe the middle class will be asked to bear an increased burden in terms of higher taxes, higher medical costs, or diminished quality in order to expand healthcare coverage to those who currently lack it."

These results are based on a Sept. 11-13 USA Today/Gallup poll, conducted in the days after Obama's prime-time address to Congress last Wednesday. The speech served as a renewed call to action for the American public and legislators to support healthcare reform. However, it does not appear to have materially increased support for the plan, and the poll reveals that Americans have doubts that the plan, as Obama described it, will work.

For example, less than a majority (43%) say they are confident that Obama's plan can be paid for mostly through cost savings in Medicare and other parts of the healthcare system, as Obama has proposed. Eleven percent are very confident of this.

On a more basic level, Americans do not expect healthcare legislation to improve the U.S. healthcare system in a number of areas -- including quality, coverage, cost, and insurance-company requirements they would have to meet in order to get procedures covered. Although the public stops short of saying reform will make these things worse -- given that about one in five expect the reforms not to make a difference either way -- in three of the four areas, more predict healthcare legislation would make the situation worse rather than better.

These are key considerations given that support for a healthcare plan -- currently 50%, including "soft" support -- could drop considerably if Americans were convinced that reform would have a harmful effect on the middle class through higher taxes, higher costs for healthcare, or reduced coverage or quality of care.

For example, the poll finds 26% of Americans saying they would support expanding health insurance coverage if it would result in higher taxes on the middle class; 13% would support expanded coverage if it would reduce the quality of care middle-class Americans receive.

Bottom Line

Despite the fact that half of Americans support the idea of new healthcare legislation, many fewer are convinced that President Obama's healthcare reform plan can expand coverage and maintain quality while not increasing middle-class taxes, and that the plan can be paid for mostly through cost savings in the existing healthcare system.

The poll suggests that support could drop if Americans come to believe the middle class will be asked to bear an increased burden in terms of higher taxes, higher medical costs, or diminished quality in order to expand healthcare coverage to those who currently lack it.

With 50% of Americans backing healthcare reform in principle, it is unclear whether the president has enough of a public mandate at this point to convince reluctant members of Congress to vote for healthcare reform. Equally unclear is whether public support for healthcare reform will grow or decrease in the coming weeks as more details of the plan are hammered out in Congress. But as Congress continues to do its work, the president and other supporters of healthcare reform have an opportunity to continue making their case to Americans, and to allay some of the public's doubts about what their vision of reform would accomplish and at what cost.

Survey Methods

Results are based on telephone interviews with 1,030 national adults, aged 18 and older, conducted Sept. 11-13, 2009. For results based on the total sample of national adults, one can say with 95% confidence that the maximum margin of sampling error is ±4 percentage points.

Interviews are conducted with respondents on land-line telephones (for respondents with a land-line telephone) and cellular phones (for respondents who are cell-phone only).

In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.