PRINCETON, NJ -- Americans currently tilt against Congress' passing healthcare legislation, with 49% saying they would advise their member to vote against a bill (or they lean that way) and 44% saying they would advocate a vote in favor of the bill (or lean toward advising a yes vote).

These results are based on a Nov. 20-22 USA Today/Gallup poll, and are essentially unchanged from a poll conducted earlier this month. Within the last month, the House has passed a version of healthcare legislation, and the Senate voted on Nov. 21 to allow debate on its healthcare bill. That debate is scheduled to begin Monday.

"Support among all three party groups has declined since the early October high -- falling by 6 points among Democrats, 8 among independents, and 12 among Republicans."

Since Gallup began tracking Americans' preferences for healthcare legislation earlier this year, there has never been a strong public mandate in favor of passing a law this year. The high point in support was 51% in early October. But since that time, opinion has shifted from a slightly positive position to a slightly negative one.

However, opinion on the issue is far from settled. When initially asked about their preferred course of action on healthcare legislation, 22% of Americans say they do not yet have an opinion on the matter (although 15% subsequently provide an opinion when asked if they lean one way or the other). The percentage with no opinion on the initial question has fluctuated since August, but has never been lower than the current 22% figure.

Because those who initially express no opinion divide fairly evenly between support and opposition when probed for their leaning, the trend on the initial question has been similar to the trend shown at the beginning of the article that combines initial preferences and leanings.

Support for Healthcare Legislation by Political Party

Republicans are overwhelmingly opposed to new healthcare legislation -- 86% would advise their member of Congress to vote against it, while 12% would want their member to support it. Democrats, on the other hand, favor it by a 76% to 17% margin. Independents oppose passage of a bill by 53% to 37%.

Support among all three party groups has declined since the early October high -- falling by 6 points among Democrats, 8 among independents, and 12 among Republicans. However, Democratic support recovered somewhat from early November (71%) to late November (76%).

Obama Gets Poor Marks on Healthcare

The poll also finds 40% of Americans approving of President Obama's handling of healthcare policy, while 53% disapprove. This is slightly more negative than what Gallup found from July through September, and represents his worst review to date on this issue.

Seventy-four percent of Democrats approve of Obama's handling of the issue, but this is below the better-than 80% of Democrats who approve of the job Obama is doing as president overall.

Republicans are nearly unanimous in their views of Obama's work on healthcare, with 89% disapproving and 6% approving. Independents are nearly twice as likely to disapprove (58%) as to approve (33%).

Bottom Line

Despite the considerable efforts of Congress and the president to pass health insurance reform, the public remains reluctant to endorse that goal. Over the past month, Gallup has found more Americans opposed to than in favor of healthcare legislation, though at least one in five say they have not made up their minds. Proportionately more independents (27%) and Democrats (24%) than Republicans (14%) are undecided, which at least improves the odds that legislation could wind up getting majority public backing. But the recent trend has been in the opposite direction, with opposition growing.

Survey Methods

Results are based on telephone interviews with 1,017 national adults, aged 18 and older, conducted Nov. 20-22, 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.