Most Americans don't want to repeal Obamacare: Here's what they want instead

While the public has long agreed with President-elect Donald Trump and congressional Republicans that the Affordable Care Act is badly flawed and requires major surgery, far more Americans believe the program should be kept but improved than repealed and replaced.

Shortly after Trump's stunning November 8 victory over Democrat Hillary Clinton – an ardent champion of Obamacare -- a Gallup poll found that while slightly more than half of Americans continued to express dissatisfaction with the program, 57 percent said they either wanted to keep the law as is or wanted to keep it and change the law significantly. Just 37 percent wanted to repeal and replace it as the Republicans have vowed to do.

Related:Could Rand Paul End Up Saving Obamacare?

Not surprisingly, views differ sharply between Republican and Democratic voters, reflecting the larger political divide throughout the country and in Washington. Seventy-one percent of Republicans told Gallup they disapprove of the law and want it repealed, while 59 percent of Democrats want to keep it with significant changes.

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President Obama's final National Christmas Tree lighting
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President Obama's final National Christmas Tree lighting

US President Barack Obama speaks during the National Christmas Tree Lighting on the Ellipse of the National Mall in Washington on December 1, 2016.

(NICHOLAS KAMM/AFP/Getty Images)

Chance the Rapper performs during the 94th Annual National Christmas Tree Lighting ceremony on The Ellipse, near the White House, in Washington, U.S., December 1, 2016.

(REUTERS/Mike Theiler)

The National Christmas Tree is lit up after US President Barack Obama and his family hit the switch, on December 1, 2016 in Washington, DC. This year is the 94th annual National Christmas Tree Lighting Ceremony.Ã

(Photo by Mark Wilson/Getty Images)

U.S. President Barack Obama and first lady Michelle Obama participate in the National Christmas Tree lighting in Washington, U.S., December 1, 2016.

(REUTERS/Jonathan Ernst)

Singer James Taylor performs during the 94th Annual National Christmas Tree Lighting ceremony on The Ellipse, near the White House, in Washington, U.S., December 1, 2016.

(REUTERS/Mike Theiler)

U.S. President Barack Obama gets a hug from Santa Claus as musician James Taylor looks on during the National Christmas Tree lighting ceremony, on December 1, 2016 in Washington, DC. This year is the 94th annual National Christmas Tree Lighting Ceremony.

(Photo by Mark Wilson/Getty Images)

Singers Garth Brooks and wife Trisha Yearwood hold hands as they perform during the 94th Annual National Christmas Tree Lighting ceremony on The Ellipse, near the White House, in Washington, U.S., December 1, 2016.

(REUTERS/Mike Theiler)

Singer Yolanda Adams performs during the 94th Annual National Christmas Tree Lighting ceremony on The Ellipse, near the White House, in Washington, U.S., December 1, 2016.

(REUTERS/Mike Theiler)

U.S. President Barack Obama speaks with his daughter Sasha as they participate in the National Christmas Tree lighting in Washington, U.S., December 1, 2016.

(REUTERS/Jonathan Ernst)

U.S. President Barack Obama joins Santa Claus for a concluding Christmas carol during the 94th Annual National Christmas Tree Lighting ceremony on The Ellipse, near the White House, in Washington, U.S., December 1, 2016. Joining in (L-R) Chance the Rapper, First Lady Michelle Obama, James Taylor, Eva Longoria, Kelly Clarkson, Garth Brooks and Marc Anthony.

(REUTERS/Mike Theiler)

U.S. President Barack Obama and first lady Michelle Obama cuddle together as they participate in the National Christmas Tree lighting in Washington, U.S., December 1, 2016.

(REUTERS/Jonathan Ernst)

U.S. President Barack Obama joins in a Christmas carol at the conclusion of the annual National Christmas Tree Lighting ceremony on The Ellipse, near the White House, in Washington, U.S., December 1, 2016. Joining the president are James Taylor, Trisha Yearwood, Marc Anthony, Garth Brooks and host Eva Longoria.

(REUTERS/Mike Theiler)

First Lady Michelle Obama and U.S. Olympic swimming gold medalist Simone Manuel read "The Night Before Christmas" to children at the 94th Annual National Christmas Tree Lighting ceremony on The Ellipse, near the White House, in Washington, U.S., December 1, 2016.

(REUTERS/Mike Theiler)

U.S. President Barack Obama gets a hug from Eva Longoria during the National Christmas Tree lighting ceremony on December 1, 2016 in Washington, DC. This year is the 94th annual National Christmas Tree Lighting Ceremony.

(Photo by Mark Wilson/Getty Images)

US President Barack Obama and First Lady Michelle Obama react during the National Christmas Tree Lighting on the Ellipse of the National Mall in Washington on December 1, 2016.

(NICHOLAS KAMM/AFP/Getty Images)

Marc Anthony sings during the National Christmas Tree lighting ceremony, on December 1, 2016 in Washington, DC. This year is the 94th annual National Christmas Tree Lighting Ceremony.

(Photo by Mark Wilson/Getty Images)

U.S. President Barack Obama sings Jingle Bells with Marc Anthony, Chance the Rapper, James Taylor and Eva Longoria during the National Christmas Tree lighting ceremony on December 1, 2016 in Washington, DC. This year is the 94th annual National Christmas Tree Lighting Ceremony.

(Photo by Mark Wilson/Getty Images)

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Taken together, the findings suggest a national unease among Americans over GOP leaders' determination to pass a budget resolution in the coming weeks that would repeal President Obama's signature national health insurance program that – for all its flaws – has provided coverage to more than 20 million Americans in recent years.

House Speaker Paul Ryan (R-WI) and Senate Majority Leader Mitch McConnell (R-KY) have joined Trump in denouncing Obamacare as irredeemable. They have vowed rapid legislative action in the coming weeks and months to repeal the law, even while the party is far from a consensus on replacement legislation.

"Obamacare is a disaster," Ryan said. "Insurance markets are collapsing. Premiums are soaring. Patients' choices are dwindling. The law has failed to deliver on its core promises, hurting far more than it is helping."

Related: Obamacare Repeal Could Push Rural Hospitals to the Brink

GOP leaders, for now, intend to repeal the program by the spring while setting the effective date a year or two down the road while Republican lawmakers hammer out a comprehensive alternative program that depends on more on market forces than government intervention and subsidies.

Yet that strategy is being met with opposition from insurers, hospitals and doctors, drug companies, consumer advocates and even many Republican governors who fear chaos and a collapse of Obamacare while the Republicans struggle to map out a new approach.

Just this week, the American Medical Association (AMA), the premier physician organization, wrote a letter to Republican leaders warning against jeopardizing the health care coverage of millions of Americans by abruptly repealing Obamacare without a suitable replacement. And Republican Gov. Rick Snyder of Michigan hailed the success of his state's expansion of Medicaid that was made possible by the Affordable Care Act.

A dozen moderate Democratic senators, including Tim Kaine of Virginia, Clinton's vice presidential running mate, wrote to the GOP leadership yesterday urging them to slow down and work with them to draft changes to the existing law to address concerns such as soaring premium and onerous taxes and mandates.

Related: Obamacare Repeal Is a Fiscal Minefield for the GOP

"There is so much we can immediately improve, but by pushing an immediate repeal through a partisan budget process, we won't have the opportunity to work together to build on that common ground," Kaine said, according to The New York Times.

G. William Hoagland, a vice president of the Bipartisan Policy Center and a former Senate Republican budget expert, said that the Republicans are still caught up in their campaign slogans and enthusiasm and aren't being pragmatic. However, reality will begin to set in when House and Senate committees begin stitching together the specific budget instructions to dismantle Obamacare, and many divisive issues rise to the surface, he said.

Related: Republicans Are Having Second Thoughts About Scrapping Obamacare Taxes

"Campaign rhetoric is one thing and legislating is another thing," Hoagland said in an interview Friday. "And I think the word 'repeal' is maybe being overused here by the Republicans – even before President-elect Trump is sworn in. What people are really talking about is amending the Affordable Care Act."

Hoagland, a health care policy expert, suggested that there is plenty of room for bipartisan compromise on changes to Obamacare, including adding Trump's proposals for lowering barriers to interstate sales of health insurance and the establishment of health care savings accounts. The biggest sticking point between Republicans and Democrats will be over how to subsidize health care costs for low-income Americans through the federal tax code and whether to make coverage mandatory or voluntary.

The Affordable Care Act mandates uninsured Americans to acquire coverage or pay the penalty. Ryan and others say their goal is to replace Obamacare with a law that guarantees "universal access" to health care coverage, but not necessarily to force everyone to be covered. Ryan yesterday declined to speculate on whether the 20 million or more Americans currently receiving coverage under the Affordable Care Act would continue to receive coverage under the GOP approach.

There is another obstacle for the Republicans in completely reinventing a national health insurance program: the cost. Blowing up Obamacare and starting from scratch would be a very costly enterprise. A complete repeal would include getting rid of a dozen major tax provisions that help underwrite the program's operating costs.

Related: GOP and Dem Governors Are Closing Ranks Against Obamacare Repeal

Before the election, the Congressional Budget Office projected that Obamacare operating costs would total $1.24 trillion between 2019 and 2026. There is compelling evidence that if the Republicans scrap all of the Obamacare taxes, they could raise at most $850 billion of the total required cost through a number of budgetary and tax policy maneuvers, according to a recent Brookings Institution analysis.

For these and other reasons, Hoagland says he could imagine a bipartisan deal next summer or fall that would retain the basic framework of Obamacare while layering in GOP provisions and innovations. He said that it would give Trump the opportunity to show off his legendary bargaining skills.

"The more I look at it . . . the more I sense that we're really talking about what you might call Trumpcare One or Trumpcare Two – Trumpcare modification of Obamacare," Hoagland said. "It just seems to me we're dealing with rhetoric right now and we're still in the campaign mode."


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