WASHINGTON -- First it was President Barack Obama's health care overhaul that divided the nation. Now it's the Republican cry for repeal.
An Associated Press-GfK poll found likely voters evenly split on whether the law should be scrapped or retooled to make even bigger changes in the way Americans get their health care.
Tea party enthusiasm for repeal has failed to catch on with other groups, the poll found, which may be a problem for Republicans vowing to strike down Obama's signature accomplishment if they gain control of Congress in the Nov. 2 elections.
Among likely voters, 36 percent said they want to revise the law so it does more to change the health care system. A nearly identical share -- 37 percent -- said they want to repeal it completely.
"We just can't ignore the health of people in our country. ... It would be an even bigger drain on the economy," said Linda Montgomery, 63, a retired software engineer from Pass Christian, Miss. "I wouldn't oppose having the law changed -- I would like to see it expanded even more."
But Joe Renier, an information technology manager, said he finds that view "actually quite scary."
"They want more power for the government," said Renier, 54, of Tucson, Ariz. "I don't believe the government has a right to tell us to buy health insurance," he said, adding that the law does nothing to address unsustainable health care costs.
In the poll, only 15 percent said they would leave the overhaul as it is. And 10 percent wanted modifications to narrow its scope.
The health care law will eventually extend coverage to more than 30 million uninsured by signing up low-income adults for Medicaid and providing middle-class households with tax credits for private insurance. Starting in 2014, most Americans will be required to carry coverage, and insurers no longer will be allowed to turn away people in poor health.
Overall, Americans remain divided about the law itself. Among likely voters, 52 percent oppose it, for a range of reasons. Forty-one percent said they support it. Strong opponents outnumber strong supporters by 2-to-1.
Health care remained among the top issues for Americans in the poll, ahead of concerns about terrorism. But Democrats are losing their edge when it comes to whom the public trusts as stewards of the health care system. Among likely voters, there was essentially no difference, with 46 percent saying they trust Obama and the Democrats, and 47 percent saying they trust Republicans.
"Seven months after they passed this bill, there is no consensus about its future," said Robert Blendon, a Harvard University public health professor who follows opinion trends on health care. "Neither side is a strong winner when it comes to the future."
A leading supporter of the law was heartened by the poll. "A lot of people have been assuming that when someone says they are dissatisfied with the law, they want to strike it down," said Ron Pollack, executive director of the advocacy group Families USA. "In fact, a significant proportion want to strengthen it."
The tea party movement remains a crucible of opposition. More than 7 in 10 likely voters who back the tea party said the law should be repealed in its entirety.
But the poll found that strong opponents are vastly different from nearly all others. Most strong opponents favor complete repeal, while majorities of those who are neutral or who moderately oppose the legislation say leave it as is or expand it.
Only 26 percent of women favored repealing the law. That restraint was evident even among Republican women -- 52 percent supported repeal, compared with 68 percent of Republican men.
People under age 30 were the most likely to say the law should be expanded to do more.
"Eventually, a public option does need to be put into it," said Mark Slack, 23, of Charleston, S.C., referring to an Obama-backed proposal for a government plan to compete with private insurance, which failed for lack of sufficient congressional support.
"The health care law may not be perfect, but it does represent an improvement that can be built on," said Slack, a graduate student who wants to teach high school English. "I'm not sure that we need to be subsidizing the insurance companies as we're doing in this bill."
Older people were more likely to favor complete repeal, with 38 percent of seniors giving the legislation a thumbs down. Much of the financing to expand coverage for workers and their families is coming from Medicare, with cuts to hospitals, nursing homes, insurers and other providers that nonpartisan experts have warned are politically unsustainable.
But Mary Ann O'Connell, 67, said the main reason she's in favor of repeal is the fine, starting in 2014, on those who fail to get coverage through an employer, a government program or by purchasing their own plan. Her 40-year-old daughter was hit with a similar penalty this year in Massachusetts, a state that already has adopted its own health care remake and served as a model for the federal plan.
"It's going to do a lot of harm to people who don't have a lot of money, because they're going to get the fine and they still won't have insurance," said O'Connell, a retired teacher living in the Boston suburbs.
The AP-GfK Poll was conducted Oct. 13-18 by GfK Roper Public Affairs and Corporate Communications. It involved landline and cell phone interviews with 1,501 adults nationwide, including 846 adults classified as likely to vote in the November congressional elections. The margin of sampling error is plus or minus 3.3 percentage points for all adults, 4.4 percentage points for likely voters.