Repeal Obamacare? Better to have a replacement first, say Americans.

Public feeling is mixed about Obamacare, and Americans are open to argument. But they tend to agree on the general outlines of what they want in health care.

First Look

Just one in five Americans say they think Congress should repeal the Affordable Care Act before hashing out details of a replacement, as Republican leaders plan to do, according to a new poll by Kaiser Health.

A full 47 percent of the public think Congress shouldn't repeal Obamacare at all. A near equal amount, 49 percent, think a repeal is in order. But of the latter group, roughly 60 percent say that lawmakers should wait to vote on whether to sweep away the old one until after they've announced the details of a new plan, a sign of the current Republican strategy's unpopularity.

“For me, the really pertinent question, the big question, is: Is there a mandate for repealing the ACA without a replacement plan?” Drew Altman, president of the Kaiser Family Foundation, told The Washington Post. “What we see in our poll and what we see in our focus groups is: If there is, it is a very weak one. It’s not obvious there’s a mandate for repealing the ACA without putting a replacement plan on the table.”

But the poll also seems to illuminate how unsure about the law much of the public remains, although there are clearer divides along partisan lines. And the malleability of opinion on the issue – after hearing messages for or against repeal, anywhere from 60 percent to 27 percent of respondents say they’d support it – might suggest that most Americans don’t see the law as unimpeachable.

Some of that might have to do with outcomes. As The Christian Science Monitor reported earlier this week, the individual insurance markets created under the law are shrinking in much of the country while premiums rise, leaving people with fewer and more costly choices.

Here’s what’s clear: Most Americans (62 percent) prefer giving the federal government a larger role in healthcare if it means guaranteeing coverage and financial help for seniors and the lower-income, while similar proportions say lowering the cost of healthcare for individuals and lowering the cost of prescription drugs should be a “top priority.” And 45 percent say dealing with the prescription opioid epidemic should be a top priority, too.

Republicans in the House have drafted a blueprint for a replacement, though their colleagues in the Senate haven’t coalesced around a plan, as the Monitor's Francine Kiefer reported:

Republicans can repeal with only a majority vote through a special budget process, but legislation to replace the law would have to clear a 60-vote threshold in the Senate, where Republicans hold a narrow 52-to-48 advantage.

That’s why Senator [Susan] Collins [of Maine] thinks lawmakers need to see a detailed path forward upfront.

“I don’t want people falling through the cracks and losing their insurance status because we didn’t have a replacement ready to go,” she said in an interview, noting from her experience overseeing insurance for Maine that insurance markets “are complex and that they cannot turn on a dime.”

Her concern is backed up by a recent report by the center-left Brookings Institution think tank in Washington.

A repeal effort “would likely destabilize the individual market and very possibly cause it to collapse in some regions of the country during the interim period before any replacement is designed,” the Brookings report found.

Doctors, hospital groups, insurers, and analysts have largely echoed that finding.

"People in this country need to understand what it is they're being asked to substitute for what's there now so they can have an informed opinion about whether it's better or not,” American Medical Association president Andrew Gurman told the NPR. 

Trump will enter office having made big promises about giving Americans better health care for less money. Much of the public is skeptical, the poll finds: About 51 percent said they were either “not at all confident” or “not too confident,” with 29 percent saying they were “somewhat confident” and 19 percent saying they were “very confident.”