Although a majority of Americans say they see reform as more important than ever, the proportions who see the plans benefiting the nation and their families have decreased to levels last seen in August, according to the Kaiser Family Foundation’s December Health Tracking Poll.

The survey also suggests that the public is engaged in the debate to a considerably higher degree than during the last major reform effort (in 1994), and that hope and frustration top the list of emotions they experience as they attempt to figure out what health care reform will mean for them.

Overall, 54 percent say the economic challenges facing the country make it more important than ever to tackle reform, while 41 percent say we cannot afford reform right now. These percentages have remained fairly steady throughout the last few months, though the gap between those who want reform now and those who don’t shrunk somewhat this month.

Also consistent are the extreme partisan divisions that lie at the heart of the debate, with the large majority of Democrats (75 percent) supportive of reform now, the majority of Republicans opposed (67 percent) and political independents tilting positive (53 percent say reform now, 43 percent say wait).

However, the percentage of Americans who believe they will be personally better off if Congress passes health care reform is down seven percentage points from last month to 35 percent, making for a much more divided public on this measure, with roughly three in ten saying they think they will be worse off (27 percent) and another three in ten not expecting to see much change (32 percent).

The same pattern holds true for views about the impact of passage on the nation as a whole, though on this measure the group who expects a positive impact remains substantially larger than those who think the country would be harmed in some way. Overall, 45 percent say the country would be better off if health care reform passes, down 9 percentage points from November, compared to 31 percent who say the country will be worse off and 17 percent who see no impact. This drop was in large part driven by a change in the views of political independents over the past month, from a majority of 55 percent who thought reform would benefit the nation in November to 38 percent who think so now. The uptick in negative views was also marked among seniors, nearly half of whom (48 percent) now say the country will be worse off if reform passes, up significantly from a previous high of 36 percent in October.

In the case of both perceived personal impact and perceived national impact, opinion now looks more like opinion in August, during the last episode of truly heated public debate over the specific policies being discussed as part of reform legislation.

Meanwhile, seniors continue to be substantially more pessimistic about the effect of reform specifically on those of Medicare age. A narrow majority of seniors (52 percent) say that their age group will be worse off if health care reform passes, more than twice as many as see potential benefits (21 percent). Those under age 65 are much more positive about the potential effects of health care reform on seniors, with more saying seniors will see their lots improved than worsened (45 percent versus 26 percent).

Source: Kaiser Family Foundation