The July 2009 Kaiser Health Tracking Poll shows that a majority of Americans continue to want health reform -- but that support has slipped as legislative debate heats up and some criticisms gain traction.

Despite the serious economic problems facing this country, 56 percent of respondents believe health reform is more important than ever (down from 61 percent in June). By a margin of two to one (51 percent versus 23 percent) the public believes the country will be better rather than worse off if health reform is enacted. A similar poll released by the Robert Wood Johnson Foundation on Tuesday shows that 85 percent of those surveyed believe reforming health care is an important step to solving the nation's economic woes.

The Kaiser poll also provides a nuanced look at some of the more difficult issues in health reform, presenting a series of positive and negative messages that have the most impact on public attitudes.

Top Positive Messages:

• Can keep own doctor or health plan (74 percent more likely to support reform if they heard)
• Would ensure financial health of Medicare (67 percent)
• Would cover pre-existing conditions (66 percent)
• Would provide financial help to get health insurance for those who need it (63 percent)
• Would save country money over time (63 percent)
• Higher quality of care for Medicare patients (59 percent)

 Top Negative Messages:

• Would increase premiums/out of pocket costs (66 percent less likely to support if they heard)
• Would result in cuts in Medicare that make doctors less willing to participate (62 percent)
• Limited own choice of doctors (62 percent)
• Get government too involved in your health care (59 percent)
• Would reduce quality of care in Medicare (58 percent)
• Would increase taxes (58 percent)
• Would increase budget deficit (45 percent)

On the cost of financing health reform, the poll finds the $1 trillion is an important milestone for the public with 42 percent saying it's too much, 36 percent saying it's the right amount, and 9 percent saying it's too little. For saying the cost is too much, their perspectives change significantly when the $1 trillion figure is put in perspective. (John Holohan and Linda Blumberg haven excellent piece on the RWJF health reform blog that puts the price tag of reform in context.)

Six in 10 respondents support the idea of creating a public health insurance option to compete alongside private plans. Respondents were split evenly, with roughly four in 10 (43 percent) believing the public health insurance plan would put private insurers out of business and a similar figure (45 percent) believing it would drive insurers to offer better products and become more efficient. As in the past, support for the public plan depends on how it's framed:

Finally on the question of "what's in it for me" 39 percent of respondents think they and their families will be better off if reform legislation passes -- compared to 21 percent who said worse off and 32 percent who said it would make no difference. The proportions are quite similar on questions of how reform will impact health care's cost and quality.