WASHINGTON – Health care is Shannon Taylor's "big, big hot button" and no wonder. She is a nurse in Tennessee who examines hospital bills for a health insurance company, and a mother who saw President Barack Obama's health care law come just in time for her family.
In the State of the Union speech Tuesday night, she will be looking for Obama to stand firm against Republicans who want to take the law apart. Health insurance for her daughter, who has lifetime medical problems, could hang in the balance.
Many other Americans feel a personal stake in what Obama will say Tuesday and do later — and what Republicans do in response. The hunger for jobs and economic growth stood out in interviews with more than 1,000 people, part of an Associated Press-GfK poll asking Americans what one thing they most want the government to accomplish this year.
It is apparent, too, that health care is still very much on people's minds, that spending has reached frightening proportions for many and that a notable share of Americans wants nothing more than to see partisan bickering end.
In upstate New York, Donald Dixon puts his faith in Republicans to restrain Democratic spending and bring down a debt that he believes makes every economic problem worse — and robs his grandsons, each with a master's degree, of good jobs.
It's enough to make the retired Baptist preacher invoke the fire and brimstone rhetoric of the pulpit, even as he renders his judgment in a cheerful tone.
Obama "tells us we are going in the right direction," Dixon says, "which to me is over the precipice of hell."
It falls upon presidents to describe the state of the union when much of that union is in the depths of winter's gloom.
The polling revealed a season of discontent; also some stirrings of hope. More than half disapproved of Obama's handling of the economy and just more than one-third said it has improved in his first two years. Still, he's considered likable, strong and in touch.
Altogether, 38 percent cited the economy or an economic issue when asked what they would most like to see the government accomplish this year. Fully 31 percent said health care is the No. 1 issue to tackle — regardless of whether they favor or oppose the law — and 21 percent cited the budget. Among economic concerns, jobs topped the list.
Dixon believes the debt already weighs on job creation and economic growth and it will take a decade to turn that around. The Republicans, he says, are off to a good start on that front.
His grandsons have master's degrees in education and business, and neither is able to get a job in his discipline. The one with the MBA lives with relatives and recently welcomed a baby. "He's been painting houses," Dixon, 74, said from Little Falls, N.Y. "Wintertime up here, you don't do much painting."
Debt is also a concern of those young enough to inherit its growing weight down the road. It's what Eric Tolbert, 19, a Purdue University student from West Lafayette, Ind., most wants the government to fix. "I think it will be all talk at first," he says of the promises to cut spending. "But we may see more progress in a year or two."
Says James Lenoir, 41, an Aberdeen, Miss., car salesman: "The economy is in a bad fix. Job creation is one of the most important things the country needs. There has been progress but not enough, fast enough."
Can the parties work together? Lenoir glumly predicts not. "On most issues, it's going to be gridlock."
Health care plays out in public opinion in ways as complicated as the law itself. Angie Wyatt, 46, an Alexandria, Ky., middle school teacher and mother of six, calls for the law to be repealed because "I don't like government control." But she does like one of its principal elements: the government's prohibition on denying health insurance to people who have been sick.
In Chattanooga, Taylor, the 46-year-old nurse, says she is well aware of abuses in the medical system, as one who pores over itemized hospital bills to be paid by the health insurer she works for. And she figures Obama's law may not be good for health insurers.
She's willing to take that chance.
"I've seen the system abusers, but those are the people you hear about," she says. "You don't hear about the old ladies who are buying four pills at a time at Walmart because that's all they can afford."
Taylor's daughter, 22, has celiac disease, an autoimmune intestinal disorder that has required expensive treatments and will follow her through life.
"She was just about to age out of my insurance coverage," Taylor said. "We were starting to get on the panicky side. Without insurance, we would be bankrupt." Her husband, disabled in a car accident, is helped with medical bills by Medicare.
Now, the health care law entitles children to stay on their parents' plans until they turn 26, three years longer than before and without the condition that they be full-time students.
And by 2014, insurers will need to accept all applicants regardless of medical history. Insurers will also be prohibited from charging higher premiums to those in poor health.
"If the House will quit being silly and trying to overturn it," she says of the law, "there will be something there for her."
Employment was the top single issue identified by those interviewed, mentioned by 23 percent. Only two other individual issues topped 10 percent: fixing or reforming health care at 15 percent, and fixing the economy at 14 percent.
Six percent set aside material worries to say they want bipartisan cooperation above all else.
The AP-GfK Poll was conducted Jan. 5-10 by GfK Roper Public Affairs and Corporate Communications. It involved landline and cell phone interviews with 1,001 adults nationwide, and has a margin of sampling error of plus or minus 4.2 percentage points.
AP Polling Director Trevor Tompson, Deputy Polling Director Jennifer Agiesta, News Survey Specialist Dennis Junius and writer Will Lester contributed to this report.