WASHINGTON -- President Obama's long, hot summer is about to turn into a chilly fall.

A USA TODAY/Gallup Poll taken after the president's dramatic address to a joint session of Congress last week shows Americans almost evenly divided over passing a health care bill and inclined to think it would make some of the system's vexing problems worse, not better.

Six in 10 say Obama's proposal, if enacted, would not achieve his goals of expanding coverage to nearly all Americans without raising taxes on the middle class or lowering the quality of health care. For the first time, a majority disapprove of the way he's handling health care policy.

Milton Downing, 51, a teacher from Wilmington, Del., is a Democrat who says Obama is doing an "awesome" job, but he worries the legislation might upend the coverage he has. "How would it affect me right now and in the future?" he asks. "I don't have enough facts on what it might do to my family."

The findings underscore the steep climb ahead for the White House in trying to push a health care plan through the House and Senate during the next few weeks. Some major provisions, including how to pay for it and whether to include a government-run plan as an option, haven't been settled.

The president's speech apparently failed to galvanize public opinion in the way the White House had hoped. While it drew a national television audience estimated by Nielsen at more than 32 million people, there's little evidence in the survey that it changed minds.

Obama's approval rating is 54%, the same as in two USA TODAY polls in August; 43% disapprove, the highest of his presidency.

"There's no doubt people share the president's objectives," says White House counselor David Axelrod, citing steps to control costs and ensure coverage when workers change jobs. "There's just profound skepticism about the ability to achieve them. That's our opposition here."

He said the White House could address those qualms by delivering on promised reforms.

At stake is the future of what has been Obama's signature domestic initiative since he launched his campaign for the White House.

"They've pushed all the chips into the middle of the table on this," says Ed Gillespie, a top adviser in the Bush White House. That means success or failure is likely to shape perceptions of Obama's presidency and affect the prospects of future initiatives.

The approval rating for congressional Democrats is a dismal 36%-61%. It's even worse for congressional Republicans: 27% approve, 70% disapprove.

The survey of 1,030 Americans has a margin of error of +/-4 percentage points.