Sunday, July 19, 2009

Skepticism on Health Reform Mounts

President Is Set to 'Take the Baton'
As Skepticism on Health Reform Mounts, He Will Intensify His Efforts

Washington Post By Michael D. Shear and Shailagh Murray

Six months into his presidency, Barack Obama may have no greater test of his ability to translate personal popularity into a successful legislative agenda than the upcoming two weeks.

With skepticism about the president's health-care reform effort mounting on Capitol Hill -- even within his own party -- the White House has launched a new phase of its strategy designed to dramatically increase public pressure on Congress: all Obama, all the time.

Senior White House aides promise "an aggressive public and private schedule" for Obama as he presses his case for reform, including a prime-time news conference on Wednesday, a trip to Cleveland, and heavy use of Internet video to broadcast his message beyond the reach of the traditional media.

"Our strategy has been to allow this process to advance to the point where it made sense for the president to take the baton. Now's that time," said senior adviser David Axelrod. "I don't know whether he will Twitter or tweet. But he's going to be very, very visible."

Another senior White House aide added: "It's time to raise the stakes on this."

But even as Obama returns to full-time campaign mode, he is facing increasing calls to show that his presidency can manage the tough, nitty-gritty of lawmaking by cutting deals with his allies to keep his health-care legislation moving in the House and Senate committees.

Conservative Democrats in the House are promising to vote against reform as it now stands, and are preparing two dozen amendments, including measures aimed at lowering the effort's long-term cost. In the Senate, members from both parties are urging the president to break his campaign promise to preserve the tax-free status of health benefits. And a chorus of weary voices from Capitol Hill is urging him to abandon his demand for passage of bills in the House and Senate by Aug. 7.

"I don't think we should be bound by a timetable that isn't realistic," Sen. Olympia J. Snowe (R-Maine), a key swing-vote on health care, told Obama last week as she reminded him that President Lyndon B. Johnson took 1 1/2 years to pass Medicare.

Obama has not officially budged on the timetable, although he and aides notably have not mentioned the August deadline in recent remarks. But he is quietly working with conservative, Blue Dog Democrats in the House on an amendment to create an independent panel to govern Medicare reimbursement rates that could help reverse crippling health-care inflation.

Most difficult for Obama is the pressure to accept a tax on health benefits as a way of financing the massive insurance reform he wants.

Speaking on "Fox News Sunday," White House budget director Peter Orszag would not rule out support for the benefits tax, but he continued to promote Obama's preference for limiting deductions for wealthy taxpayers.

Some Democrats close to the negotiations say they think it is only a matter of time before Obama backs off. One proposal that has emerged would tax insurance companies, as opposed to beneficiaries, and is considered a potential compromise approach that he may be able to embrace.

Aides said Obama and his team plan a rapid response to new developments, as they did Thursday with a quickly arranged conference call to rebut assertions by the Congressional Budget Office that health-care costs would go up, not down, if the Democratic bills pass.

The effort began Friday with impromptu remarks by Obama from the Diplomatic Room, even as groups allied with the White House launched political ad campaigns this weekend aimed at wavering lawmakers. On Monday, his advisers say, he will do a round of interviews to drive the narrative for the week. Private meetings with lawmakers will become more frequent and urgent.

The decision to vault Obama to the front carries huge risks.

The decades-long drive to reform the health-care system now rests largely on Obama's ability to quell revolts among Democratic allies, many of whom have spent the past several weeks picking at pieces of his proposals.

If conservative House Democrats succeed in sowing fear of rising deficits, it will be seen as Obama's fault that he could not rein them in. If Democrats in the Senate do not agree on financing, Obama must explain the failure despite his party's majorities in both chambers.

The health-care debate was at the center of private discussions at the annual summer meeting of the National Governors Association over the weekend. The health-care legislation under consideration in Congress envisions a significant expansion in eligibility for Medicaid, whose costs are shared by Washington and the states. Their budgets squeezed by the recession, governors fear a costly mandate to cover the newly eligible. The governors devoted most of a private lunch to the issue Saturday and earlier voiced objections to Senate Finance Committee Chairman Max Baucus (D-Mont.) over funding plans.

Obama's top strategists, including Axelrod and Chief of Staff Rahm Emanuel, have repeatedly defended the administration's ambitious agenda by saying that success breeds success -- each legislative victory makes the next one easier to accomplish, they insist. The flip side, then, is that a health-care failure could doom the rest of Obama's agenda.

Obama's advisers express confidence that the setbacks of the past week can be overcome, and they insist they have spent "no time" discussing the impact on his political fortunes if health-care reform does not pass this year.

"We don't do doom-and-gloom," Axelrod.

But the president's top advisers also recognize that the sense of optimism about health-care reform that existed in Washington several months ago has largely evaporated.

Cable news programs repeatedly declare the president's health care program is "teetering" or "embattled," despite a week in which Obama's proposals were endorsed by the doctor and nurses associations and committees in both legislative chambers passed major bills.

"We're swimming upstream against a culture of failure on health care in Washington," said one adviser, who spoke on the condition of anonymity to discuss the administration's strategy.

The White House decided early in the year on a hands-off approach to health-care legislating.

"Had we put a plan out, the entire debate would have been changes to the plan," said Emanuel, a veteran of the failed Clinton health battle. "It would have been how the president is failing or succeeding."

But even as he shifts into a more active role, Obama must be mindful of his legislative allies. Rather than strong-arming these old bulls, the White House must tiptoe around them.

Baucus was a veteran lawmaker in 1994 when the Clinton plan ran aground. House Energy and Commerce Chairman Henry A. Waxman (D-Calif.) is a leading health-care expert. Senate health committee Chairman Edward M. Kennedy (D-Mass.), who is battling brain cancer, voted to create Medicare in 1965.

For health-care reform to succeed, Obama will have to carefully navigate between paying the appropriate respect to those men while exerting the leadership that many are demanding.

"It's getting hotter, and there are bumps, but we are closer to health-care reform than ever before," Emanuel said.

Staff writer Alec MacGillis contributed to this report.