Dreams of Obama’s health care victory lap dashed by political, legislative realities

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Obama will try to salvage health care bill

WASHINGTON — President Barack Obama had hoped a historic victory on health care would be the centerpiece of his State of the Union speech Wednesday. Instead, he’ll be appealing to jittery Democrats to save what was once his top domestic initiative, now stalled in Congress.

The loss of their 60th Senate seat in a Massachusetts special election last week cost Democrats the ability to override Republican opposition in Congress, leaving them with no clear path to finish Obama’s sweeping health care bill just when it was on the verge of passage.

House Speaker Nancy Pelosi, D-Calif., floated a new strategy Wednesday: passing some smaller bills that reflect popular proposals even as she continues working with the White House and the Senate to move comprehensive legislation.

According to Rep. Tim Walz, D-Minn., the House could vote to repeal the insurance industry’s decades-old antitrust exemption, and may also act to revamp the way Medicare pays hospitals and doctors. Neither of those measures would expand coverage, but the Medicare changes could improve the quality of care and reduce costs over time. The House could vote within weeks on the antitrust measure.

It’s definitely not where Democrats had hoped to be.

Before Massachusetts, they were envisioning the ultimate Washington photo-op: a beaming president striding into the House chamber to give his speech following a final vote to pass health care overhaul.

“That didn’t happen,” said Rep. George Miller, D-Calif., one of the authors of the House bill. “That’s the legislative process.”

Although Miller believes Democrats will, in the end, pull together and pass comprehensive legislation to expand coverage and try to control costs, other lawmakers worry they will have nothing to show voters for more than a year of grueling work. They want Obama to restore the sense of open-ended possibilities that accompanied his election.

“The president is a strong persuader, and I think it makes an awful lot of difference, and I think he will bring everybody together,” said Rep. John Larson, D-Conn. “Obama’s gotta be Obama.”

Until now, Obama hasn’t been able to make a convincing case that the 2,000-page Democratic bills will improve the lot of average working families already covered by health insurance.

The president previewed his message last week in recession-weary Ohio, when he told an audience of workers and business people it’s not possible to deliver popular reforms such as eliminating insurance denials for pre-existing medical problems unless nearly all Americans are covered. The nation would be better off with a big bill that makes deep changes in the health care system, he argued, rather than scaled-back legislation that borrows from a menu of political consensus items.

White House senior adviser Valerie Jarrett said the president will reaffirm his belief but will not lay out a game plan for breaking the impasse in Congress. It’s a difficult line to walk, since Obama needs lawmakers to move as quickly as possible. Time is working against his health care plan, especially with primaries and midterm elections approaching.

“Part of the American people’s frustration … is really not health care,” Jarrett said. “It’s watching month after month after month of Congress talking and talking.”

Pelosi said that giving up is not an option. “I don’t see that as a possibility,” she said. “We will have something.”

Neither of two remaining routes to get comprehensive legislation on Obama’s desk are easy. One involves Senate Democrats using a special budget-related procedure that requires only 51 votes to make changes in the bill acceptable to the House. Two centrist senators have already said they would oppose the maneuver. Such a move would be certain to enrage critics of the legislation.

The other solution would be to lower expectations and pass a bill that might attract support from Republicans and political independents. It wouldn’t come close to covering all Americans, but it could smooth some of the rough edges of today’s coverage problems, and provide help for small businesses to get and keep health insurance. Republicans, however, may not be willing to help.

The sweeping approach got an endorsement Wednesday from Catholic bishops. Without retreating on their objections to abortion funding restrictions in the Senate bill, the bishops cast health care overhaul as a moral imperative.

“The health care debate, with all its political and ideological conflict, seems to have lost its central moral focus and policy priority, which is to ensure that affordable, quality, life-giving care is available to all,” representatives of the U.S. Conference of Catholic Bishops said in a letter to lawmakers. “Now is not the time to abandon this task, but rather to set aside partisan divisions and special-interest pressures to find ways to enact genuine reform.”

Republicans are getting ready for a new phase in the debate. House GOP members on Wednesday signed a “Declaration of Health Care Independence” that lists their priorities, including no new mandates and legislation that’s fully paid for.

Associated Press writers Julie Pace and Erica Werner contributed to this report.