Health Care Reform Fades on Obama's Agenda

(Jan. 27) -- Health care reform was supposed to be the crowning achievement of President Barack Obama's first year. Instead, it was little more than a footnote in a his first State of the Union speech, which focused on jobs and the economy.

The president did not get to his signature issue until after he had declared jobs his "No. 1 focus in 2010" and talked about financial reform, clean energy and education first. Only then did he get around to the elephant in the chamber.

"By now it should be fairly obvious that I didn't take on health care because it was good politics," Obama said, eliciting laughter from the gathered lawmakers. Then, stating what many pundits by now consider the obvious, the president recounted what went wrong.

"This is a complex issue, and the longer it was debated, the more skeptical people became," he said. "I take my share of the blame for not explaining it more clearly to the American people. And I know that with all the lobbying and horse-trading, this process left most Americans wondering what's in it for them."

But, he said, the problem is not going away. "By the time I'm finished speaking tonight," he said, "more Americans will have lost their health insurance. Millions will lose it this year. Our deficit will grow. Premiums will go up. Patients will be denied the care they need. Small business owners will continue to drop coverage altogether. I will not walk away from these Americans, and neither should the people in this chamber."

Obama spoke after months of grueling negotiations on both sides of Capitol Hill that saw clashes over everything from a public insurance option to abortion coverage yet seemed within reach until last week. The election of Scott Brown in Massachusetts as the 41st Republican senator left few commentators predicting that health care reform could survive.

"I know it's an election year," Obama said at one point. "And after last week, it is clear that campaign fever has come even earlier than usual. But we still need to govern."

Signaling that he wasn't done fighting for health care, he appealed to the senators and House members before him.

"As temperatures cool, I want everyone to take another look at the plan we've proposed," he said. "There's a reason why many doctors, nurses and health care experts who know our system best consider this approach a vast improvement over the status quo. But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.

"Here's what I ask of Congress, though: Do not walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people," he said. "Let's get it done."

Hours before the address, Speaker of the House Nancy Pelosi sent mixed signals on how to get it done.

In an interview with Politico, Pelosi said she would consider a piecemeal approach that would put elements of the legislation up for a vote separately now that comprehensive legislation appears beyond reach of the 60 votes needed to pass the Senate.

But Pelosi also told columnists that she could round up enough votes in the House to pass the Senate version of health care reform if it is done through the reconciliation process. The controversial tactic requires only 51 senators for approval instead of the filibuster-proof 60.

Obama has admitted that his hands-off approach to health care reform may have been a mistake. Yet in his speech, "He clearly is leaving it in Congress' court," said Gail Wilensky, a senior fellow at Project Hope who headed the Medicare and Medicaid programs under the first President Bush. "It was as non-specific as you could get."

Another conservative, Stuart Butler, head of domestic policy at the Heritage Foundation, agreed that the president needs to take the reins on the issue.

"Candidate Obama pledged to lead in a bipartisan way on health care," he said. "But President Obama handed over the reins to a very partisan House leadership. The result was a free fall in public support. He's got to be candidate Obama again, build broad support by reaching out to both parties."

David Kendall, senior fellow for healthy policy at Third Way, a centrist Democratic think tank, said after the speech that Obama had "shifted the momentum towards passing health care reform" by putting it in the context of his larger economic program.

"He didn't walk away from the challenge of passing controversial policies," he said. "He made reform more important than ever to the success of his agenda. Without reform, the middle class will have less money to spend on college for their children, more anxiety about losing their coverage, and greater health care costs when they retire."

Democratic pollster Celinda Lake agreed with Obama that "once the House settles down a bit, they will realize they have to pass it."

"There's still an enormous amount of momentum behind health care reform," Lake said. "For Democrats, ideology does matter and Democrats truly believe in this. It will be very hard for the president or the Democrats to walk to away from it. "