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Obama Readies Reform Specifics
In Health-Care Address, President Is Expected to Take Firmer Positions

By Ceci Connolly
Washington Post Staff Writer
Monday, September 7, 2009

Looking to rescue his signature domestic policy initiative with a prime-time address to Congress on Wednesday, President Obama for the first time is poised to "draw some lines in the sand" over the size and shape of legislation to remake the nation's health-care system, top advisers said Sunday.

Until now, Obama has resisted taking firm positions on specific elements of a broad health-care bill, instead expressing openness to many ideas. But the approach has left lawmakers divided over contentious elements, such as how to rein in costs. And with a growing chorus in favor of a slower, less ambitious approach, Obama is inching toward a proposal that would bear his name and carry the political risks of sponsorship.

The president returned from Camp David on Sunday and spent part of the day working on his address, some of which may be tested Monday in a Labor Day appearance in Cincinnati, aides said.

"People will leave [Wednesday's] speech knowing where he stands," White House press secretary Robert Gibbs said Sunday on ABC's "This Week." "And if it takes doing whatever to get health care done, the president is ready, willing and able to go do that."

Obama is not inclined to make veto threats, as President Bill Clinton did on the issue of universal health care, Gibbs added, "but I'm sure he will draw some lines in the sand."

Even as preliminary drafts of Obama's address circulated Sunday, administration officials continued to hold out hope that bipartisan talks in the Senate may provide a road map -- and political cover -- for the direction the president will take Wednesday.

"Let's see what the Finance Committee does," said one administration aide who is involved in health policy but is not permitted to speak to the media. "Then we'd have five bills to pull from."

Finance Committee Chairman Max Baucus (D-Mont.), after learning of Obama's plans to speak, suggested that he may be ready to introduce a bill this week. The announcement was evidence that the mere mention of an Obama speech "is already having an effect," said a senior White House official who requested declined to discuss internal deliberations publicly.

Others were more cautious.

"He doesn't have a consensus at this point in time," said Sen. Ben Nelson (D-Neb.).

Still, Nelson and several fellow Democrats hinted at a possible compromise on one of the thorniest unresolved questions: whether to create a government-run insurance plan -- or "public option" -- for individuals and small businesses that have trouble buying coverage in the private market.

From the earliest days of his presidency, Obama has made a top priority of twin goals: to extend coverage to millions of uninsured Americans and to slow the fast-rising rate of inflation for medical care. Many people worried that his initial efforts to frame the initiative in a broader economic context would exacerbate deficit woes, polls indicated.

In August, opponents seized control of the discussion, elevating side issues such as abortion and end-of-life counseling. Veterans of previous health-care debates said that the escalation of the attacks was to be expected, but that the White House was slow to respond.

Obama's speech to a joint session of Congress -- coming 16 years to the month after Clinton used a similar strategy to begin his health-care effort -- is intended to "refocus the debate back on why we need to do this," administration spokeswoman Linda Douglass said.

Liberal Democrats, with a nod from Obama, have pushed for the public option as a way to hold down insurance costs. But the industry, Republicans and some conservative Democrats argue that it could undermine the existing marketplace if it has the power to set prices. On Sunday, administration officials walked a fine line on the topic, maintaining that the president still prefers the option as a "tool" for creating competition in the health sector.

Nelson and Sen. Amy Klobuchar (Minn.), Democrats who occupy opposite ends of the ideological spectrum, gave tentative support to a backup concept initially raised by Sen. Olympia J. Snowe (R-Maine). Under the idea, a government-run program would be implemented only if private insurers could not deliver affordable insurance plans to most consumers within three to five years.

A similar fallback "trigger" was included in the Republican-sponsored Medicare prescription drug law, known as Part D. So far, the government drug coverage has not been needed.

"If somehow the private market doesn't respond the way that it's supposed to, then it would trigger a public option or a government-run option, but only as a fail-safe backstop to the process," Nelson said Sunday on CNN's "State of the Union" program. "And when I say trigger, you know, out here in Nebraska, in the Midwest, I don't mean a hair trigger."

Klobuchar said she was in wait-and-see mode, unwilling to accept or oppose the trigger idea until she could review the specifics of the plan.

Sources close to the Finance Committee negotiations indicated last week that the bipartisan negotiators known as the "Gang of Six" were leaning toward a third alternative: forming nonprofit, member-run health cooperatives. Baucus aides did not respond to calls Sunday about his preference.

The group, which may lose Sens. Charles E. Grassley (R-Iowa) and Mike Enzi (R-Wyo.), is also uncertain about how large a Medicaid expansion it could support and whether to tax insurance companies on pricier policies.

Several prominent Republicans counseled against comprehensive reform, suggesting that more modest changes to insurance regulation would have a better chance of being enacted.

Sen. Lamar Alexander (Tenn.), the third-ranking Republican in the Senate, suggested that Obama use Wednesday's address to scale back his ambitions.

"I think he should say, 'My fellow Americans, let's start over and let's focus on cost -- cost to you when you buy your health insurance, cost to the American people for their government, and let's do it step by step,' " Alexander said on "Fox News Sunday." "Let's don't try to change the whole system at once."

Staff writer Shailagh Murray contributed to this report.

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