By Michael D. Shear
Washington Post Staff Writer
Saturday, April 17, 2010; A03
President Obama's decision Thursday night to grant same-sex couples hospital visitation rights is the latest and most visible example of a strategy to make concrete steps toward equality for gays and lesbians without sparking a broad cultural debate or a fight with Congress.
The approach has angered some of the president's fiercest supporters, who are eager for bold change, but other politically savvy activists have encouraged Obama to act in small ways to reshape government rules and regulations on behalf of gays and lesbians.
Soon after Obama's election, staffers from the Human Rights Campaign presented the transition team with a list of 70 actions the president could take without congressional approval.
The activists sat in a room at the transition's headquarters as a stream of soon-to-be officials with the departments of Justice, State, Labor and Health and Human Services rotated in for discussions, according to several of those present. Melody Barnes, who now heads the president's domestic policy council, sat in, too.
Over the next several months, the administration quietly began acting on the recommendations: The State Department started issuing embassy ID cards to same-sex partners of diplomats; Housing and Urban Development ended discrimination in housing assistance programs; HHS pledged to change its policies regarding HIV-positive visitors and immigrants.
And then, last May, HRC staffers got a call from Obama's legal office. Top officials in the White House had seen a gut-wrenching story about a lesbian couple who had been kept apart in the hospital when one collapsed and died. It was time to act, they decided.
"They were thinking about how do you do it. What are the legal ways that HHS can address this issue?" recalled Allison Herwitt, the legislative director for HRC. "They picked up the phone to say, 'We are really energized about this issue.' "
Nevertheless, the issue of hospital visitation languished for months as the White House got pulled deeper into the health-care debate and other pressing issues.
Kevin Cathcart, the executive director of Lambda Legal, which had filed a lawsuit on behalf of the Florida couple, said he repeatedly raised the issue with White House officials in telephone calls, private conversations and group meetings.
And then, several activists were invited to a March 9 meeting at the Old Executive Office Building. Members of the White House counsel's office were there, along with officials with the Office of Public Engagement, including Brian Bond, who handles gay and lesbian issues for the president. They discussed the ramifications of government action on the hospital issue.
West Wing officials made it clear that things were about to move quickly. "We're on track to getting this," they told those assembled.
Around the same time, other officials began talking to hospitals with religious affiliations to gauge what the reaction might be. Josh Dubois, who is in charge of the president's outreach to the religious community, called Sister Carol Keehan of the Catholic Health Association.
"They reached out to say this was a concern of some groups, and they wanted to know were there any obstacles," Keehan said.
Keehan's response was positive. Friday, the CHA issued a statement saying that Obama's memorandum "reaffirms these basic human rights for each person at most critical points of their lives."
It will take more than six months for the Department of Health and Human Services to implement Obama's order.
Despite the concerns of some gays and lesbians, officials at Washington area hospitals say they rarely encounter situations in which gay couples have been kept apart. Visitation limits apply only to hours and the number of people in a room, they say.
Bill Robertson, president of the Adventist Healthcare system that includes Washington Adventist and Shady Grove Adventist hospitals, said the faith-based organization "does not impose our worldview relative to any range of things, other than that people deserve compassion and the best of care."
In Virginia, a 2007 law mandates the kind of visitation policy Obama ordered.
Cathcart said he is pleased that his client's case helped push Obama to take action. But like many gays and lesbians, he describes the pace of change as "frustratingly slow."
"They can and should and are starting to do the smaller things," he said. "But if they can't work with Congress to deliver something more . . . there's still going to be a lot of anger and frustration in the community."
Staff writer Lena H. Sun contributed to this report.