That decision -- to go big one last time, rather than small -- emerged quickly inside the White House after senior advisers to President Obama concluded privately that his goals for comprehensive changes to the health-care system could not be done piecemeal.
And after initially reeling from the surprise election of Republican Scott Brown to the Senate in Massachusetts, Obama's chief political strategists came to believe that voters would punish Democrats more severely in this year's elections for failing to try, they said.
"This is a big, long-term threat to families, businesses and the solvency of the country," senior adviser David Axelrod said, describing the thinking inside the West Wing. "And we've come a long way. And this is an opportunity to try and complete it and deal with a problem that we know is only going to get worse."
Obama's top aides say they recognize the risk for the president if this latest effort fails, providing more ammunition to Republicans that the party in power cannot govern effectively. By once again embracing comprehensive reform, Obama could help the Republican narrative that he wants a government takeover of health care.
GOP reaction
Reaction Monday was swift and blunt from GOP leaders, who had been making the case for weeks that the president should scrap the previous bills and start over. They said Obama's latest move represented more of the same problematic policies that Democrats in Congress had been pushing for months.
"The longer Washington sticks with its failed approach to health care, the longer Americans have to wait for the real, step-by-step reforms that will actually lower costs and lead to a better system," Senate Minority Leader Mitch McConnell (R-Ky.) said in a statement Monday.
But White House advisers said they concluded weeks ago that there was still a narrow path to legislative and political victory -- either by securing a modest amount of bipartisan support at a live, televised summit on Thursday or, more likely, by using parliamentary maneuvers to pass the legislation in the Senate without needing 60 votes.
On Capitol Hill, it took longer to come to accept that view, according to legislative and White House sources. Democratic members worried that they, too, might fall to the populist anger that swept Brown into office. And polling out of Massachusetts suggested that even voters who were wary of health-care changes wanted bipartisan cooperation -- and did not want Brown to be a roadblock.
"The White House position was not to push [legislators] -- let them come to it," said a senior Democratic strategist who has advised the president and his team on health-care strategy. "It was clearly one that members had to be given the space to come to this decision."
A senior Democratic Senate aide described this week's efforts as a welcome "attempt to try and change the story line" on health care, which he said had become mired in the legislative process. He said the president is trying to demonstrate that he is willing to go the "last mile" to get it done.
"Now that we've gotten a plan, we're going to need the active and ongoing engagement of the White House and the president," the aide said, reflecting a view among Democratic lawmakers that Obama has been slow to lead on the contentious issue. "They're not just going to be able to dump it on us." In the House, particularly, Democratic leaders are not assured of the votes they need for passage.
After hinting for weeks that he would pivot exclusively to jobs this year, Obama has also bet that success on health care will help repair some of the damage to his reputation from a bruising, year-long legislative battle that called into question his commitment to transparency, open debate and reform.
Shaping the debate
After Obama's question-and-answer session with House Republicans last month was met with a surprisingly favorable reaction, White House officials saw a potential opening for the president to step in and shape the debate. It fit a familiar pattern: Repeatedly, as a candidate and as president, Obama had delegated a difficult task to others and, after watching them falter, attempted a rescue himself, leaning heavily on his intellect and rhetorical skills.
"That's a big promissory note that's out there," said William Galston, a senior fellow at the Brookings Institution. "Now he has to redeem it. He has to fight for it. That means he has to do a lot of one-on-one advocacy. It's not going to be enough to receive groups of people ceremoniously."
Now, the White House is working to sell the president's plan as a reasonable compromise that bridges differences between the House and Senate versions and includes select ideas from Republicans. And they hope that, even if it fails, the new push can put Republicans on the defensive.
Well before the Thursday summit, which will be broadcast live on television, White House officials are making the case that Republicans must bring their own alternatives if they object to the Obama plan -- or risk being portrayed as obstructionists.
"I've seen, certainly, comments where folks have said, 'We should go just to tell everybody why this is a bad idea.' Well, that's great," White House press secretary Robert Gibbs said. "I just hope that the second page of the talking points that those guys, that any individual, would bring on that would be to list what you would do."
The White House's best hope -- perhaps its only hope -- is that Obama can use a masterful performance during the six-hour appearance to "stiffen the spine" of congressional Democrats, one senior official said, persuading them to pass health-care legislation using the mechanism known as reconciliation, which requires a simple majority of 51 rather than 60 votes to prevail in the Senate.
Reconciliation had once been seen as a risky maneuver that Republicans could use against Democrats in the fall midterm elections, portraying it as a partisan move. Now, White House officials say, it is the likeliest outcome if they hope to advance anything resembling the health-care proposals already on the table.
"This is our last, best hope for comprehensive health-care reform," sad a senior administration official, speaking on the condition of anonymity to speak frankly about the Thursday summit, which is being described as a "starting point" rather than an end phase.
As one senior administration official put it, "this is like the 'last exit for gas' sign on the interstate."
Now that the White House is committed, can the Dems get HCR done? Please, do.
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