With Democratic health care reform efforts in jeopardy, President Obama takes the unusual step of addressing a joint session of Congress next Wednesday to try to convince wavering Democrats -- and skeptical Americans -- that his health care plan isn't just important but vital.
"We've been talking for months and months, all the ideas are on the table," White House senior adviser David Axelrod told ABC News. "We're 90 yards down the field. Now we have to pull those strands together and deliver an overall vision of where to go. Now it's time to close the deal, and that is when you make your final appeal."
The president, Axelrod said, wouldlay out specifics of what he wants in the bill and how it would help Americans with health insurance and those without it. Obama will address at least three thorny topics -- how to pay for the bill, how to keep it deficit neutral and how it will affect insurance.
The hefty cost of health care overhaul -- the bipartisan Congressional Budget Office estimated in June the price tag could go up to $1 trillion over 10 years for some proposals -- has many Democrats worried about how the government will pay for it. The president has repeatedly said he would not sign a bill that adds to the budget deficit, but many moderate and conservative Democrats are still not convinced.
Liberal and progressive Democrats in the House are concerned about signals the White House had sent that it wouldn't insist on a government-run public health care option to compete with private insurers and drive down costs. It's unclear how specific the president will be in demanding that this be a component of the bill, given the apparent lack of support for such a measure among Democrats in the Senate.
But there remains a public education component, aides said. Many Americans are concerned about how reform will affect their existing health insurance plans, and the coverage provided by their employees. A health care survey by Thomson Reuters released last week found that many Americans lack confidence that health care reform will result in more affordable or better-quality medical care.
The president will, aides said, discuss what's in the bill and its impact on the 200 million Americans who have private health insurance. He will also address what's not in the bill, taking on some of the myths surrounding the debate, aides said.
"The president is going to deliver a forceful message about how to reform this system in a way that brings stability to those that have insurance and to help those that don't have insurance get the coverage they can afford," Axelrod said. "What they are going to see is the president of the United States make a very strong case for what we have to do and why we have to do it at a pivotal moment in this debate and a pivotal moment for our country."
White House officials are looking at four bills circulating in Congress and other proposals to try to bring together legislation that a majority in both the House and Senate will pass.
This approach was clearly not plan A -- the president had wanted Congress to pass bills before the August recess, but that stalled not only because of Republican resistance but because many Blue Dog fiscally conservative Democrats wanted a clear plan on how the government would pay for health care reform.