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.
The president had wanted to spend the last few weeks, when lawmakers were back in their home states for August recess, reconciling the two bills, but instead August was defined by confusion, fear, anger and opposition to health care reform, as illustrated in many raucous town hall meetings.
Analysts said the president's speech needed to acknowledge the new landscape and not rehash what Americans have heard from him before.
"This is make or break time for President Obama on health care, because the public has turned so sour and he has a divided Congress. He needs to first rally the Congress, but more importantly, he needs to turn the tide of public opinion," said political analyst David Gergen. "This speech has upsides but it's also a very potentially tricky, very treacherous speech for him."
Gergen said the president's plan needs to be simple and specific, one that would convince lawmakers and citizens that it won't break the bank and get government involved in people's medical decisions.
"What he has been doing in the last few weeks has not worked, so this is clearly time to hit the reset button and reframe the argument, and that means he has to not only find a simple plan, but he has to come up with fresh ways for the public to understand it and to support it," Gergen said. "This is the 11th hour in the health care fight, and this is time for him to take charge, to rally the Congress and to rally the country. That's what's important in this speech."
One of the key points of contention that Obama will likely have to address is the idea of a government-run insurance plan that would compete with private companies. Republicans said a public option plan would drive private companies out of business and lower the quality of care Americans get. Some citizens who have shown up at town hall meetings have expressed concern that such an option would entail a government takeover of their health care coverage.
The president has enough support in the House for a public option plan, but he may not get the same camaraderie from the Senate.
If Obama doesn't push the public option, "that is going to bring a howl from his Democratic left" and "the unions that would be all over him," Gergen said. At the same time, "it may work with the public."
"We'll have to wait and see," Gergen added.
Beyond State of the Union speeches, addresses to joint sessions of Congress -- the definition of the presidential megaphone -- are rare. Presidents George W. Bush and Bill Clinton gave only two each in their eight years in office.
In fact, 16 years ago this month, Clinton gave an address about health care reform -- an anniversary the White House likely wants to forget, considering that the Clinton administration's health care push was unsuccessful.
ABC News' Huma Khan contributed to this report.