The Play-by-Play on Health Care

The Democrat, Republican gap increases as some tell Obama to improve messaging.

Sept. 1, 2009— -- President Obama may have been on vacation for a week, but there's been no break in the debate over health care.

Republicans are stepping up their offensive as the time for lawmakers to convene back in Washington, D.C., approaches, and Democrats try to devise new strategies to gain Americans' support for their health care agenda.

Here's a rundown of what's really happening in the political world and when Americans can expect movement on health care legislation.

The Democrats' Angle

Sen. Ted Kennedy, who died last week after a battle with brain cancer, pushed health care overhaul until the very end of his life, and now many Democrats are evoking his memory to push their agenda and pass legislation. There is even talk of a bill being named after the late senator, who said health care reform was the cause of his life.

"I hope that his lifetime dream -- that America finally will follow Canada and every other advanced nation in the world in providing affordable health care to all of our people -- will pass," former President Bill Clinton said at a speech in Toronto Sunday, praising Canada's system, a model that many critics feel won't work for the United States.

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Kennedy pushed universal health coverage until the very end of his life and was a strong proponent of making health insurance a requirement for all Americans.

Democrats say Kennedy's death may help re-energize the debate in Washington, which has been increasingly divided not just across partisan lines, but even within the Democratic Party. Some conservative Democrats are opposed to measures proposed by the president and want clarity on how the government would pay for the overhaul.

Yet others say the way the message is being presented needs to be changed as Americans increasingly grow skeptical of health care reform.

Former Sen. Tom Daschle said the White House and Democrats need to do a better job at making the issue of health care reform "a moral imperative."

"I don't think we've succeeded at that yet," the former nominee for the position for Health and Human Services secretary said in an interview with The New York Times. "I think the more we can bring everybody to an understanding about how this in many respects is the civil rights battle of the early part of this century -- it's a fight for the disabled, it's a fight for the sick, it's a fight for equal rights when it comes to health."

Daschle said the GOP has demonstrated an "organizational strength" that is lacking on the Democrats' side and the left needs to do a better job at boiling the issue down to themes that "really motivate and have emotional value."

What Republicans Are Saying

While Kennedy's death is likely to have an impact in health care discussions on the Hill, some Republicans say that evoking his memory in the health care debate could set a dangerous precedent.

"He was the champion of this issue for a long, long time," Republican National Committee Chairman Michael Steele said on ABC News' "Top Line" Monday. "I am not of a mind to reform health care for the sake of anyone's memory, because I'm concerned how that impacts my mom and my dad.

"I disagree with his view of health care for this country -- that's part of the debate, but I don't want to see the country being guilted into health care because of the unfortunate passing of a great senator," Steele said.

Last week, Steele proposed a "seniors' bill of rights" to try to target the group of Americans most concerned about the changes that could occur in their benefits.

Several GOP leaders are wary about the future of bipartisan negotiations. Utah Sen. Orrin Hatch, a close friend of Kennedy's, pulled out of negotiations in the Senate before recess and Wyoming Sen. Mike Enzi lashed out at the Democrats' plan, saying it would "make our nation's finances sicker without saving you money."

Senate Republican leader Mitch McConnell of Kentucky said Monday there is no need for an overhaul of the entire health care system, calling the U.S. system the best in the world.

Given the divergent views, Republican leader and former Senate majority leader Bob Dole advised Obama to go at it alone and present his own bill, saying that the president should be "out front with his specific plan on this make-or-break issue."

"Many of us were taught that the president proposes and Congress disposes," the former senator from Kansas wrote in an op-ed Monday in The Washington Post. "Today, Congress is doing both -- with the president relegated to the role of cheerleader in chief as he campaigns for various House committees' efforts.

"Certainly, Obama supports much in these proposals -- but Barack Obama is our president, not a commentator," Dole wrote. "Right now, the president's biggest problem is with congressional Democrats, who are split and searching for a way out of the medical wilderness.

"In short, the president, Congress and the public are choking on all this, and choking is not covered by the legislation," he wrote.

According to Dole, once the president has clarified and put forth his position, the debate will narrow and will encourage bipartisan discussions.

Dole created the Bipartisan Policy Center with Daschle and another former senator, Howard Baker.

What Happens in September

As if some Democrats already hadn't taken a lot of heat from their constituents in town hall meetings -- Missouri Sen. Claire McCaskill's eventful town hall Monday again featured a chorus of boos and some cheers -- lawmakers could be in for a tough fight when they return to the Hill in September.

The House and Senate both reconvene next week, Sept. 8, and health care will be their topmost priority.

The president has said he would like to see some changes passed by the end of the year. While health care is likely to remain the dominant issue in the Senate, lawmakers also have to deal with other issues relating to the economy and job growth.

Latest From the White House

Obama returned from his week-long vacation in Martha's Vineyard Monday, and the White House pushed back critcism that the president has stepped away from the debate, saying that while the president may not be addressing the issue of health care openly, he has been talking with members of the Senate finance committee and members of Congress.

"Characterizing the role that the president is playing as inactive would be inaccurate," White House press secretary Robert Gibbs said Monday. "I think that just because the president might be doing something else doesn't mean he's not focused on health care."

Gibbs continued to defend the president's commitment to a bipartisan solution despite suggestions by some that Obama has given up on rallying the right.

"I think many may believe that we can't afford to do anything. I think this president believes we can't afford not to," he told reporters.

The Sticking Points:

How to pay for it: Some of the toughest opposition has come from within Obama's own party because of concerns about the cost of reform. The president has tried to calm those fears, saying that he would not vote for a bill that would add to the budget deficit, but that has done little to keep conservative Democrats and some Republicans from expressing concern.

The public option: The proposal for a government-run insurance program that would compete with private insurers has probably been the thorniest issue in the heated debate over health care. The bill last being considered by the Senate did not appear to include a government insurance option that Obama wanted. Instead, it included a proposal to create a system of nonprofit, but independent co-ops to provide insurance options outside the normal insurance industry.

Some say a public option is necessary to create more competition in the industry and provide Americans greater choice on their health care coverage.

"Ninety-four percent of the insurance markets out there right now are highly concentrated, which means a few companies dominate. They keep the price up. They can charge whatever they want and you don't have anywhere to go," said Richard Trumka, secretary-treasurer of the AFL-CIO, which represents labor unions.

"That's why the public option is so important ... to create competition, so that if that company gets a little out of hand, you have somewhere to walk to and go to, to the public plan that will keep it down," Trumka said Monday at the Center for American Progress.

Labor unions have staunchly supported Obama's proposed public option plan, which some Republicans fear will drive private insurance companies out of business.

The president will attend the AFL-CIO's convention Sept. 15 in Pittsburgh, Pa.

ABC News' Elizabeth Gorman contributed to this report.

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