Sept. 6, 2009 -- This Sunday, White House advisers and lawmakers previewed a big week ahead for President Obama, who will attempt to take the lead on health care reform, and regain momentum after a summer marked by heated, partisan and confusing debate.
White House Press Secretary Robert Gibbs and senior White House adviser David Axelrod sounded confident ahead of Obama's big speech to Congress this Wednesday evening, to be televised live to the nation. In the speech, they said, Americans would hear exactly where Obama stands on health-care reform.
"They'll leave that speech knowing exactly where the president stands, exactly what he thinks we have to do to get health-care reform done this year," Gibbs said on ABC News' "This Week."
"The president has an opportunity on Wednesday to speak to the nation and the Congress on this," Axelrod said on NBC's "Meet the Press." "We've been through a long debate now. All the ideas are on the table. It's time to bring the strands together and get the job done for the American people here."
Liberals, Conservatives Unwilling to Back Down Over Public Option
So far, consensus has been difficult to achieve, with lawmakers divided along inter- and intraparty fault lines over the best way to lower insurance costs, and how to pay for health care reform in light of an economic recession and a skyrocketing budget deficit.
The president is stuck in the middle, between Senate Republicans who could block much of what the president wants, and liberal supporters who want it all. Republicans reject the president's idea to create a the public option -- a government-run insurance exchange intended to compete with and lower the costs of private insurance. House Democrats overwhelmingly favor the idea. Progressive Democrats say they will not pass a bill without it.
"We support what the president has said all along he'd like to see, and that is a robust public option. He campaigned on it. He continues to talk about his support for it. And we're going to stand behind him. Nancy Pelosi has said that nothing is going to pass that floor without a public option," said Rep Maxine Waters, D-Calif., on ABC.
Former Democratic National Party chair Howard Dean, who is himself a doctor, said compromise on the public option is unacceptable.
"If, for whatever reason, he chooses to go in a different direction [than the public option], then I'd scale back the bill. I wouldn't spend five cents on it," Dean said on Fox. "I'm very hopeful that he will stick to his guns and that we'll have the reform we were promised in the campaign."
Despite the White House toning down insistence on the public option in recent weeks, Gibbs said the president would continue to support a public option in his speech Wednesday.
"He will talk about the public option and why he believes and continues to believe that it is a valuable component of providing choice and competition. It helps individuals and small businesses, at the same time provides a check on insurance companies so they don't dominate the market," Gibbs said.
Critics Says Public Option Alternatives Won't Work
Lawmakers have floated compromise alternatives to the public-option such as an insurance co-op -- a group of private insurers that would be set up by the government, but controlled by its members. Minnesota Gov. Tim Pawlenty, who is often mentioned as a potential 2012 GOP presidential candidate, said a co-op was not a viable solution.
"To say that that is the solution, I think, defies what we know about the experience with co-ops already. It hasn't substantially altered the trajectory of health care costs," Pawlenty said on CNN's "State of the Union."
Another compromise solution, recommended by a bipartisan group of former lawmakers including former Republican Sen. Bob Dole, is the idea of a public-option trigger that would give private insurers time to reform the industry and lower costs, but trigger the public option if they failed to do so by a deadline.
Sen. Ben Nelson, R-Neb., said he supported the idea.
"If there's going to be a public option, it has to be subject to a trigger," Nelson said on CNN. "In other words, if somehow the private market doesn't respond the way that it's supposed to, then it would trigger a public option or a government-run option, but only as a fail-safe backstop to the process."
However, Dean rejected the notion of postponing the public option.
"The problem is it won't work. It doesn't add anything. If you're going to do that, just do the insurance reform," Dean said on FOX. "Don't pretend you're doing reform."
Pawlenty rejected the idea of any type of public option, now or in the future.
"The trigger option simply kicks the can down the road," Pawlenty said. "All it does is delays the inevitable, and for a lot of reasons, it's a bad idea. I think, if the Democrats embrace the public option, even in the form of the trigger, they're going to shoot themselves in the foot."
Republicans Warn Against Using the Reconciliation Process
Despite these battles awaiting Congress when it returns from recess on Tuesday, the president remains committed to health care reform this year, fueling speculation that with a large Democratic majority in the House, and a Democratic majority in the Senate, Democrat lawmakers would resort to the budget reconciliation process, by which a bill could pass the House and Senate on an up-or-down vote, avoid a Senate filibuster, and require only a simple majority of 51 senators in order to pass.
Former Senate Majority Leader Tom Daschle said Congress should not rule out invoking the reconciliation process.
"If we can't do it any other way, we shouldn't be bound by this process. I think both parties have used it. We used it to pass a single most important health bill ever in the last 20 years, the Children's Health Insurance Plan. We used reconciliation to do that," Daschle said on ABC.
"The Republicans tried to use it to pass the Alaskan National Wildlife Refuge," Daschle said. "And they've used it for every tax cut so far. There's no question both Republicans and Democrats have used it in the past."
But Alexander warned Democrats of the consequences.
"One, it would create a bad health-care bill because under the provisions in the rules, the parliamentarian would write the bill, so all the senators would be voting on are tax increases or Medicare cuts, and you wouldn't get to put in the bill things like pre-existing conditions or buying insurance across party lines. So it would be a bad bill," Alexander said.
"Second, it would be thumbing your nose at the American people who have been trying to say to Washington for the last several months, 'Slow down. I mean, too many Washington takeovers, too much debt. You're meddling with my health care,'" Alexander said. "So thumbing their nose at the American people by ramming through a partisan bill would be the same thing as going to war without asking Congress' permission. You might technically be able to do it, but you'd pay a terrible price in the next election."
Failed Health Care Reform Could Hurt Democrats
But not getting anything passed could be costly, too. Some analysts are predicting Democrats could lose up to 25 seats in the House if health care reform fails.
"Democrats are on a dangerous slide. And when we see this kind of sea change in public option take place, it should be a flashing warning sign," David Wasserman, House editor of the Cook Political Report, said in an interview with ABC.
Indeed, since the beginning of the president's push for health care reform, his popularity has dipped according to the daily Gallup polls, from a high of 68 percent to 50 percent last week.
Stuart Rothenberg, editor of the Rothenberg Political Report, said health care reform was now critical for the president's credibility.
"If he is perceived to fail on health care, it is going to raise significant questions about leadership, his leadership, and really, when you get down to it, that's what the presidency is about," Rothenberg told ABC.
Still, Democrats remain hopeful the president can recapture a largely runaway debate over health-care reform, and improve his standings by taking a strong lead.
"I think he's got to stand up and lead and be strong," Dean said. "What people value more in a president than anything else is strength, and that's what we've got to see this week."
ABC News' David Kerley contributed to this report.