Obama Moves to Next Priority: Health Care

After signing a huge economic stimulus package and launching a plan to stem home foreclosures, President Obama will step before a joint session of Congress Tuesday and launch arguably the most ambitious component of his domestic agenda: a plan to provide affordable medical insurance to all Americans.

By designating health care as a top priority now, experts say Obama is trying to take advantage of a narrow window of opportunity when the public and many interest groups favor change and the economic crisis is making health coverage an imperative.

Overhauling the health system also keeps the public and Congress focused on big issues and the economic recovery, and away from Cabinet nomination glitches, mounting ambivalence about the cost of the stimulus package (PL 111-5) and stock market fears about a federal takeover of the banking system.

“The audience clearly is the country as a whole and the message is ‘let’s not lose sight of what still needs to be accomplished,’ ” said Linda L. Fowler, a presidential scholar at Dartmouth College. “Congress provides a backdrop for his message. He’s going over the lawmakers’ heads to get the public to pressure them to come around [to his thinking].”

Obama focused on how health care dovetails with the recession on Monday, telling governors gathered for their annual Washington meeting that he will release $15 billion of stimulus funds to help states meet rising Medicaid costs. Medicaid is the joint federal-state entitlement program that provides health care for the poor.

As a candidate, Obama called for creating national pools for individuals to buy their own inexpensive insurance and expanding eligibility for the poor and children to enroll in Medicaid and the State Children’s Health Insurance Program.

Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan think tank, and a senior adviser in the Clinton administration during its failed health overhaul efforts in the early 1990s, said by spotlighting health care in his address, Obama is fulfilling an important campaign promise and addressing an inefficient cog in the economic gearbox.

“You can’t fix the economy in the long run before you get health costs under control,” Nichols said. One immediate focus, Nichols said, is realigning payments the government’s big health programs Medicare and Medicaid make to doctors, hospitals and other providers so they have financial incentives to offer better care.

Obama hopes to offset any reimbursement cuts to hospitals and small physician practices by expanding coverage to 47 million uninsured Americans, many of whom now put off preventive care for chronic conditions.

The health care overhaul plan was supposed to be shepherded by Obama’s nominee for Health and Human Services secretary, Tom Daschle, a former South Dakota senator (1987-2005), and Senate majority leader.

Daschle’s withdrawal after revelations that he paid $140,000 in back taxes and interest in early January has left some of that task to Budget Director Peter R. Orszag and National Economic Council Director Lawrence H. Summers, both of whom have stressed the need to move quickly, according to Democratic sources.

“Its importance has been amplified by the economic downturn,” Nichols said.

Though Obama’s job-approval ratings remain strong, daily tracking by the [@url@Gallup Pollhttp://www.gallup.com/poll/116026/Assessing-Obama-Job-Approval-One-Month-Mark.aspx@] and Rasmussen Reports show his support has declined amid heightened concerns about the recession.

Experts say Obama’s challenge in selling complicated and expensive initiatives such as a health care overhaul will be to exude confidence in his agenda while tamping down expectations for a quick recovery.

“He’s torn between competing goals,” said George C. Edwards III, a presidential scholar at Texas A&M University. “It’s a sensible and honest thing to say we’re going to climb the hill and may not get there in one term, but it doesn’t give people a lot of confidence. And the people who are most unsure are independents who he’s going to need for political leverage.”

Obama can at very least try to sell change by pointing to the urgency of the problem.

One in six Americans younger than 65 lacks any form of health insurance and millions of others who have coverage are struggling to pay medical bills. An increasing number of Americans who aren’t poor or sick enough to qualify for public assistance — and who are grappling with rising food, energy and housing costs — are putting off visits to doctors and preventive tests, making them more likely to be hospitalized later for illnesses that could have been prevented.

Experts say the depth of the crisis actually gives Obama considerable latitude to propose bold policy solutions, as long as he can demonstrate taxpayer dollars are being spent responsibly.

“Franklin D. Roosevelt took power at a time when opposition to government spending was more intense than it is today,” said Benjamin Ginsberg, a political scientist at Johns Hopkins University. “Because we’re in an emergency, this administration has an enormous opportunity to be flexible. Speaking to the nation in a joint session of Congress underlines the urgency of the situation.”


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