With speech, Obama aims to retake control of healthcare

After a rocky August, President Obama is hitting the reset button on healthcare strategy.

News reports indicate that the president will address a joint session of Congress on health reform next Wednesday during prime time.

The goal will be to reassert himself in a process that has divided congressional Democrats and left most Republicans in sharp opposition to key elements of the plans working their way through both houses of Congress.

By delivering the speech in the evening, Mr. Obama also hopes to reach significant numbers of Americans. Over the summer, public approval of his job performance and his healthcare initiative has steadily declined.

Reports indicate Obama intends to provide specifics about what he wants in the final legislation, something he has declined to do so far as various congressional committees drafted bills.

Whither the 'public option'?

At this point, talk of a bipartisan plan has evaporated. So, analysts say, what he needs to do is unite his own party, in both houses of Congress, and proceed from there.

One central question is where he will come down on the so-called “public option,” a public health insurance plan to compete with private insurers. Obama has said that he prefers including the public option, but has never insisted it be in any legislation that winds up on his desk.

Obama’s path is risky. If he ditches the public option, the left will be upset. But if he insists on it, he will lose critical votes of Democratic moderates. If he is vague, he could wind up where he is now – with the public not certain what he is proposing.

“It’s a real tightrope he’s walking here,” says Steven Schier, a political scientist at Carleton College in Northfield, Minn. “I would be surprised if he is that explicit personally about something as controversial in his own party as the public option in a major speech.”

The public option is only one element of a reform effort that initially aimed at sweeping change across the healthcare system. And so Obama will have plenty of other things to discuss.

Focusing on consensus

Chances are he will highlight what he says is the 80 percent of the package where there is consensus. These elements include preventing insurance companies from withholding coverage from customers with preexisting conditions or dropping coverage when a customer gets sick. Out-of-pocket expenses would be capped and caps on lifetime coverage would be stopped.

The plan also includes a mandate that people purchase health insurance through a new marketplace, or exchange. If families cannot afford insurance, they would get a subsidy. Healthcare providers would be given incentives to coordinate care, in an effort to bring down inflation.

It’s the remaining 20 percent of the reform that has caused much consternation. But the efforts of the various congressional committees to date won’t go for naught. Obama aides are reportedly going through the bills to see which elements to keep and which to skip.

One big challenge for Obama is that most Americans are satisfied with their own healthcare, even if they think the system as a whole needs fixes. When Obama insists that under a government-run reform, people will be able to keep their health plan and providers if they are satisfied, many are skeptical.

“If you look at polls, the public is more antigovernment than [it has] been in a long time,” says Mr. Schier. “The specter of calling a federal bureaucrat for healthcare is enough to send all kinds of voters – especially independents – around the bend.”

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