The morning after President Barack Obama urged Congress to finish the job on health care overhaul, a key moderate Democrat on Thursday likened the sweeping legislation to a patient hovering near death.
"I think it's on life support, but it still has a pulse," said Sen. Mary Landrieu, D-La. "If there is a way forward, some of us are really committed to finding it. It doesn't look clear how we're going to move it."
Another Senate moderate, Mark Pryor of Arkansas, had a similar assessment.
Asked if it's possible that no health care bill will emerge this year, Pryor responded: "I think it is a real possibility — I don't know that it's a probability.
"It's very possible that health care is just a stalemate and you can't solve it this year," he said.
The downbeat assessments came even as House Speaker Nancy Pelosi, D-Calif., reaffirmed her resolve to revive the bill, which has been in limbo since Democrats lost their 60-seat Senate majority in a Massachusetts election last week.
Obama gave lawmakers no specific guidance on how to move forward in his State of the Union message, and some lawmakers said they would have liked to hear more details. Several warned that Obama will need to make a sustained effort to nudge the legislation to the finish line.
Sen. Evan Bayh, D-Ind., said, "No speech can untie that Gordian knot" — referring to the complexities confronting Democrats as they consider how to untangle far-reaching bills, passed separately by the House and Senate, now that they lack the 60 votes needed to advance legislation in the Senate. Republicans are practically unanimously opposed.
Democrats from the president on down want to turn their attention to jobs and the economy and not spend much more time debating health care, as they did for much of the past year. Rather than attracting voters' support, the debate alienated them, as Obama acknowledged Wednesday.
"This is a complex issue, and the longer it was debated, the more skeptical people became," the president said. "I take my share of the blame for not explaining it more clearly to the American people. And I know that with all the lobbying and horse-trading, the process left most Americans wondering, 'What's in it for me?'"
But the problems with the current system aren't going away, Obama said, citing rising premiums and deficits, along with small businesses that are dropping coverage and patients being denied care.
"I will not walk away from these Americans, and neither should the people in this chamber," he told the gathering and a prime-time TV audience.
Reaching out to the GOP
Obama extended an olive branch to Republicans, saying he would welcome suggestions from anyone from either party on moving ahead. Republicans responded by saying they did have ideas, such as limiting medical malpractice awards, even as they rejected Obama's approach. The president would ban insurance company practices like denying coverage based on pre-existing conditions, while requiring nearly all individuals to carry insurance, with the aim of extending coverage to more than 30 million uninsured.
"All Americans agree, we need a health care system that is affordable, accessible and high quality," Virginia Gov. Bob McDonnell said in the Republican response to Obama's address. "But most Americans do not want to turn over the best medical care system in the world to the federal government."
Democratic leaders say they will pull together in the end and pass comprehensive legislation, but time is working against them, especially with primaries and midterm elections approaching. Two remaining routes to get comprehensive legislation on Obama's desk aren't easy. One involves Senate Democrats using a special budget-related procedure that requires only 51 votes to make changes in the bill acceptable to the House. Two centrist senators have already said they would oppose the maneuver, which is certain to enrage critics on the political right.
To complicate matters, the changes House Speaker Nancy Pelosi is demanding in the Senate bill would cost $300 billion over 10 years, according to a senior Democratic aide who spoke on condition of anonymity because of the sensitivity of the talks between House and Senate leaders. The changes include easing a tax on high-cost insurance plans, closing the Medicare prescription coverage gap and extending to all states Medicaid deals that Nebraska and Louisiana got.
Pelosi floated a new strategy Wednesday of passing some smaller bills that reflect popular proposals even as she continues working with the White House and the Senate to move comprehensive legislation.
The other option Obama and his allies have is to lower expectations and pass a scaled-back bill that might attract support from Republicans and political independents.