President Barack Obama's move to grant same-sex partners full visitation rights in hospitals is the latest example of his making concessions to liberals without getting too far ahead of public opinion.
Obama has moved just as cautiously, if not more so, on immigration and gays in the military. Supporters and some critics agree that he tries to walk a line that neither angers liberals who helped elect him, nor fires up conservatives hoping to defeat Democrats this fall and to oust Obama in 2012.
He seems to have struck that balance late Thursday, when he quietly began the process of requiring nearly all U.S. hospitals to allow patients to designate people who can visit and consult with them at crucial moments. Obama specifically cited gay men and lesbians, saying they "are often barred from the bedsides of the partners with whom they may have spent decades of their lives."
The directive made headlines nationwide. But it drew scarcely a whisper of complaints from Republicans or mainstream conservative groups.
Some gay rights activists, meanwhile, offered tepid praise, noting that it took Obama more than a year to fulfill a promise he made during his 2008 campaign.
Evan Wolfson, executive director of Freedom to Marry, called it "a small, but welcome step forward" that will help many people. But he added: "Piecemeal steps, addressing one protection at a time, will take up a lot more time than either the administration or American families can afford."
Activists noted that the administration is moving slowly to fully dismantle "Don't Ask, Don't Tell," the 17-year-old policy that has kept many gays and lesbians from serving openly in the military. And Obama continues to oppose same-sex marriage even as a few states have legalized it.
Obama's new announcement appeared to upset few hospitals, in part because many already follow the policy he described.
"Hospitals try to accede to a patient's wishes," said Jan Emerson, spokeswoman for the California Hospital Association. "So if the patient says 'I want so-and-so to be here,' unless there's some reason, like the patient has a communicable disease, the hospital is going to do what it can to abide by that."
At Washington Hospital Center in the nation's capital, Obama's order "is consistent with our policy," said chief nursing officer Elizabeth Wykpisz. "We have a non-discrimination policy" for visitors and patient representatives, she said, "and sexual orientation is part of that."
Some liberals see similar caution by Obama in other areas. In the long battle over revising health care laws, for instance, he quickly dropped a proposed public option for insurance, despite campaigning for it and seeing consistent liberal support for it.
Perhaps no constituent group is more frustrated than advocates of changing immigration laws to provide pathways to legal status for millions of illegal immigrants.
Last month, when up to 200,000 people marched in Washington for immigration reforms, Obama appeared in a video to say he would do what he can to forge a bipartisan consensus this year.
But lawmakers from both parties say far-reaching changes to immigration laws will be extremely difficult. Advocates are impatient.
"It's time to tell Congress that now that health care reform has passed, they have 200,000 good reasons to move immigration reform next," says the Web site of America's Voice, which supports an immigration overhaul.
Public opinion has shifted more dramatically on gay rights than on immigration in recent years.
President Bill Clinton's 1993 bid to allow gays to serve in military triggered a political firestorm, and the "Don't Ask, Don't Tell" compromise. But a top military official's recent call on Congress to allow gays to serve openly produced barely a ripple.
An August 2009 survey by the Pew Research Center found that 57 percent of Americans favored allowing gay and lesbian couples to enter into legal agreements giving them many of the rights married couples enjoy such as hospital visits and consultations on crucial health decisions.
But a clear majority opposed same-sex marriages, again in line with Obama's positions.
Obama has taken other steps to engage gay voters. He nominated an openly gay lawyer, David Huebner, as ambassador to New Zealand and Samoa. When the Senate confirmed him, he became the third openly gay ambassador in U.S. history and the first pick by Obama.
Obama has expanded some federal benefits to same-sex partners, but not health benefits or pension guarantees. He has allowed State Department employees to include same-sex partners in certain embassy programs available to opposite-sex spouses.
But many activists feel he has fallen short of his campaign rhetoric.
The hospital directive was "a smart political move" to address a "very real problem," said Richard Socardies, who was President Bill Clinton's adviser for gay policies. But he asked, "is this window dressing or the beginning of a refocused effort to get some of the easy stuff done," such as welcoming gays into the military and applying the State Department's domestic partner policies to other federal agencies.
Immigration is even trickier. Pew's polling "has found significant public support for both tougher enforcement and the so-called 'path to citizenship, but several factors suggest that the debate could be a difficult one," Pew's Scott Keeter said in a recent speech.
Opponents of pathways to legal status for illegal immigrants are more energized than are proponents, Keeter said in an interview Friday. And the nation's high unemployment, which is likely to continue well into next year, increases resentment of immigrant workers, he said.