When he addresses a joint session of the U.S. Congress on Wednesday night, President Barack Obama will face difficult hurdles in persuading skeptical members of his own Democratic Party as well as minority Republicans to support his vision of how to move the country forward on health care reform.
After more than a month in which the health care debate moved from Capitol Hill to the home districts of members of Congress, the focus has shifted back to Washington and what many analysts say will be Barack Obama's most important address of his presidency.
With three versions of health care legislation approved so far by House of Representatives committees, and one by a Senate panel, Democrats must forge legislation that has a chance of passing in either chamber, and win as much support as possible from Republicans who are nearly united in their opposition.
President Obama used a speech on Monday in Cincinnati, Ohio to rally support for his cause, suggesting that Republicans and other opponents of the Democrats' reform plans have offered no solutions of their own. "I've got a question for all those folks, 'What are you going to do. What is your answer? What is your solution?' And you know what? They don't have one," he said.
The president met on Tuesday with House Speaker Nancy Pelosi and Senate Democratic leader Harry Reid to discuss strategy. Pelosi again drew a link between the need to reform the U.S. health care system and efforts to stabilize the economy. "The present situation is unsustainable. And as the president has said, health care reform is entitlement reform. So in order for us to reduce the [federal budget] deficit, it is essential that we have real health care reform," he said.
Remarks earlier on the Senate floor by Senator Reid and Republican leader Mitch McConnell showed that basic arguments for and against proposals put forward by the Democrats and supported by the president have not changed.
Reid accused Republicans of using disruptive tactics in opposing reform, while McConnell asserted that Americans have made clear they oppose Democrats' plans.
REID: "It is painfully clear to everyone who has seen this debate's disturbing turns and dishonest tactics [that] now more than ever we need people willing to work together in good faith."
MCONNELL: "The White House has attempted to re-tool its message on health care many times. It should be clear by now that the problem is not the sales pitch, the problem is what they are selling."
The focus of controversy continues to be the proposed government-sponsored public health insurance option to provide Americans with an alternative to private company insurance plans, which Republicans assert would move the country toward socialized medicine.
After meeting with the president on Tuesday, Speaker Pelosi said inclusion of a public option will be essential to passing a bill in the House. Senator Reid referred to the need for a public option "or something like" it while House Majority Leader Steny Hoyer indicated he believes that a bill could be passed in the House without it.
House Democratic leaders still face opposition from some skeptical moderate and conservative Democrats, and demands from the most liberal Democrats that a government-sponsored public health insurance option be a mandatory part of a final bill.
Representative Jim Clyburn, who is responsible for generating Democratic votes, said he does not think Democratic leaders can achieve the 218 vote majority they need to pass a bill in the House, if a public option is not included.
However, he suggested that legislation could be passed that would allow, but not require, a government-sponsored insurance option, leaving a "robust" public option to emerge later.
As lawmakers prepared to hear from the president, Senate Democrat Max Baucus continued his efforts to win support from three key Republicans and two Democrats on the Senate Finance Committee.
White House spokesman Robert Gibbs told reporters on Tuesday that President Obama remains focused on results, saying he will speak directly to the American people on Wednesday night to clear up confusion and myths about what is and is not contained in health care reform proposals.
