WASHINGTON — In pursuing his proposed overhaul of the health care system, President Obama has consistently presented himself as aloof from the legislative fray, merely offering broad principles. Prominent among them is the creation of a strong, government-run insurance plan to compete with private insurers and press for lower costs.
Behind the scenes, however, Mr. Obama and his advisers have been quite active, sometimes negotiating deals with a degree of cold-eyed political realism potentially at odds with the president’s rhetoric.
Early last month, for example, hospital officials were poised to appear at the White House to announce a deal limiting their industry’s share of the costs of the overhaul proposal when a wave of jitters swept through the group. Senator Max Baucus, the Finance Committee chairman and a party to the deal, had abruptly pulled out of the event. Was he backing away from his end of the deal?
Not to worry, Jim Messina, the deputy White House chief of staff, told the hospital lobbyists, according to White House officials and lobbyists briefed on the call. The White House was standing behind the deal, Mr. Messina told them, capping the industry’s costs at a maximum of $155 billion over 10 years in exchange for its political support.
Some Democrats and industry lobbyists now argue that, in negotiating deals through Mr. Baucus’s committee with powerful health care interests, the White House was tacitly signaling as early as last spring that it might end up accepting something more modest than the government insurer the president has said he prefers.
The Finance Committee, for example, appears to be coalescing around the idea of nonprofit insurance cooperatives instead of a government-run plan. It is a proposal the health care industry prefers, but many liberal Democrats oppose, in both cases because cooperatives are likely to have less leverage over health care prices.
Rahm Emanuel, the White House chief of staff, disputed that the administration had elevated the work of the Senate finance panel above the four other committees that have all approved strong government insurers.
“They are an important committee,” Mr. Emanuel said. “They have a bipartisan process. The president would like that to work, just as he is proud that the other committees have done their work. They don’t get an exalted status over everybody else.”
But he also acknowledged the political realities that have made the Finance Committee’s still-unfinished cooperative plan a center of attention.
“We have heard from both chambers that the House sees a public plan as essential for the final product, and the Senate believes it cannot pass it as constructed and a co-op is what they can do,” Mr. Emanuel said. “We are cognizant of that fact.”
Asked whether the president would accept the weaker co-op, Mr. Emanuel declined to comment. “I am not going to fast-forward the process,” he said.
Industry lobbyists and moderate Democrats in both chambers, though, argue that the White House’s actions behind the scenes show a recognition that the finance panel’s anticipated compromise is the most likely template for any final legislation.
“The House has largely been a sideshow,” said Representative Jim Cooper of Tennessee, a member of the so-called Blue Dog caucus of conservative Democrats. “The Senate Finance Committee is where it really matters. That’s the bottleneck.”
Members and staff of the four other committees working on health care say the White House has generally stayed on the sidelines of their work. “They have been — what is a good way to put it? — available for consultation,” Mr. Cooper said. “They haven’t been hands-off, but they haven’t been hands-on.”
Mr. Obama and his top aides have immersed themselves in the Senate Finance Committee process. The president talks to Mr. Baucus several times a week, people briefed on their conversations say. Mr. Obama has also held a few calls with the panel’s ranking Republican, Senator Charles E. Grassley of Iowa.
In addition, Mr. Obama invited both senators to a private lunch at the White House early in the summer and met with six panel members for another White House session last week. White House advisers have held long evening and weekend meetings with Finance Committee staff members, even poring over copies of the Tax Code together.
Nancy-Ann DeParle, charged with leading the White House health effort, has a standing biweekly meeting with Mr. Baucus, while Peter R. Orszag, the White House budget director, has spent so much time in the senator’s office that he helps himself to the Coke Zeros tucked away in Mr. Baucus’s personal refrigerator.
Lobbyists for both the drug and hospital industries say that, as early as June, White House officials directed them to work out cost-saving deals with Mr. Baucus’s committee.
Drug industry lobbyists said they negotiated a deal to contribute $80 billion over 10 years toward the cost of an overhaul with Mr. Baucus, under White House supervision, before taking it to the president for final approval. House lawmakers have said they were caught by surprise when it was announced.
Hospital industry lobbyists, speaking on condition of anonymity for fear of alienating the White House, say they negotiated their $155 billion in concessions with Mr. Baucus and the administration in tandem. House staff members were present, including for at least one White House meeting, but their role was peripheral, the lobbyists said.
Several hospital lobbyists involved in the White House deals said it was understood as a condition of their support that the final legislation would not include a government-run health plan paying Medicare rates — generally 80 percent of private sector rates — or controlled by the secretary of health and human services.
“We have an agreement with the White House that I’m very confident will be seen all the way through conference,” one of the industry lobbyists, Chip Kahn, director of the Federation of American Hospitals, told a Capitol Hill newsletter.
Mr. Emanuel and liberal Democrats argued that the White House had worked more closely with the Senate Finance Committee because it was stepping in to break up legislative logjams. In the same way, they said, Mr. Obama and Mr. Emanuel had personally interceded to resolve a last-minute revolt by conservative House Democrats that threatened to derail a bill in the House Energy and Commerce Committee at the end of July.
Representative Henry A. Waxman, the California Democrat who is chairman of the Energy and Commerce Committee, said the president had personally assured House members that he did not intend to let the Senate Finance Committee determine the final legislation.
“This is going to be a genuine conference with give and take,” Mr. Waxman said. “The president has said that personally to the senators, and he has said it personally to us.”
He added: “The president has said he wants a public option to keep everybody honest. He hasn’t said he wants a co-op as a public option.”
Still, industry lobbyists say they are not worried. “We trust the White House,” Mr. Kahn said. “We are confident that the Senate Finance Committee will produce a bill we fully can endorse.”
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