Define his presidency

President Obama's success or failure in getting Congress to pass comprehensive health care reform this year could help define the rest of his presidency. If he fails, he would be politically weakened and would likely struggle to get the rest of his ambitious legislative agenda through Congress.

President Obama told ABC he would use his speech to "make sure that Democrats and Republicans understand that I'm open to new ideas, that we're not being rigid and ideological about this thing, but we do intend to get something done this year."

He dodged repeated questions on whether he would veto any health care bill that did not provide for a government-run health care plan to compete with private insurers.

"There are principles that if they are not embodied in the bill, I will not sign it," he said.

The bill should not increase the deficit, should expand health care coverage to the uninsured and include insurance reforms, he said.

Legislators have offered a variety of proposals, but appear divided over most of them.

Senate Finance Committee Chairman Max Baucus, D-Mont., who leads a group of six senators trying to craft compromise proposals, will put forward a plan including sweeping insurance market changes and a fee on companies that will help pay to cover the uninsured, said a source familiar with the proposal.

It calls for nonprofit cooperatives to compete with insurance companies but does not contain the government-run health insurance option sought by many liberal Democrats and backed by President Obama, the source said.

One administration official said the president would use his speech on Wednesday to articulate his vision of bringing affordable coverage to those 46 million Americans without insurance and more security to those who do.

"His plan will bring reforms that will reduce the unsustainable growth in the cost of health care, which has doubled in the last decade and will again, unless we act," said the official, who requested anonymity.

Insurance companies, pharmaceutical manufacturers, hospital managers—and average American patients—all have huge stakes in how the battle plays out.

"We're at the point in the legislative debate where he needs to put some things on the table and take some other things off," said Darrell West, director of governance studies at the Brookings Institution think-tank in Washington.

Getting the votes

President Obama discussed health care with Senate Majority Leader Harry Reid, D-Nev., and House of Representatives Speaker Nancy Pelosi, D-Calif., on Tuesday afternoon. The two Democrats expressed optimism after the meeting that a reform measure would pass.

Rep. Pelosi said she believed the House would not pass a reform bill without a public option.

Sen. Olympia Snowe, R-Maine, a member of the Senate negotiating group, supports a compromise that would not initially include a public option but would "trigger" the creation of a government program if insurance companies failed to meet cost and quality benchmarks.

President Obama's speech will be aimed at least as much at Democrats in Congress as the public. If he can energize and unite them, he can pass health care reform, analysts said. Reuters