On Wednesday, September 9, President Obama will discuss health care reform before a joint session of Congress. During this address, the President is expected to detail what he wants accomplished with health care reform and explain why those issues are important. Until this time, the Administration has offered guiding principles for lawmakers but left the heavy lifting and specific policymaking to Congress. In addition to detailing specifics, in delivering his address, the President has the tough job of navigating through certain “hot button” issues and fragile dividing lines drawn by those who support health care reform.

On the one hand, President Obama must placate lawmakers who either oppose or desire to limit the scope of a government-run public option. For example, the fiscally conservative Blue Dog Coalition – that, in July, successfully negotiated with House Energy and Commerce Committee Chairman Henry Waxman to allow doctors and other health care providers participating in a government- run public plan to negotiate their own payment rates rather than be compelled to receive Medicare rates – remain committed to their approach. Without the deal struck with Chairman Waxman, the Blue Dogs would have been able to hold up the House bill in Committee. The President also must reassure moderate and conservative Democrats who have grown increasingly wary of the political ramifications of passing a health care overhaul that the public views as being too liberal. Among Republican negotiators in the “Gang of Six,” Senate Finance Committee (SFC) members, Charles Grassley (R-IA) and Michael Enzi (R-WY), last week expressed their continued support for bipartisan efforts. However, neither Senator Enzi nor Senator Grassley supports a public option. Notably, a draft health care reform proposal circulated on September 5, by Senator Max Baucus (D-MT), chairman of the SFC, to his “Gang of Six” colleagues did not contain a government- run public option.

On the other hand, the President is faced with lawmakers who adamantly support the inclusion of a public plan in health reform legislation. Last Thursday, the Congressional Progressive Caucus, the largest nonparty caucus in Congress with 83 declared members working to advance progressive issues and positions, sent President Obama a letter stressing the urgency of health reform. In the letter, the group emphasized that any health care bill that does not provide, at a minimum, a public option built on the Medicare provider system and with reimbursement based on Medicare rates would be unacceptable. In the letter, the group stressed that “[a] health reform bill without a robust public option will not achieve the health reform this country so desperately needs. We cannot vote for anything less.” House Speaker Nancy Pelosi also continues to emphasize that a public option is essential to health care reform.

With so many lawmakers at odds on a key specific component of health care reform, it is unclear how, and to what extent, President Obama will address this issue on Wednesday and bridge the divide among supporters of health care reform. What the Administration has made clear is that the President can no longer allow Congress to be the chief architect and spokespersons for the overhaul of a health care system in which so many have a deeply vested and often personal interest. Although President Obama is taking control of the health care messaging and will, in his clearest pronouncement to date, set forth those specific measures which must be included in a reform bill that he is willing to sign, he is not expected to draw a line in the sand with respect to the public option.

Whatever course is set, it seems clear that the President will have to convince the American people and a sufficient number of lawmakers in both the House and the Senate to vote in favor of a health reform plan which will bear the undeniable mark of the President of the United States.