WASHINGTON (AP) - His health care remake near collapse, President Barack Obama on Wednesday implored lawmakers not to abandon a historic opportunity even as he accepted part of the blame for failing to sell the complex plan to average Americans.
"Do not walk away from reform," Obama pleaded with Congress in his first State of the Union speech. "Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people."
Obama defended his ambitious proposal, saying it would protect most Americans from being rejected for insurance if they get sick, preserve choice of doctors, bring down the federal deficit and provide affordable coverage for millions now uninsured.
But the loss of their 60th Senate seat in a Massachusetts election last week cost Democrats the ability to override Republican opposition in Congress, leaving them with no clear path to finish health care overhaul just when it was on the verge of passage.
Deep disagreements between House and Senate Democrats have broken out over how to move forward. Lawmakers say it will take more than a speech to salvage the plan - if indeed it can be done.
"I take my share of the blame for not explaining it more clearly to the American people," Obama said. "And I know that with all the lobbying and horse-trading, this process left most Americans wondering what's in it for them."
Before Massachusetts, Democrats had dreamed of the ultimate Washington photo-op: a beaming president striding into the House chamber to give his speech following a final vote to pass health care overhaul.
"That didn't happen," said Rep. George Miller, D-Calif., one of the authors of the House bill. "That's the legislative process."
Although Miller believes Democrats will, in the end, pull together and pass comprehensive legislation to expand coverage and try to control costs, other lawmakers worry they will have nothing to show voters for more than a year of grueling work.
Time is working against Obama's health care plan, especially with primaries and midterm elections approaching. Still, Obama urged Democrats and Republicans to let temperatures cool and take another look at the bills passed by the House and Senate last year.
House Speaker Nancy Pelosi said that giving up is not an option. "I don't see that as a possibility," said Pelosi, D-Calif. "We will have something."
Neither of two remaining routes to get comprehensive legislation on Obama's desk are easy. One involves Senate Democrats using a special budget-related procedure that requires only 51 votes to make changes in the bill acceptable to the House. Two centrist senators have already said they would oppose the maneuver, which is certain to enrage critics on the political right.
To complicate matters, the changes Pelosi is demanding in the Senate bill would cost $300 billion over 10 years, according to a senior Democratic aide who spoke on condition of anonymity because of the sensitivity of the talks between House and Senate leaders. The changes include easing a tax on high-cost insurance plans, closing the Medicare prescription coverage gap and extending to all states Medicaid deals that Nebraska and Louisiana got.
Pelosi floated a new strategy Wednesday: passing some smaller bills that reflect popular proposals even as she continues working with the White House and the Senate to move comprehensive legislation.
According to Rep. Tim Walz, D-Minn., the House could vote to repeal the insurance industry's decades-old antitrust exemption, and may also act to revamp the way Medicare pays hospitals and doctors. Neither of those measures would expand coverage, but the Medicare changes could improve the quality of care and reduce costs over time. The House could vote within weeks on the antitrust measure.
The Medicare changes may find support in the Senate, but the antitrust repeal was left out of the Senate bill.
The other option Obama and his allies have is to lower expectations and pass a scaled-back bill that might attract support from Republicans and political independents. It wouldn't come close to covering all Americans, but it could smooth some of the rough edges of today's coverage problems, and provide help for small businesses to get and keep health insurance. Republicans, however, may not be willing to help.
Republicans are getting ready for a new phase in the debate. House GOP members on Wednesday signed a "Declaration of Health Care Independence" that lists their priorities, including no new mandates and legislation that's fully paid for.
In the GOP response to Obama's speech, Virginia Gov. Bob McDonnell said Republicans will resist expanding the role of the federal government in health care. He called for limits on jury awards in medical malpractice cases and allowing insurance companies to sell coverage across state lines.
"Our solutions aren't thousand-page bills that no one has fully read, after being crafted behind closed doors with special interests," McDonnell said.
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Associated Press writers Julie Pace and Erica Werner contributed to this report.