WASHINGTON — With the struggle over healthcare entering an even tougher phase, President Obama has hit both a milestone and a speed bump in his dual pursuit of a major overhaul of the nation's medical system and a rebirth of progressivism in America.
House approval of legislation Saturday -- even if Democrats can move it no further -- was an accomplishment that has eluded presidents for decades. But the close vote and the exertions it took to secure a majority were laden with warning signs as the issue moves to the Senate.
Even though the House is a bastion of liberalism, the healthcare overhaul was a tougher sell than expected and the bill turned out to be more conservative in its price tag, more limited in the scope of its government-run insurance option and tighter in its restrictions on abortion funding than many Democrats had hoped.
Moreover, the narrow victory -- 220 to 215 in a chamber where Democrats hold 258 seats -- was unsettling for liberals because moderate Democrats have a louder voice in the Senate and Republicans have more stalling power.
What is more, the political climate has become more challenging for progressivism than it was when Obama's agenda for change was launched in his 2008 presidential campaign and ratified with his resounding election one year ago.
"The joys and the exultant expectations . . . have been mainly silenced by a year of economic turmoil and international uncertainty," Democratic pollster Peter Hart wrote in a recent memo marking Obama's election anniversary.
"But more striking than the domestic and international struggles is the sense of disappointment and disgust the American public feels toward Washington," he said.
When Obama was campaigning, public animus toward President Bush was read as a broad mandate for change.
Now polls find many independent voters questioning whether Obama is bringing the change they wanted.
A year ago, rising healthcare costs were at the top of voters' worries; now, with unemployment in double digits, jobs are paramount.
"It's an historic accomplishment, but I'm not sure it's consistent of the public mood," Vin Weber, a Republican strategist and former House member, said of the House healthcare bill.
"They began pursuing it at a time when they believed we were entering a new progressive era in American politics. But the public has shifted in its attitudes toward taxing, spending and the size of deficits in the last eight to nine months."
One telling sign of the shift is the fact that Obama and Democratic leaders have had to lean so hard on Democrats to take a vote many saw as fraught with political risks rather than rewards.
"Given the heated and often misleading rhetoric surrounding this legislation, I know that this was a courageous vote for many members of Congress," Obama said Sunday in a Rose Garden appearance, "and I'm grateful to them and for the rest of their colleagues for taking us this far.
"Now it falls on the United States Senate to take this baton and bring this effort over the finish line," he said.
That finish line may not be crossed as soon as Democrats had hoped.
It looks increasingly likely that a bill will not be ready for Obama to sign before the new year, though Democratic leaders still cling to that date as a goal.
"It's too bad the president has to spend all this time trying to rustle up votes within his own party," said Jim Manley, spokesman for Senate Majority Leader Harry Reid (D-Nev.). "But I honestly believe the House vote gives us momentum that Sen. Reid is going to use when he talks to his colleagues about the legislation this week."
Reid is hoping to bring the issue before the Senate in a week or so, but he has yet to put the finishing touches on the bill that will be the starting point of debate -- a blend of versions produced by two committees.
Final details have to be determined and analyzed for their effect and cost, but it is clear the Senate bill will have major areas of overlap with the House's: Both bills will expand Medicaid coverage for the needy, provide private-insurance premium subsidies for people of modest means, and set new rules to make it harder for insurance companies to deny coverage or charge higher rates to people based on their medical status or history.
Both would also require everyone to have health insurance, and set up a new insurance exchange to offer affordable policies for small businesses and individuals who do not get coverage from their employers.
Both bills would include one government-run "public option" among the choices.
However, Reid has said that his bill -- in a concession to moderates -- would allow states to "opt out" of offering the government plan. The Senate version may or may not include the House bill's requirement that employers provide coverage for workers.
In another major difference, the Senate bill would offset the cost primarily with a tax on companies that offer very expensive health insurance policies.