Reporting from Washington — President Obama handed same-sex couples a victory without picking a drawn-out fight with conservatives this week when he ordered hospitals around the country to honor patients' wishes about who may visit their sickbeds or risk losing Medicaid and Medicare money.
Experts predict Obama’s directive -- which requires hospitals receiving Medicare and Medicaid money to follow all legally valid advance directives -- will change daily practices in some medical centers.
But the memo creates no new rights or benefits and does not apply only to gay couples. So in issuing it, Obama sidestepped the more controversial question of whether same-sex couples are entitled to broader legal recognition of their partnerships.
Though some conservative groups expressed skepticism about the president's broader goals, they largely endorsed the memo's effect. The response was considerably more muted than it might have been if Obama had addressed other issues advocated by gays, a crucial part of his Democratic base.
More than a year after Obama was inaugurated, many of those supporters are agitated over his reluctance to press Congress to pass an employment nondiscrimination act.
Also frustrating for them is his slow march toward repeal of the "don't ask, don't tell" policy banning gays from serving openly in the military. A military task force will study a possible repeal at least through the rest of the year.
In that context, the hospital visitation measure represented a bow to pragmatism and, some advocates for gays feared, a tacit recognition that other priorities for gays may be stalled this year.
White House officials have been "getting a lot of pressure from the gay community," said Jimmy LaSalvia, executive director of GOProud, a group of gay conservatives. "They're either unwilling or unable to deliver on their promises and they had to come up with something."
At the same time, LaSalvia said, conservatives are likely to stand aside for the memo.
"Hospital visitation is not a lightning rod," he said. "I think the folks reacting harshly to this decision are on the fringe of the fringe."
The Catholic Health Assn., which represents 1,200 systems and facilities across the nation, applauded the move, saying it emphasizes the importance of letting patients decide who comes to their bedsides.
"We have long championed the rights of all patients to designate who they want to speak for them in healthcare decisions when they are not able to speak for themselves," said Carol Keehan, president and chief executive of the association.
"All persons of goodwill can understand and agree that when a person is sick, they deserve to decide who they want to visit them," she said.
Groups opposed to expanding legal rights for same-sex couples offered careful criticism.
"We would agree with the spirit of it," said Carrie Gordon Earll, senior director of public policy for the conservative advocacy group Focus on the Family.
But she voiced skepticism about a part that directs the Health and Human Services Department to conduct a study of the treatment of same-sex couples.
"There's obviously something else coming here," she said. "Most certainly, [Obama's] political agenda is to undermine traditional marriage, and we're highly sensitive to anything that he orders that continues to move down that road."
Many hospitals honor the advance directives or stated wishes of patients.
But decisions often fall to nurses or doctors who don't know the rules, said Tara Borelli, a staff attorney at Lambda Legal, a New York group that represents patients in such cases.
"Hospital staff are often caught in the middle of the family fight," Borelli said. "They might not have access to information about what the law is, or assume that accommodating the wishes of the family is the most important thing to do."
But if hospitals fear losing federal payments, she said, they may work harder to make sure their employees follow the rules.
"That's part of why having federal regulations that use the power of the purse is immensely important," Borelli said.