WASHINGTON -- President Barack Obama, faced with falling approval ratings and increasingly impatient with Senate negotiations over health care, is weighing a shift in strategy that would offer more details of his goals for overhauling the nation's health care system.
The president is considering a speech in the next week or so in which he would be "more prescriptive" about what he feels Congress must include in a bill, top adviser David Axelrod said Tuesday in an interview. The speech might occur before the Sept. 15 deadline the White House gave to Senate negotiators to seek a bipartisan bill, Axelrod said. He suggested that two key Republicans have not bargained in good faith.
Congress reconvenes next Tuesday after an August recess in which critics of Obama's health proposals dominated many public forums.
Some Obama allies, watching his approval ratings tumble in polls along with support for a health care overhaul, have urged the president to take a more hands-on approach. They feel he gave too much leeway to Congress, where one bill has passed three House committees, another has passed a Senate committee and a third has been bogged down in protracted negotiations in the Senate Finance Committee.
Axelrod indicated that Obama would not offer new proposals but would be more specific about his top priorities.
"The ideas are all there on the table," Axelrod said. "Now we are in a new phase, and it's time to pull the strands of these together."
He said there is serious discussion in the White House of Obama "giving a speech that lays out in specific ways what he thinks" about the essential elements of a health care bill.
Axelrod said it was possible that the speech could occur before a planned Sept. 15 Obama address on health care in Pittsburgh.
Obama has called for innovations such as a public health insurance plan to compete with private insurers, but he has not insisted on it. It was not clear Tuesday the degree to which he might press for various proposals in a new speech.
Obama also plans to meet with Democratic congressional leaders on Tuesday.
Axelrod condemned recent comments by two chief Senate Republican negotiators -- Charles Grassley of Iowa and Mike Enzi of Wyoming -- who have sharply criticized key elements of Democrats' health care plans even as they insisted that a workable bipartisan plan was possible.
Their remarks, Axelrod said, "were not exactly consistent with good-faith negotiations."
In an August fundraising letter, Grassley asked people for "support in helping me defeat Obama-care." He said Democratic-drafted bills would be "a pathway to a government takeover of the health care system."
Enzi, in a radio address Saturday, said Democratic proposals would restrict medical choices and make the country's "finances sicker without saving you money."
The two men are part of a six-senator, bipartisan negotiating team that also includes GOP Sen. Olympia Snowe of Maine. Hopes for a workable bipartisan plan have dimmed in recent weeks, and Axelrod's comments were the most dismissive yet from a White House official.
Congress' August recess was brutal for Obama and his allies, as lawmakers faced raucous crowds denouncing Democrats' health proposals. When Congress reconvenes Tuesday, Democratic leaders hope to change the dynamic by holding quiet, closed-door sessions with nervous colleagues and arguing that far-reaching health care changes can be good politics as well as good policy.
They also hope GOP-led opposition has peaked. But that's far from clear, and Republicans are eager to hand Obama his first major defeat.
A new CNN/Opinion Research poll found that 53 percent of Americans disapproved of Obama's handling of health care, while 44 percent approved. In March, far more people had approved than disapproved.
In a Kaiser Health Tracking Poll in August, 40 percent said they favored passing some sort of health care revision this year, a dramatic drop from 62 percent in June.
Liberal groups have held hundreds of events in a bid to show that a robust overhaul is more popular than August's news reports would suggest.
The message lawmakers will hear when they return to Washington "will be very different than what they heard when August started," said Jacki Schechner of Health Care for America Now.
One idea her group will stress, she said, is that the politically smart vote, even in toss-up districts, will support widespread changes meant to expand health insurance coverage and options.
Nervous Democratic lawmakers need to be told, "you got elected to do something," she said. "And you might get re-elected if you actually do something."
Many first- and second-term House Democrats believe the noisiest protesters at town hall forums do not represent most of their constituents, said Rep. Chris Van Hollen, D-Md., who is tasked with getting his colleagues re-elected. Democratic leaders will try to build on that point, he said, listening to members' concerns and emphasizing the political and societal risks of doing nothing.
Some Democrats say Republicans blundered by basing so much of the opposition on demonstrably untrue claims, such as assertions that the House legislation would lead to "death panels" for elderly patients. In the Capitol's cool, calm setting, party leaders hope to persuade lawmakers that such claims are easily denied.
Democrats also are portraying top Republicans, including Grassley and Enzi, as cynics who pretend to want a bipartisan accord while never intending to compromise in any meaningful way.
Liberals now want Congress and Obama to push for full-blown health care changes, saying there's no need for Democrats to compromise when, with their substantial majorities in both the House and Senate, they are the game's only players.
Republicans approach Labor Day feeling upbeat about the ground they gained during the August recess. Some are confident that no amount of closed-door hand-holding of nervous Democratic lawmakers will reverse the momentum.
"After a disastrous month at home, the fact that Democrats' new health care strategy is to hide in Washington from the people who elected them to get health care passed shows what bad shape they're in," said Antonia Ferrier, spokeswoman for House Republican leader John Boehner of Ohio.
The GOP's most effective attacks, many Democrats say, deal with Obama's questionable claim that the nation can significantly expand health coverage without increasing the deficit over 10 years. The nonpartisan Congressional Budget Office says none of the pending health plans would control long-term spending, and that ones with the elements Obama wants would expand the deficit by about $1 trillion over the next decade.
Some Democrats say the congressional leaders will have to trim more costs from the health bills that have cleared one Senate committee and three House panels, even though it would antagonize liberals and make it harder to cover uninsured people, one of Obama's top goals.