STEVE INSKEEP, host:
Now, a key part of the White House strategy on health care has been to make deals with some of the key interest groups.
NPR national political correspondent Mara Liasson reports on how that's going.
MARA LIASSON: Earlier this month, at the University of Maryland, the president touted the support his health care overhaul was getting from a broad array of special interests.
President BARACK OBAMA: And our overall efforts have been supported by an unprecedented coalition of hospitals and seniors' groups, businesses, drug companies, even.
LIASSON: The work to assemble that coalition began years ago, even before President Obama was elected, when consumer groups met with their erstwhile opponents: drug makers and health insurers. They even hired outside mediators to guide their discussions, and they agreed on the basic underpinnings of a health care overhaul. Everyone would have to be covered, and insurers would have to cover everyone, regardless of their health.
Then, early this year, when the president was at the peak of his powers, the White House made individual deals with hospitals, drug makers and doctors. The terms were simple: The industry groups would support the broad outlines of a health care bill, and the administration would agree to limit fees and budget cuts affecting these groups. Rahm Emanuel is the White House chief of staff.
Mr. RAHM EMANUEL (Chief of Staff, White House): There are going to be people, no doubt, who will say, oh, you gave too much away here before. There's a price to that, no doubt about it. But it is better to have those constituencies -like nurses, like doctors - supporting the outcome of reforming health care than opposing you.
LIASSON: But not every Democrat is on board. In the House, many members of the president's own party think the White House sold out cheap to big PhRMA when it agreed to accept just $80 billion in drug rebates to low-income seniors.
In the Senate Finance Committee last week, New York Senator Charles Schumer tried to kill the drug deal by supporting an amendment to force the pharmaceutical companies to give up even more.
Senator CHARLES SCHUMER (Democrat, New York): Frankly, most people would say the so-called deal that PhRMA cut with whomever was pretty lenient. Which side are you on? The senior citizen who needs help saving money in this bill on one side, PhRMA on the other?
LIASSON: But the amendment killing the drug deal was defeated. All the Republicans voted no and so did three Democrats, including Delaware Senator Tom Carper.
Senator TOM CARPER (Democrat, Delaware): I'll tell you, if somebody negotiated a deal with me and then you came back and said to me a couple weeks later, oh, no, no. We're going to double what you agreed in those negotiations to do -that just doesn't seem right to me. And whether you like PhRMA or not, we have a deal.
LIASSON: While the president heaps praise on the drug makers and the hospitals, some of his harshest attacks are directed at a politically unpopular interest group that didn't make a deal with the White House: the insurance companies.
At a labor rally in Minnesota, he made it personal. The insurance industry, he said, is raking in profits while it fights reform.
President BARACK OBAMA: This is when the special interests and the insurance companies and the folks who think, you know, this is a good way to bring Obama down, this is when they're going to fight with everything they've got.
LIASSON: In fact, while individual insurance companies are fighting hard to defeat pieces of the health care overhaul they hate, like the public option, they are, for the first time, supporting health insurance reforms. And health insurance lobbyist Karen Ignagni is very careful when she criticizes the tone the president has taken toward her industry.
Ms. KAREN IGNAGNI (Health Insurance Lobbyist): Our members made a decision to play a 2009 game. And it's different than what we did in '93 and '94. And so I think the inconvenient fact here associated with the rhetoric, in particular, has been that our members support reform.
LIASSON: Unlike in 1993, the health insurance trade groups have not launched multimillion-dollar ad campaigns against health care legislation, a fact Rahm Emanuel acknowledges.
Mr. EMANUEL: Unlike other sectors, they haven't fully invested in the reform, but they have not been the biggest-funded opponents of health care reform, either. I wouldn't exactly call them Switzerland in this deal.
(Soundbite of laughter)
LIASSON: Not neutral Switzerland, maybe, but the insurers' reaction to being vilified by the president has been remarkably restrained. As one health care player put it: The insurance companies will take a lot of verbal abuse in order to get 30 million new customers. And their semi-neutrality only validates Rahm Emanuel's belief that the deals were the right thing to do.
Mr. EMANUEL: Because in the rough sledding - and, you know, when you're trying to do something this big, it is rough - having what has traditionally been opponents proponents has enabled to get us to this point.
LIASSON: There is a spirited debate inside the Democratic Party about who co-opted whom in the special interest health care deals. But many overhaul supporters believe that without these side agreements, the health care effort would have been mortally wounded by the town hall rebellion in August, and the deals may be one reason health care legislation is still slogging forward, step by difficult step.
Mara Liasson, NPR News, Washington.
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