Health care plan tests Pelosi's leadership

House Speaker Nancy Pelosi sent her 256 caucus members home for the August recess armed with pocket cards listing Democratic health care talking points, then started stumping herself, working to convince Americans of what they'd gain under the plan.

Selling the plan has proven to be a tough balancing act, and a test of Pelosi's leadership. How she steers the process could help define her legacy.

Pelosi has had to maneuver gingerly through the competing interests of Democratic liberals, moderates and conservatives. Angry opposition in some town hall meetings have knocked some Democrats off stride.

The centrist Democrats known as Blue Dogs fear losses in their more conservative congressional districts - losses that could imperil the party's majority in the House.

Nowhere is the tension within her ranks more evident than in the current uproar over whether a final bill should contain a government insurance option to compete with private insurers.

Pelosi cheered her liberal flank last week, declaring to reporters: "There's no way I can pass a bill in the House of Representatives without a public option."

But the issue has become a flash point. Other Democrats, including House Majority Leader Steny Hoyer of Maryland, have remained open to moving a health reform package without that provision.

"I'm for a public option, but I'm also for passing a bill," Hayer said Friday during a teleconference call with reporters.

Pelosi herself has had to choose when not to dig in. Earlier, for instance, she said that despite her support for a woman's right to an abortion, she would not let a dispute over financing abortions through the health care bill stand in the way of passing the legislation.

Complicating her work are the television images of lawmakers back home during the August recess confronting angry constituents, many of them challenging the idea of a government option or raising discredited claims about what the legislation would do.

In Denver, Pelosi herself was greeted by a raucous but orderly crowd of about 200, some decrying government interference in health care, others pointing to how private insurance companies have failed patients.

Other members have met with worse - threats and shouting matches. But they've also taken away a deeper understanding of their constituents' concerns, Pelosi said.

"They respect the differences of opinion that have emerged," she said.

The speaker, eager to hear reports from the field and keep the party's message on track, participates in a weekly call with members of her caucus.

"The reports we get back are very positive," she said. "By and large, members are getting a very good reception."

Still, a phone hotline and an e-mail address relay some of the thornier questions that arise from town hall meetings to Pelosi's staff, allowing prompt responses on details such as how the legislation addresses home health care, or when a small business would be mandated to provide health care coverage.

"That it is still moving forward speaks to the fact that the leadership has been successful," said Ken Thorpe, chairman of health policy at Emory University in Atlanta, and a senior official at the Health and Human Services department during President Bill Clinton's unsuccessful push for health care reform.

"She's very hands-on," Thorpe said.

In her own home turf, Pelosi has found support. Health care providers at San Francisco General Hospital welcomed her back. Faith leaders gathered in the church where her children attended preschool and introduced her to supportive organizers as "our Nancy." The only interruption was enthusiastic applause as she repeated her familiar mantra of reform that will reduce the cost of care, improve quality, retain choice and expand coverage.

Myrna Godinez took the day off her job as a bookkeeper at a produce store to hear Pelosi spell out the details of the legislation. Godinez has health insurance through her job, but her 2-year-old son is covered through a state-sponsored low-cost insurance program that suffered deep cuts during California's budget crisis.

"I was worried about my son," said Godinez. "I feel more comfortable now. I believe she will make this pass."

Progressives like Rep. Barbara Lee, D-Calif., who chairs the Congressional Black Caucus, said that in the tough give-and-take before she left Washington for the August recess, Pelosi was a pragmatic leader, even when dealing with widely divergent views within her own caucus.

"She's doing a great job of bringing her caucus together," said Lee. "She's been very effective, very accessible. This has shown her ability to listen and to bring people together from a variety of points of view."

Republicans have pointed to the loud exchanges in some town hall events, and to differences among Democrats as signs that the speaker's losing her upper hand.

"They lack a cohesive message," said Ken Spain, a spokesman for the National Republican Congressional Committee. "Members are all over the place on where they stand on the bill, and I think that's reflective of the speaker's leadership."

Pelosi appeared undaunted by the hurdles, saying she expected to have more than the requisite votes to pass the legislation out of the House.

"I have a certain serenity about this," she said. "Stay tuned."