WASHINGTON - President Barack Obama's drive to overhaul the U.S. healthcare system faces uncertain prospects as lawmakers struggle to find agreement on cutting costs and funding the $1 trillion program.
The outcome is at a critical juncture in the U.S. Congress. Here are some possible scenarios involving shortfalls in reaching his goals as planned:


Obama's timetable for an agreement passed by both chambers in Congress by the time lawmakers go on recess around August 7 appears to be slipping.

If there is a delay, it is still likely Obama will get an agreement from Democratic leaders to resume negotiations as soon as they return in September with the goal of getting him a bill he can sign by year's end.

White House spokeswoman Jen Psaki described an emerging consensus on Capitol Hill on healthcare and said Obama is optimistic that he's on track, after his first six months in office, to fulfill his promise to sign a health care reform bill before the end of the year.


Democrats would normally be able to use their sizable majorities in the House and Senate to push through an agreement. But a group of fiscally conservative Democrats is forcing Obama to focus more on cutting costs before discussing ways to pay for the new system.

As a result, it is possible that in the end, Obama will have to settle for less than he wanted and that the end result may be not as expansive as he had hoped in making healthcare accessible to all of the millions who do not have it.

If that happens, look for him and lawmakers to declare victory anyway and announce that further steps will be taken in the months and years ahead to improve on the system.


One reason Obama has been so adamant about getting an agreement as soon as possible is to keep up the momentum and not let efforts to complete an overhaul die, as the last attempt to change the system did in 1993 when Bill and Hillary Clinton's proposals went down in defeat.

The president has been using the bully pulpit of the White House to argue for a deal, and is quite willing to use campaign-style tactics to exert maximum pressure.

The danger is that Americans are not convinced that a healthcare revamp is an urgent priority -- equal to bringing the U.S. economy back to life -- or that the cost is simply too prohibitive, and desire to address the issue could fade.

If his signature domestic policy initiative collapses, Obama would have a much tougher time selling himself as an effective leader to U.S. voters if he runs for a second term in 2012.

And some of his Democratic allies in Congress could also be put on the defensive in next year's mid-term election, which could allow Republicans to cut into Democrats' hefty majorities in both houses -- further complicating Obama's other big policy initiatives including climate change and financial regulation.

(Reporting by Steve Holland; Editing by Eric Walsh)