Going into the fall, Obama has a plateful

Heading into the fall, President Obama has his work cut out for him.

Healthcare reform, his top domestic priority, is hardly the only issue on his plate. Obama is fighting wars in Iraq and Afghanistan. Iran and North Korea's nuclear ambitions demand attention. The Jan. 22 deadline for closing the Guantánamo Bay prison camp looms large. And the appointment of a federal prosecutor to review treatment of Bush-era detainees has reignited debate over past conduct in the war on terror.

Back on domestic affairs, major climate-change legislation and reform of financial regulations also loom.

But it's the drive for sweeping changes in the healthcare system that may well define Obama's first year in office. And after a rough August, with its rowdy town halls and claims that "death panels" would "pull the plug on grandma" under Obamacare, the president enters the home stretch politically weakened.

"August did damage," says Cal Jillson, a political scientist at Southern Methodist University in Dallas. "Essentially, the big package that envisioned a ‘public option' as well as health insurance reform and cost reductions, the whole nine yards, is probably off the table."

Still, Mr. Jillson believes there's "a good prospect for a significant health reform bill." It is likely not to include the so-called public option, a government-run health-insurance plan designed to compete with private insurers, but he predicts it will include elements of health-insurance reform, such as preventing insurers from denying insurance to people with preexisting conditions or dropping coverage when they get sick. It would also likely ban lifetime caps for coverage as well as caps on out-of-pocket expenses.

Forces beyond Obama's immediate control made success on big, sweeping reform a long shot from the start.

He took office in January with an economy in free-fall, and took bold steps to keep a deep recession from turning into a depression - winning passage of a $787 billion stimulus bill, bailing out banks and insurers like AIG, and propping up the domestic auto industry. By the time Obama got to his own signature priority, healthcare reform, the public's appetite for big government action had waned.

His diminished mandate has been reflected in sliding public opinion. At the beginning of July, Obama's weekly average job approval rating in the Gallup poll was 60 percent. By the end of August, he was approaching 50 percent. On the handling of healthcare policy, Obama has polled at 44 percent and 43 percent approval both times Gallup asked the question this summer.

The good news for Obama is that the public trusts him more than other players – congressional Democrats, congressional Republicans, the healthcare industry – to improve the system.

But the loss of two key allies – Sen. Edward Kennedy of Massachusetts, who died Aug. 25, and former Sen. Tom Daschle of South Dakota, who was to be Obama's health secretary and reform "czar" until he withdrew over tax issues – cannot be overestimated.

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