WASHINGTON – Tom Daschle's decision to withdraw his nomination as health and human services secretary clouds hopes that President Barack Obama will make significant progress on health reform in his first 100 days in the White House.
But the problems of unaffordable medical bills and millions of uninsured aren't going away, and a deepening recession has more Americans feeling worried about their jobs and insecure about their health benefits.
So even if Obama's hand-picked architect of health reform suddenly leaves the political scene, the president himself still has an opportunity to refocus the nation's attention on its health care woes and on his own program for making things better.
"It's a real blow to the effort because Tom really was knowledgeable," Sen. Christopher Dodd, D-Conn., who himself is deeply involved in health care issues, said Tuesday. "This is an issue I had hoped would be a priority, and that we could deal with it very quickly."
He added: "It hurts. It slows things down. So this has been a setback."
At the White House, spokesman Robert Gibbs put on a brave front. "I don't think the effort slows down for health care reform, and I think Sen. Daschle and others would admit that the effort is far bigger than any one individual."
"We'll miss Sen. Daschle's leadership," said White House senior adviser David Axelrod, "But this issue has great power of its own."
Obama has a chance to recover some lost momentum right away. As early as Wednesday, he's expected to sign legislation to expand health coverage for uninsured children of low-income working parents, a major priority for Democrats. The president's words at the signing ceremony will be closely followed.
The White House has been planning a health care summit early in the spring to kick off the health reform campaign, but that may now be delayed.
Obama must quickly select a new HHS nominee who can be confirmed smoothly. The list of possible picks includes Kansas Gov. Kathleen Sebelius and others with state and national leadership credentials, including Howard Dean, the former Democratic presidential candidate and party chairman, Vermont governor and medical doctor, Pennsylvania Gov. Ed Rendell and Ohio Gov. Ted Strickland.
Not only could prospects for health reform dim further if the choice is delayed, but it means that problems at HHS agencies such as the Food and Drug Administration could continue to fester. Agency heads are not usually named until a cabinet secretary is in place.
The loss of Daschle hurts Obama in two ways. Daschle knows both the details of health care policy and the ways of the Senate. If a bipartisan deal is to be struck on health care, the best chance is in the Senate, which is not as polarized as the House.
"He brought special traits to the job that were tremendous advantages," said Judy Feder, a health care policy expert who was a top HHS official in the Clinton administration. "But the commitment of the president is the key here. You can't underestimate that."
Most health care reform advocates say conditions are still favorable to get a bill passed. Interest groups from insurers to small businesses, to the seniors lobby AARP say the time has come. Key committee chairmen in the Senate and the House remain committed.
Senate Finance Committee Chairman Max Baucus, D-Mont., whose panel will write much of the bill, said he's not slowing down. "It will take a couple, three weeks at best, not a lot longer, to get health care reform legislation up and ready," Baucus said. "So this has no effects on our efforts in the Congress."
But false starts do take their toll in Washington. You don't get back lost time. Other crises flare, competing for time and attention. Former President Bill Clinton's delay in getting a health care bill written and delivered to Congress is widely seen as a major factor in the subsequent collapse of the legislation. And the Obama administration has no shortage of serious problems to confront.
Between the loss of Daschle and continuing economic problems, "I don't see how we get to health care reform until the fall," said Robert Laszewski, a policy analyst and consultant for health care companies. "This really sets the momentum back. I think they are in disarray ... and it's going to have a very negative impact on health care reform."