What if Obama fails on healthcare reform?

It is an outcome that the Obama White House and its loyal supporters are absolutely not willing to entertain in public: failure to pass comprehensive healthcare reform.

Everyone knows it’s a possibility – that when all is said and done, the Democrats may simply not be able to garner enough votes to pull off the complicated legislative maneuver required to pass reform. The goal is to get it done by Sunday, when President Obama plans to head abroad. But if not, then what?

“The failure of healthcare reform would be very devastating for the Obama administration,” says Darrell West, director of Governance Studies at the Brookings Institution in Washington. “It would cast doubt on his entire presidency.”

The layers of devastation would go deep, he and others say: Failure would disillusion Mr. Obama’s progressive base and discourage all the people who worked on behalf of his campaign. It would leave the big Democratic majorities in both houses of Congress – in addition to Obama himself – open to the charge that they are incapable of leading. It would increase the possibility of a tidal-wave election in the fall midterms.

The rest of Obama’s agenda would be cast in doubt. He has already signaled a desire to tackle financial regulation, immigration, and campaign-finance reform next, but if he can’t pass healthcare, he will have no momentum.

Some Democrats from Republican-leaning districts and states locked in tough reelection battles may be relieved by a defeat of health reform, but they still will have little to show for Obama’s first year in office. The public simply has not been impressed by the argument that the administration saved the nation from going off the edge of a cliff, economically.

“I don’t think you can have any other view: If [Obama] can’t pass healthcare, the Democrats go into the fall with a hugely reduced president,” says Terry Madonna, director of the Center for Politics and Public Affairs at Franklin & Marshall College, Lancaster, Pa. “I don’t think there’s any way you can rationalize that.”

Obama, he continues, is “trapped in the dangerous middle.” If healthcare passes, the Republican mantra will be “repeal it, repeal it” – a rallying cry for the party’s energized base. If Obama fails, it would be an even greater failure than President Clinton experienced in 1994 when his health reform effort fell apart.

“It was never a defining issue for Clinton,” Mr. Madonna says. “This is a defining moment and issue for Obama. That’s why I believe it will happen. They’ll do whatever it takes.”

Mr. West of the Brookings Institution also predicted the legislation will pass the House by the narrowest of margins, with the Democrats giving any member they possibly can a pass.

On Monday afternoon, the House Budget Committee voted to send the healthcare plan to the House Rules Committee, the next step on the way to a vote on the House floor later this week.

Obama, meanwhile, worked the outside strategy Monday, delivering a campaign-style speech in Strongsville, Ohio. “We know what will happen if we fail to act,” Obama said, forecasting a rise in government debt, the cost of coverage, and the rolls of the uninsured.