Bush, at low point in polls, will push domestic agenda
WASHINGTON: Carrying some of the worst public approval ratings of any president in a generation, President George W. Bush is heading into his State of the Union address on Tuesday night seeking to revitalize his domestic agenda but facing stiff resistance over the initiatives the White House has previewed so far.
Administration officials said Monday that among Bush's proposals would be a plan to help states provide health care coverage to people who lack insurance by diverting federal aid from hospitals, especially public institutions. The provision is likely to draw loud criticism from municipalities across the nation and will significantly affect the New York City Health and Hospitals Corporation, the nation's largest municipal health care system.
Officials said Bush's speech would include proposals to address the nation's energy needs and global warming, partly by promoting the use and development of alternative fuels. He is also expected to renew his call for an overhaul of immigration law and to propose altering tax policies to help the uninsured.
The president's advisers said they hoped Bush's address would re-energize his domestic agenda by striking a bipartisan and ambitious tone as he faces further isolation on his Iraq policy.
"The power of the ideas requires people to take notice and take seriously important domestic initiatives," said Dan Bartlett, the White House counselor. "There will be key signals to the American people that despite disagreements over the war, other work can be done."
Bartlett said a major theme of the address would be that "divided government does not mean we cannot govern."
But the initial response to Bush's health care plans has not been positive, on Capitol Hill or among constituencies including employers and labor unions. And with the president's political authority diminished and the new Democratic majority in Congress emboldened, the fate of his domestic agenda, and his ability to forge compromises on his terms, is in question.
Behind the president on the podium will be not Representative J. Dennis Hastert, the former speaker and Bush's stalwart Republican ally, but Representative Nancy Pelosi, Democrat of California, with whom Bush traded insults throughout the 2006 campaign.
Giving the Democratic rebuttal will be Senator Jim Webb, Democrat of Virginia, whose son is serving in Iraq and who reported having a tense exchange with Bush at the Congressional Christmas party. The audience in the House chamber is expected to include the actor Michael J. Fox, who has become the face of the movement to overcome Bush's objections and increase federal financing for stem cell research.
The chamber will include an increasing number of Republicans who are questioning or breaking ranks with Bush on the war and other issues, as Senator John W. Warner of Virginia, the former chairman of the Senate Armed Services Committee, did Monday in criticizing the president's decision to send more troops to Iraq.
Bush also faces an increasingly skeptical public, one that has given him some of his lowest marks in several recent polls.
According to a CBS News poll conducted Thursday through Sunday, 28 percent of Americans approve of the way the president is handling his job, and more than twice as many, 64 percent, disapprove. It is the lowest approval rating the president has received in a CBS News poll, though it is statistically little different from the rating of 30 percent he received earlier this month.
Only Jimmy Carter has received a lower approval rating, 26 percent, in 1979, in surveys conducted by CBS News or its polling partner, The New York Times. In a Gallup poll conducted in August 1974, just before his resignation, Richard M. Nixon had a 24 percent approval rating.
In a new ABC News/Washington Post poll made public on Monday, only 33 percent approved of Bush's job performance, and 65 disapproved, tying the record for his worst marks in that poll.
Asked about the new batch of low ratings, Bush's spokesman, Tony Snow, attributed them to discouragement over Iraq that could be overcome at home.
"George W. Bush as a president," Snow said, "is not somebody who is going to cease to be bold because there has been — because right now people are concerned about the progress of the war. Instead he understands his obligation as commander in chief is to go ahead and address forthrightly big problems and come up with solutions that not only are going to have political appeal, but they're also going to be effective in making life better for Americans."
On health care, Bush is trying to drive the debate through plans that would not cost the federal government additional money at a time when the White House is committed to showing a plan to balance the budget. This weekend, the administration sketched out a proposal under which people whose health care programs exceed a certain value would face a higher tax bill, with the revenue going to tax incentives to encourage the purchase of health coverage by lower-income people.
Two leaders of fiscally conservative advocacy groups, Grover Norquist of Americans for Tax Reform and Pat Toomey of the Club for Growth, endorsed Bush's plans. But in separate interviews, each expressed concern that Congressional Democrats would approve a plan that put greater emphasis on tax increases.
Labor leaders were outspoken in opposing the plan. "This is a wrongheaded, crazy proposal," said Gerald M. Shea, assistant to the president of the A.F.L.-C.I.O. "It would throw into turmoil the employment-based system of health insurance, and it would impose a new tax on the middle class."
Several public health officials reacted with alarm to Bush's plan to encourage states to take Medicaid money now earmarked for public hospitals and use it for state programs to cover the uninsured. The Bush administration proposes cutting Medicaid payments to public hospitals and other "safety net" providers by $3.9 billion over the next five years. Preliminary estimates suggest that 40 percent of the savings would come at the expense of the New York City Health and Hospitals Corporation, which operates 11 hospitals, 4 nursing homes and more than 80 community clinics.
Kenneth E. Raske, president of the Greater New York Hospital Association, called the proposal "an absolute disaster for New York."
Deborah Bachrach, a deputy commissioner in the New York State Health Department, said it would affect hospitals "that serve some of the lowest-income, most vulnerable patients."
Defending the proposal, Michael O. Leavitt, the secretary of health and human services, said: "We want to be able to redirect federal payments away from institutions and to needy individuals. Rather than perpetually paying bills for the uninsured, it's better to help them buy health insurance."
White House officials outlined the health care proposals ahead of the address to make way on Tuesday for a new emphasis on energy policy initiatives.
White House aides met Monday with two lawmakers who have pressed for the promotion and development of alternative fuels, Senator Tom Harkin, Democrat of Iowa, and Senator Richard G. Lugar, Republican of Indiana.
A Senate aide briefed on the meeting said the senators were told that the plan would be "very ambitious" in terms of increasing the development and use of alternative energy sources. They were also told that the plan would address "the use side," which could indicate a move to improve fuel standards, the aide said.
The new initiatives will require a political push by Bush, who will begin touring the nation to promote his policies on Wednesday.