By Ceci Connolly
Washington Post Staff Writer
Sunday, June 28, 2009

In the high-stakes battle over health care, a growing cadre of liberal activists is aiming its sharpest firepower against Democratic senators who they accuse of being insufficiently committed to the cause.

The attacks -- ranging from tart news releases to full-fledged advertising campaigns -- have elicited rebuttals from lawmakers and sparked a debate inside the party over the best strategy for achieving President Obama's top priority of a comprehensive health-system overhaul.

The rising tensions between Democratic legislators and constituencies that would typically be their natural allies underscore the high hurdles for Obama as he tries to hold together a diverse, fragile coalition. Activists say they are simply pressing for quick delivery of "true health reform," but the intraparty rift runs the risk of alienating centrist Democrats who will be needed to pass a bill.

In recent days -- and during this week's congressional recess -- left-leaning bloggers and grass-roots organizations such as MoveOn.org, Health Care for America Now and the Service Employees International Union have singled out Democratic Sens. Ben Nelson (Neb.), Mary Landrieu (La.), Ron Wyden (Ore.), Arlen Specter (Pa.) and Dianne Feinstein (Calif.) for the criticism more often reserved for opposition party members.

"Will Mary Landrieu sell out Louisiana for $1.6 million?" says one Internet ad that suggests a link between contributions she has received from the medical industry and her reluctance to back the creation of a government-sponsored insurance option.

In many instances, the ad buys are relatively small. But Obama demonstrated the political power of Internet-based grass-roots activity in the presidential campaign. Still, as health care moves from electoral rallying cry to the tedious work of legislating, Obama finds himself caught between his campaign foot soldiers and the elected politicians who will vote.

One of his most stalwart supporters, for instance, says time is running out on efforts by the president and Senate Finance Committee Chairman Max Baucus (D-Mont.) to forge a bipartisan compromise on legislation affecting more than one-fifth of the economy.

"We are getting to the point if people aren't going to respond to the patience and openness of Senator Baucus, we should begin to make a different plan," said Andrew Stern, president of the 2 million-member SEIU.

Stern said his organization issued a release chastising Feinstein last week, because she should "put her foot on the gas, not the brake" on health reform.

"The gas pedal to go where?" Feinstein replied, explaining she has questions about how a broad expansion of health coverage will be paid for.

"I do not think this is helpful. It doesn't move me one whit," she said. "They are spending a lot of money on something that is not productive."

Much of the sparring centers around whether to create a government-managed health insurance program that would compete with private insurers. Obama supports the concept, dubbed the "public option," but he has been vague on details. Left-of-center activists want a powerful entity with the ability to set prices for doctors and hospitals.

But in the Senate, where the Democrats do not have the 60 votes needed to stop a filibuster, members are weighing alternatives such as a nonprofit cooperative or a "fallback" provision that would kick in only if market reforms fail.

"Democratic senators are taking millions of dollars from insurance and health-care interests and getting lobbied by those donors and coming out against a position that 76 percent of Americans agree on," said Adam Green, interim chief executive of Change Congress.

While recent polls show high initial support for a government option, the number declines if told the insurance industry could fold as a result. Change Congress and its sister group Progressive Change Campaign Committee are airing cable and Internet ads against lawmakers such as Landrieu and Nelson, who have not endorsed a robust public plan.

Green, in an interview, was hard-pressed to articulate a substantive argument for the public plan but said that it "has become a proxy for the question of Democrats who stand on principle and represent their constituents."

The Web-based MoveOn.org plans to run ads this week against Sen. Kay Hagan (D-N.C.) over the issue.

"The Democrats were voted into office to fix this problem," said MoveOn political advocacy director Ilyse Hogue. "It is absolutely our job to hold them accountable."

One Democratic strategist who is working full-time on health reform was apoplectic over what he called wasted time, energy and resources by the organizations.

The strategist, who asked for anonymity because he was criticizing colleagues, said: "These are friends of ours. I would much rather see a quiet call placed by [Obama chief of staff] Rahm Emanuel saying this isn't helpful. Instead, we try to decimate them?"

Richard Kirsch, campaign manager of the labor-backed Health Care for America Now coalition of 1,000 groups, believes grass-roots pressure and targeted advertising are already having an impact. After the group aired a spot in Pennsylvania attacking Specter for remarks critical of a public plan -- and supplemented that with flyers and phone calls -- the lawmaker shifted.

At an event Thursday, Specter said he is willing to consider a compromise. "That shows Senator Specter has come a long way," Kirsch said.

Listening to constituents, even those speaking over the airwaves, is part of "representative democracy," Specter said.

But Kirsch may still end up being disappointed by the newest Democratic senator. Specter, voicing the sort of flexibility the groups dislike, said, "This legislation is so complicated and so important that we all ought to be flexible and not approach it with fixed positions."

Like Specter, Wyden is sanguine about ads in his home state intended to pressure him to embrace a liberal bill.

"I get an election certificate from the people of Oregon," said Wyden, whose bipartisan health bill picked up its 14th co-sponsor last week. "As far as these ads are concerned, I pay them no attention."