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With strong majorities in both the House and Senate, Democrats should be able to pass whatever bill they like. Instead, Democratic leaders have found themselves battling both the liberal and conservative wings of their party.

House Republicans released a list of 44 conservative-leaning House Democrats who have made statements that indicate their opposition to the bill that’s advancing through the chamber, and an additional 57 liberal Democrats who have said they cannot support a bill if it doesn’t include a public option.

Rep. Raul M. Grijalva, Arizona Democrat and a leader of the House’s liberal caucus, said the president didn’t do enough Wednesday to push for a public option.

“President Obama was elected to bring change and progress. I fear that if my party and the president do not appreciate the mandate the American people have given us, the people will lose confidence in the idea that they can vote for change and get what they voted for,” he said.

Conservative-leaning Democrats were likewise lukewarm to Mr. Obama’s remarks.

“I believe that we can make necessary reforms without creating a purely public, new government entitlement program,” said Sen. Blanche Lincoln, Arkansas Democrat.

Mr. Obama offered liberals little encouragement in his remarks, telling them that rather than holding firm on a public plan, they should realize the goal is to push down the costs of insurance.

“The public option is only a means to that end — and we should remain open to other ideas that accomplish our ultimate goal,” he said.

Instead, Mr. Obama’s list of must-haves covered basics to which many in both parties would agree: Consumer protections such as requiring coverage of pre-existing conditions, and allowing portability of health insurance when workers switch jobs.

Somewhat more controversially, Mr. Obama said he wants to mandate that most businesses provide health insurance coverage, and require that all individuals be covered by a policy, just as automobile owners are required to have car insurance.

In yet another overture to Republicans, who want a tort reform bill to try to control malpractice costs, Mr. Obama proposed allowing states to go forward with demonstration projects to test what can work in reducing the kind of “defensive medicine” that adds to insurance costs.

The president used memories of Sen. Edward M. Kennedy to push Congress to act, and pointed to three Republicans — Mr. McCain, Sen. Orrin G. Hatch of Utah and Sen. Charles E. Grassley of Iowa — who he said worked with Mr. Kennedy to try to expand health coverage.

Vice President Joseph R. Biden Jr., sitting with Mrs. Pelosi behind the president, teared up at the mention of Mr. Kennedy, a longtime fighter for expanded health coverage, who died last month.

The joint session offered Mr. Obama a chance to reset the discussion using a set-piece major speech — a format the president mastered during the 2008 campaign.

The White House said Mr. Obama had considered an address from the Oval Office but decided this speech was too long for that forum, and required a joint session of Congress.

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