Obama met with Republicans at the White House in search of an elusive bipartisan compromise on his call to expand coverage to the nearly 50 million uninsured Americans as well as restrain spending increases in health care.
But the 13-10 party-line vote in the Senate health committee signaled a deepening rift in Congress. While Democrats respond to Obama's call for action with renewed determination, Republicans are using harsher words to voice their misgivings.
In the House, Democrats began pushing legislation through the first of three committees, although moderate and conservative members of the rank and file were demanding changes. In the Senate, lawmakers were considering fees on health insurance companies as a new source of potential financing for a $1 trillion package that's short on funds.
"We have delivered on the promise of real change," Sen. Christopher Dodd, D-Conn., said as he presided over the Senate health committee vote, alluding not only to his bill but also to Obama's campaign promise.
The president was in the Rose Garden for the latest in a daily series of public appeals to Congress to "step up and meet our responsibilities" and move legislation this summer. Obama also pushed his message in network television interviews, telling employers that his plan would require them to offer benefits or face a fine.
"If you can afford it, either give your employees health insurance or pay into the pot so that we're not subsidizing you," Obama told CBS News.
He also reversed a campaign stance against requiring everyone to buy health care coverage.
"I'm now in favor of some sort of individual mandate as long as there's a hardship exemption," he said. "If somebody truly just can't afford health insurance even with the subsidies that the government is now providing, we don't want to double penalize them."
Wednesday's Senate health committee vote "should make us hopeful - but it can't make us complacent," Obama said. "It should instead provide the urgency for both the House and the Senate to finish their critical work on health reform before the August recess."
The health panel's $615 billion measure would require individuals to get health insurance and employers to contribute to the cost. The bill calls for the government to provide financial assistance with premiums for individuals and families making up to four times the federal poverty level, or about $88,000 for a family of four, a broad cross-section of the middle class.
Obama wants the House and Senate to act on health care this summer so lawmakers can reconcile differences in their respective bills after Labor Day and put final legislation on his desk this fall.
Obama's all-out effort since he returned from his overseas trip last week has "galvanized things," Sen. Charles Schumer, D-N.Y., said.
Obama met at the White House with Republican Sens. Susan Collins of Maine, Saxby Chambliss of Georgia, Bob Corker of Tennessee and Lisa Murkowski of Alaska.
"I urged him not to rush consideration of the bill," Collins told reporters later. "This bill is going to affect virtually every American. If the president tries to rush this through in the next two weeks ... I fear the process will be very divisive."
Another senior Republican, whom Obama courted only a few months ago to become his commerce secretary, also sounded alarm bells.
"This supposed health care fix is a health care failure and a disaster for the American people," Sen. Judd Gregg, R-N.H., said. "We still have time to turn this process around instead of steamrolling our country into a sub-par government-run plan, but it will require serious action from Democrats and Republicans and a pledge to put politics aside."
The debate is taking on a campaign-like edge. In the cross-hairs are moderate senators, Democrats and Republicans, whose votes could make the difference in a closely divided Senate.
Obama's political organization launched a series of 30-second television ads on health care, which were to begin airing Wednesday in Washington and on cable TV nationally. A version will run for two weeks on local stations in Arkansas, Indiana, Florida, Louisiana, Maine, North Dakota, Nebraska and Ohio to prod senators to back the health care effort.
In the ads, private citizens describe problems they've had with the medical system and say it's time for action. The sponsor is Organizing for America, Obama's campaign organization, which has become part of the national Democratic Party. The group would not reveal the cost.
Sen. Ben Nelson, D-Neb., one of the lawmakers targeted, said the ads would not affect his decision. He has concerns that the evolving Democratic plans would give government too big a role.
Obama supports a government-run insurance plan to compete with private insurers, but he says he doesn't want to overturn the system of employer-sponsored health benefits that has served middle-class families for better than half a century. He wants the legislation to be fully paid for and the total cost kept around $1 trillion over 10 years.
"The American people have to recognize that there's no such thing as a free lunch, right?" Obama told NBC News. "So we can't just provide care to everybody that has no costs whatsoever."
Wednesday's vote in the Health, Education, Labor and Pensions committee took the Senate only part of the way toward passage of an overhaul bill. Another panel, the Finance Committee, still has to unveil its approach. The plan is to combine the two bills for a floor vote.
Senate Finance Chairman Max Baucus, D-Mont., met Wednesday with committee Democrats to try to settle how to pay for the bill and other issues.
"We're just not quite there," Baucus said after the meeting. Obama has pushed Baucus to have a bill ready by week's end, but Baucus declined to say whether he'd made a timetable commitment to the president.
Finance Committee members are considering a proposal from Sen. Chuck Schumer, D-N.Y., that would raise $100 billion over 10 years by imposing new fees on health insurance companies.
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Associated Press writers Erica Werner and Alan Fram contributed to this report.
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