Q+A: What's at stake in Obama healthcare speech

Obama wants to overhaul the $2.5 trillion U.S. healthcare system by cutting costs and expanding coverage to the 46 million Americans without health insurance. But his fellow Democrats who control Congress have struggled to craft a reform bill and most Republicans have fought it.

Here are some questions and answers about the nationally televised speech, set for 8 p.m. EDT (0000 GMT).

WHAT IS AT STAKE?

Unlike the sputtering economy and Iraq and Afghan wars, healthcare reform is a challenge that was not inherited from Obama's Republican predecessor, George W. Bush. Obama's ability to push a plan through Congress is seen as a major test of his leadership, less then eight months into his presidency.

Confusion over how reform would work and concern about costs have helped drive down Obama's once-lofty poll numbers. The speech to a rare joint session of the House of Representatives and Senate during evening "prime-time" television hours ties Obama's image even more closely to the issue.

Obama campaigned as someone who would work with Democrats and Republicans, and has said he wants a plan to pass with support from both parties. Some analysts have said failing to do so would prove bipartisanship is an impossible dream.

The last Democratic president, Bill Clinton, tried to reform healthcare early in his first term. His failure helped cost Democrats their control of Congress in 1994, and some experts have said a failure by Obama could similarly hurt his party in the 2010 midterm election.

WHAT DOES OBAMA NEED TO DO?

Obama must offer specifics about his plan, analysts say, to squash fears opponents have exploited to fan anti-reform sentiments, such as claims the overhaul would lead to government-funded abortions or create bureaucratic "death panels" to decide who gets care.

He must spell out how he can pay for the nearly $1 trillion plan without boosting the huge U.S. budget deficit or cutting health insurance coverage for those who have it.

He needs to rally and unite his fellow Democrats. While Republicans have been almost unanimous in opposition, Democrats have been divided, with some liberals demanding more sweeping reforms and some conservatives balking at the cost or worrying that the public option was too much government interference in the private insurance industry.

WHAT ABOUT THE PUBLIC OPTION?

Analysts will be listening closely to what Obama says -- or does not -- about the "public option," a government-run insurance plan proposed as an alternative to private insurance.

The public option is heavily supported by Obama's liberal base, but strongly opposed by the insurance industry, which has spent millions lobbying against it. Continued...