President Obama's extraordinary mea culpa news conference Thursday was about more than making a fix in a provision of the Affordable Care Act.
It was about turning around a downward slide that could threaten the future of his presidency.
For more than three years, congressional Republicans have flailed at the Affordable Care Act with limited success. Now, in the space of six weeks, the administration's own missteps — the botched roll-out of the federal exchange website and the broken promises over consumers being able to keep insurance plans they like — have significantly eroded confidence in Obama's signature legislative achievement and Democratic unity behind it.
What's more, with a string of apologies and some uncomfortable admissions, Obama Thursday fueled questions about his administration's competence and his own leadership, the most fundamental of presidential characteristics.
"There have been times where I thought we got, you know, slapped around a little bit unjustly. This one's deserved, all right? It's on us," he said at one point. At another: "I do make apologies for not having executed better over the last several months." And one more: "We fumbled the roll-out on this health care law."
He said he would delay for a year provisions in the health care law that required insurance companies to end policies that didn't have minimum coverage standards. But the insurance industry warned that step could raise premiums for everyone and state insurance commissioners questioned whether it was even feasible at this late date.
And the revolt on Capitol Hill didn't seem to abate. House Republicans plan to vote Friday on a bill the White House opposes that would allow Americans to keep existing health care plans through 2014. Some Senate Democrats said they hoped to continue with plans for a similar measure.
"What's happened in recent weeks is, I think, a dagger aimed at the heart of Obama's presidency," says presidential scholar William Galston of the Brookings Institution, a veteran of the Clinton White House. "I say that not only because of the centrality of health care reform to the administration's agenda and to his legacy but also because it has posed a direct challenge to his standing as president in the eyes of the American people."
Obama's approval-disapproval rating was at 42%-52% in the daily Gallup Poll Thursday, in the neighborhood of George W. Bush at this point in his second term and well below the standing of Bill Clinton and Ronald Reagan. For the first time in his presidency, a majority of Americans said Obama was not a strong and decisive leader.
Approval of the Affordable Care Act also may be dropping fast. Just a few weeks ago, 44% approved of the law, 47% disapproved. Now just 40% approve and 55% disapprove, the worst in at least a year.
Surely only dire circumstances could have convinced the candidate once known as "no-drama Obama" to announce a policy change and then field questions for almost an hour in the White House press room. Not a person given to public introspection or apology, his tone was contrite and even confessional at times.
To be sure, presidents have recovered from serious setbacks before. Reagan faced tough hearings over the Iran-contra scandal but finished his second term with a tax code overhaul and breakthrough agreements with the Soviet Union. Clinton survived impeachment. A booming economy and a falling jobless rate could do a lot to restore Obama's reputation.
If things go as the White House hopes, the HealthCare.gov website will be operating well by the end of this month. By the end of next March, when the sign-up period is scheduled to end, many of those consumers now concerned about losing their current plans will be persuaded that they're better off with a new one.
At the moment, however, the Obamacare landscape is sufficiently rocky that when a reporter asked about about stalled negotiations over Iran's nuclear program, it seemed to be almost a relief.
Follow @susanpage on Twitter.