A coalition of liberal groups that includes major labor unions such as the Service Employees International Union and the activist group MoveOn.org announced today it will spend $40 million to make health insurance a major issue in the campaign, with Elizabeth Edwards, the wife of former Democratic presidential candidate John Edwards, as the one of the group’s main spokespersons. The group, which has dubbed itself “Health Care for America Now!” plans to spend its money running ads in battleground states, canvassing 45 states to get people to sign petitions supporting the initiative and trying to get every member of Congress to sign a pledge to expand health insurance to all Americans.

Meanwhile, on Capitol Hill, Democratic staffers are trying to set up a structure for getting a bill through Congress next year.

The staffs of Sen. Max Baucus (D-Mont.), the chairman of the Senate Finance Committee and Sen. Ted Kennedy (D-Mass.), who heads the Senate’s Health, Education Pensions and Labor Committee, are already meeting with key health care experts, including some from Massachusetts, which passed a landmark health care law two years ago.

In a series of meetings over the next month, Senate aides plan to meet with doctors’ groups, insurance companies, business associations and other key players in reforming health care. Their goal is to have the outlines of a health care proposal by the end of this year that can be introduced in the opening days of the next president’s administration.

“We want to create a mandate,” said Richard Kirsch, one of the leaders of the health care organization of the liberal groups, many of whom worked together to oppose President Bush’s 2005 Social Security plan.

Barack Obama has already pledged to make passing health care reform a centerpiece of his first term, and his campaign has recently added a group of advisers who specialize in the subject, including Elizabeth Edwards, Sarah Bianchi, a former Clinton White House aide and Neera Tanden, Hillary Clinton’s policy director during the primaries. Tanden is working as a domestic policy adviser, while Bianchi and Edwards are participating in campaign conference calls on health care with other experts.

“It’s important for this to be one of the first things that’s considered,” Edwards said in an interview, referring to the priorities of a new administration. “I’d like to see it on the agenda in 2009.”

The coalition of liberal groups is hoping to make sure health care is a priority even if John McCain is elected and to make sure the majority of Congress backs the goal as well.

McCain has also said he would make health care a major issue if he wins the presidency, but Democrats and labor groups oppose many of his proposals, as the Arizona senator is trying to transform the health care system into one in which individuals buy their own health care in a less-regulated market, which means they could have lower costs but also would assume more risk.

The new coalition, while not outlining a specific health care plan, has goals that resembled what Obama and the Democratic candidates proposed in the primaries, offering subsidies to people so health insurance is affordable to the 47 million Americans who currently don’t have it, creating new regulations that would prevent insurance companies from charging high prices or not offering insurance to people who already have chronic illnesses and allowing people to either buy insurance from a private company like Kaiser or enroll in a government-managed health care plan that would be run like but separate from Medicare.

But, even if Obama were elected, there’s no broad agreement on exactly how a universal health care bill would work, which is the problem Democrats faced in 1993 when the Clintons pushed the issue. Insurance companies, who drove much of the opposition in 1993, have signaled they would not support an approach like Obama’s, which add regulations for them but does not require all people to purchase health insurance. Democratic Senate aides are pointing to the legislation passed in Massachusetts in 2006 as a model. That legislation included increased subsidies for low-income people but also a mandate that all people in the state purchase insurance, something Obama has railed against on the campaign trail.

A bipartisan coalition that now includes more than a dozen senators is pushing a more radical health care reform in which people would buy coverage directly from insurance companies instead of getting it through their employers, with people getting tax credits to buy insurance in a more-tightly regulated system. Obama advisers had earlier largely ruled out that idea as too much of a drastic change for the vast majority of Americans who currently get their insurance through their employer.

While Obama has suggested ending tax cuts for people who make more than $250,000 a year to fund the health care subsidies, few Republicans will back what is effectively a tax increase, and some members of the GOP would likely need to support an agreement so it could pass in the Senate.

“It’s much easier to oppose something than get something passed,” Kirsch admitted.

By Perry Bacon Jr. of The Washington Post