WASHINGTON_President Barack Obama, who has spent weeks urging lawmakers to embrace his health care agenda at White House meetings, is focusing now on a broader and more distant audience, the American people, whose qualms about his plan seem to be growing.

In a news conference televised live Wednesday and at scheduled events Thursday in Cleveland, the president is speaking directly to families about their pocketbook and medical concerns, urging them to ignore political opportunists and naysayers in order to achieve sweeping changes, which previous administrations could not attain. Unlike other developed countries, the United States lacks universal health care.

"If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket," Obama said Wednesday night, looking past the dozens of reporters assembled for his White House news conference, and peering straight into the TV cameras. "If we do not act, 14,000 Americans will continue to lose their health insurance every single day."


On Thursday in Ohio the president will undertake two more events focused on health care, the issue dominating his administration even as the economy still suffers and wars continue in Iraq and Afghanistan. For his supporters, Obama's stepped-up pace is coming not a second too soon.

For all his efforts, which have included public statements each weekday for the past few weeks, Republican lawmakers and other critics sense momentum building against Obama's plan. They particularly cite nonpartisan cost projections that have not predicted the savings the White House promises.

The number of Americans who disapprove of the president's health care plan has jumped to 43 percent, compared with 28 percent in April, according to the latest Associated Press-GfK poll. Obama still holds a strong hand, with most Americans favorable to him in general, and half supporting his health care agenda.

But it's the negative trend that worries his supporters, and some want the president to be even more forceful and visible in pushing his top domestic priority.

"He's the great communicator," said Rep. Jim Cooper, a moderate Democrat who wants lower costs but supports the overall thrust of Obama's efforts. "If anybody can explain this, he can."

"The White House needs to assert more authority," said Cooper, who has focused on health care for years. "I'll be relieved when they take over the marketing of this, because Congress has done a terrible job."

It's hard for Obama, or anyone, to succinctly advocate health care changes just now because multiple versions are slowly moving through the Democratic-controlled House and Senate.

"The case has not been made" for a particular version because the eventual legislation is unclear, said Democratic Rep. Artur Davis. With critics seizing on the confusion to attack the Democratic proposals' costs, enhanced government role and uncertain benefits, Davis said Wednesday, the administration soon must decide whether to accept a partial victory that might leave room for a later push for the rest.

For now, Obama keeps insisting on all the major elements of his far-reaching proposal and warning of dire consequences if they are not enacted. Turning the focus away from Capitol Hill _ even as he tries to build pressure on wavering lawmakers _ Obama said Wednesday that the debate "is about every family, every business and every taxpayer who continues to shoulder the burden of a problem that Washington has failed to solve for decades."

He zeroed in on perhaps the least popular segment of the health care world, insurance companies, alluding often to "health insurance reform" instead of "health care reform."


He cited a Colorado woman with cancer that her insurance company would not cover. He referred to a "middle-class college graduate from Maryland whose health insurance expired when he changed jobs." He used the word "families" 22 times in 55 minutes.

"Reform is about every American who has ever feared that they may lose their coverage if they become too sick, or lose their job or change their job," the president said. "It's about every small business that has been forced to lay off employees or cut back on their coverage because it became too expensive."

Obama praised the work of the Cleveland Clinic, which he will visit Thursday before holding a town-hall forum on health care at the nearby Shaker Heights High School. The clinic pays doctors a salary, which does not depend on how many procedures or tests they perform.

"They've set up a system where patient care is the No. 1 concern, not bureaucracy, what forms have to be filled out, 'what do we get reimbursed for,'" Obama said. "Those are changes that I think the American people want to see."

It's a theme that lawmakers back in Washington can expect to hear repeatedly.