Thinking big: Why Obama rejected calls to pare down ObamaCare

Mr. Emanuel, who had long advocated for a smaller health-care bill, argued that the state of play in Congress did not favor the Democrats’ sweeping legislation, which was helping drive down Mr. Obama’s approval ratings, one person involved in the talks said…

White House senior adviser David Axelrod was among those to articulate the arguments for moving forward with the comprehensive approach, in conference calls with congressional leaders and elsewhere, according to Democrats familiar with the debate, though the senior White House aide said he did not take sides in the central legislative strategy debate.

The president explored a scaled-back approach and asked his staff to examine areas of broad political agreement, according to congressional aides involved in the process. The exercise quickly pointed to a practical problem: You could not make incremental changes that were politically popular without pursuing the whole package.

For instance, Republicans and Democrats agree they should prevent insurers from denying coverage based on pre-existing conditions. But without a mandate requiring healthy people to buy coverage, insurers would wind up with a slew of sick customers without healthy ones to balance them out. That would likely lead to either soaring premiums or a bankrupt industry.