* Healthcare advocates seek to maintain momentum
* Political climate ripe for reform despite downturn
* Experts see bipartisan approach to any legislation
By Susan Heavey
WASHINGTON, Nov 6 (Reuters) - Proponents of healthcare reform may have found their ally in U.S. President-elect Barack Obama, but the real campaigning has just begun.
While all eyes are on the president's transition team as it begins evaluating the nation's struggling economy and two wars, consumer advocates, union groups and others are determined to keep affordable healthcare front and center.
"We are going to embark into an all-out campaign to try to get universal healthcare coverage and healthcare reform enacted," said Dennis Rivera, chair of the Service Employees International Union's (SEIU) healthcare division.
"Starting right now, we are hiring coordinators all over the country to run this campaign as if it was a presidential campaign and our candidate is basically going to be healthcare reform."
Healthcare remains a worry even as the economy falters. Still, when voters cast their ballots on Tuesday, just 9 percent said it was their top concern, behind the economy and the war in Iraq, according to CNN.
Most Americans receive their coverage through work or government programs such as Medicare and Medicaid, which insure the elderly, disabled and poor. Nearly 46 million have no insurance and hundreds of thousands more are losing it as unemployment reaches a 14-year high.
Many other Western countries have entirely government-run systems.
Experts say the sour economy simply highlights the precarious state of the nation's healthcare system.
"I think now is the time for a real effort on major healthcare reform," said Dr. Mark McClellan, a former economic and health official under both presidents Bill Clinton and George W. Bush.
He now heads the Brookings Institution's Engelberg Center for Health Care Reform.
"The economic downturn makes it more urgent that we make sure that we're spending our money well on healthcare," McClellan told Reuters.
The stakes are high as the $2.3 trillion healthcare industry accounts for about 16 percent of the U.S. economy. Sweeping reform will not be easy -- even for Democrats who have made healthcare a signature issue and won a bigger majority in Congress, as well as control of the White House.
SEIU's Rivera and other advocates said Obama must take bold steps in his first 100 days in office and introduce broad legislation to make use of his political momentum.
Reformers are keen to avoid the missteps of the early Clinton administration, when too many competing efforts and a lack of outreach to various interests doomed then-First Lady Hillary Clinton's plan, several experts said.
Democratic Sen. Edward Kennedy, a life-long supporter of expanded healthcare access, wants to see lawmakers united behind one bill and has spent months meeting with a variety of groups, including the National Federation of Independent Business, a staffer said.
"I think everyone in the Congress ... is going to be taking their cues from the Obama White House on this effort," said Michael Myers, staff director for the Senate Health, Education, Labor and Pensions Committee, which Kennedy chairs.
But Senate Finance Committee Chairman Max Baucus, in a letter to Obama on Thursday, said he will issue a list of specific healthcare priorities next week for lawmakers to address, such as developing a mix of public and private insurance options.
"Many of my reform objectives as Finance Committee Chairman will dovetail with your own health plan; in the places where our opinions and policy plans diverge, I am eager to work with you to achieve consensus," wrote Baucus, a Democrat whose committee oversees Medicare and other government programs that together pay the largest share of the nation's health costs.
In the U.S. House of Representatives, California Democrat Rep. Henry Waxman, whose state houses numerous biotech companies, is challenging current House Energy and Commerce Committee Chairman Rep John Dingell, a Michigan Democrat and staunch supporter of the ailing auto industry.
Automakers and other companies are feeling the squeeze of providing employee benefits amid tighter economic conditions and Republicans could push for market-oriented reforms that encourage people to shop for their own coverage.
Pharmaceutical and equipment makers, as well as health insurers and pharmacy benefit managers, will also want a say.
If Democrats make good on their promises, major insurers such as UnitedHealth Group Inc (UNH.N) and WellPoint Inc WLP.N could see more enrollees. Drugmakers such as Pfizer Inc (PFE.N) and GlaxoSmithKline Plc (GSK.L)(GSK.N) could see greater use of their products, but also pressure to cut prices.
"Congress ought to proceed in a way that learns from past mistakes, understands the costs and their repercussions and doesn't end up torpedoing changes that would make the system more affordable and higher quality for everybody," Sen. Charles Grassley, the Finance Committee's ranking Republican said.
Democrats said they anticipated meetings with their counterparts now that the election has been settled.
What is unclear is how large a role the federal government will play in any new healthcare scheme. It is also not clear how Congress would pay for expanded coverage at a time when the 2009 federal budget deficit could reach $1 trillion.
Whenever health reform gets tackled, Obama has made it clear part of any reform issue must cut costs, Caris & Co analyst David Moskowitz said.
"The healthcare lobbyists are going to have to work even harder for the next several years," he told Reuters. (Additional reporting by Ransdell Pierson in New York; Editing by Andre Grenon)