While an advocate of a single-payer system, the congresswoman from Madison has had to accept Obama's public option plan.
After more than 10 years in Congress, Rep. Tammy Baldwin can't claim a landmark law that bears her name like the McCain-Feingold campaign finance reform co-authored by Wisconsin colleague Sen. Russ Feingold of Middleton.
Nor has the liberal Democrat from Madison burst onto the national political scene like her younger Republican counterpart, Rep. Paul Ryan of Janesville, part of the new generation of GOP leaders in Washington.
Even on her signature issue - health care reform - Baldwin may end up having less influence than Rep. Ron Kind, D-La Crosse, and other moderate Democrats wary of the kind of government-run health plan Baldwin supports.
But working quietly behind the scenes, Baldwin, 47, has managed to earn the confidence of Democratic leaders, hone a reputation as a skillful negotiator and lay the groundwork to push through legislation on health care, gay rights and the environment.
She won a coveted seat on the powerful House Energy and Commerce committee, where this year she helped muscle through a climate change bill. And she helped broker a compromise on the health care reform bill approved by the committee last month.
While final decisions on health care reform will be made "above her pay grade" - including whether to allow a government-run health plan to compete with private insurers - Baldwin is affecting other aspects of the bill, congressional scholar Norman Ornstein said.
"When you're dealing with a trillion dollar bill, being at the margins is not a petty thing," said Ornstein, of the conservative American Enterprise Institute.
Health care - more specifically a push for universal, government-run health care - has defined Baldwin's political life. It's the issue that spurred her to enter politics as an openly gay 24-year-old candidate for the Dane County Board 23 years ago and compelled her to first run for Congress in 1998.
And it's personal. A childhood illness, myelitis, which causes a swelling of the spinal cord, left Baldwin temporarily uninsurable.
"I've been waiting for this moment my entire political life," Baldwin said in a recent interview.
Even so, the moment is not quite what Baldwin had in mind.
A longtime proponent of a single-payer, government-run program, Baldwin has been forced to adjust those ambitions as her colleagues in the House and Senate consider a more modest "public option." Under that plan, people without insurance would be able to obtain coverage through a federal program; eventually, people with private insurance could opt into the program.
But that plan remains in doubt as Republicans and moderate Democrats have questioned its cost and scope. President Barack Obama also has appeared to waffle over whether the public option is crucial to the reform bill he's urging Congress to pass.
Baldwin said she remains hopeful the House will adopt the public option.
"Some of the apprehension about a strong public option is because people haven't seen a real, live example of how it can work and how it can keep costs down and provide competition and keep private insurance companies honest," she said.
She cited Wisconsin's popular SeniorCare prescription drug program as "a living model of precisely what we want to be able to accomplish" on a larger scale.
Although she remains a co-sponsor of a single-payer plan, Baldwin's embrace of the public option has been a blow to backers of universal health care.
"She's doing that as a pragmatic approach because she wants to get something passed," said Tracy Coombs, spokeswoman for the Coalition for Wisconsin Health. "We're disappointed in that, very disappointed. But we understand. Politics is the art of the possible."
Coombs also said Baldwin should hold public meetings on health care instead of her recent series of "telephone town halls," in which she invited constituents to join in a giant conference call.
"She has a great deal of support in her district and it would give us a chance to show her support - and she's more than capable of handling the opposition," Coombs said.
That complaint over meetings has been echoed by Baldwin's conservative critics, who accuse her of ducking the tough questions that have rained down on many of her colleagues at listening sessions this summer.
"They're hiding, that's what they're doing," David Viney, an Evansville farmer, said of Baldwin and other federal lawmakers who aren't holding public meetings on health care reform.
Baldwin defended the telephone calls, saying it has enabled her to reach 14,000 people, far more than public meetings would. And she has conducted public meetings on health care and other issues in the past and will do so in the future, she said.
Private and cerebral by nature, and a lawyer by training, Baldwin says her political skills are best suited to the relationship building and negotiating done by legislators.
As a UW-Madison student, Baldwin's mother attended protest rallies in the 1960s. Her maternal grandparents, who raised Baldwin because of her mother's addiction to prescription drugs, were vigilant voters and frequently wrote letters to elected officials.
Both means of political action made an impression on Baldwin, and by the time she was in middle school, Baldwin took up political activity herself, serving on her school's committee to improve relations with homeowners near the school.
"It was a light bulb moment for me that a small group of people could make a difference," she said of her middle school committee work.
A lifelong resident of the district she represents and a top student at West High School, Baldwin spent eight years on the Dane County Board before joining the state Assembly in 1993.
Five years later, she was a surprise winner in the 1998 Democratic primary for the second congressional district, defeating a local state senator and the county executive. She had something the others didn't: a volunteer and fundraising network organized by the national gay rights group Human Rights Campaign.
Baldwin went on to become the first Wisconsin woman and the first openly gay person in the country elected to Congress.
That path-forging win has allowed Baldwin to develop a national fundraising base among gays and lesbians that the average House member doesn't have. Since her initial race for Congress - when she raised $3.1 million compared with the House average of $848,000 - Baldwin has raised more money than the House average for each of her campaigns.
Safe in her liberal Madison seat, Baldwin has been raising less in recent years while launching her own political action committee to deliver $121,000 to liberal candidates around the country.
Pushing climate bill
After Democrats won control of Congress in 2006, House Democratic leaders named Baldwin to the Energy and Commerce committee, which has jurisdiction over federal health, energy and environmental policy. The assignment signaled the leadership's confidence in Baldwin, as many others were lobbying for the seat, said her colleague, Rep. Rush Holt, D-N.J.
In June, Baldwin used her influence on the committee to cajole her House colleagues into supporting the climate bill, which narrowly passed by a vote of 219 to 212. A Senate version is awaiting a vote.
"I was something of a holdout on the bill and she helped persuade me it was a good thing to do," Holt said. "She helped me obtain some promises I really needed, that as the bill moves forward there will be more (money) in there for research" on how to reduce carbon emissions.
As a junior member of the committee, she's still mostly offering an assist to Rep. Henry Waxman, D-Calif., committee chairman, Speaker Nancy Pelosi, D-Calif., and the health and energy subcommittee chairmen, who have led the writing of the health and energy legislation.
But Baldwin is in the "center of gravity" among House Democrats, Ornstein said.
"Your impact depends upon how well you work with others, and she's done that," he said. "It is clear that if Baldwin stays in the House, her stature will continue to rise."
Careful approach in public
Baldwin acknowledges that since she's been in Congress, she's more cautious in public than she was as a state legislator. But she says there's a reason for that.
"You're on that bigger stage, in a bigger spotlight and you recognize the consequence of a misstep is greater," she said. "You have to be mindful of the fact I get quoted in the New York Times. There's consequence and we're dealing with very important issues, and I want to get it right."
Whether that careful approach helps Baldwin broaden her appeal enough to run for statewide office or relegates her to a perpetual supporting role remains to be seen.
With her fundraising prowess, congressional experience and likable, low-key manner, she could run for the U.S. Senate seat held by Herb Kohl some day. If she does, she'll have to overcome the label of a Madison liberal - "a better fit for the district than the state" - said David Wasserman, House editor of The Cook Political Report, which analyzes federal and gubernatorial elections.
Baldwin herself said she would consider higher elective office if it gave her an opportunity to have more influence on health care policy.
At a recent event with Gov. Jim Doyle, she said she had no plans to run for governor when Doyle leaves office next year, although she said the office's four-year term "is enticing."
Doyle then chimed in, "Six-year terms are nice, too," referring to the term of a U.S. senator.
Baldwin smiled and laughed.
"They are," she said.
Family: Lauren Azar, partner.
Education: West High School, 1980; Smith College, mathematics and government, 1984; UW-Madison, law, 1989.
Political career: U.S. Representative, 2nd Congressional District, 1999-present; state Assembly, 1993-99; Dane County Board, 1986-1994; Madison City Council, 1986.
Web site: tammybaldwin.house.gov/faqs.html