Can Obama recover from his health care crisis?

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The president’s approval ratings have tumbled to their lowest ever, with President Obama’s support down to 40 percent in recent polls.

Congressional Democrats, with President Clinton’s endorsement, are now urging controversial changes to the health care law, despite Obama’s pleas for patience. The administration is sounding less confident that Healthcare.gov will work on Nov. 31, as the administration had promised. And data released on Wednesday confirmed that so far, the Affordable Care Act’s implementation is failing.

This is unlike Syria, the IRS, revelations about the NSA or the government shutdown, all second-term controversies the president has endured. This is his signature issue, one that affects millions of Americans. There’s no villain that Obama can take on, such as Edward Snowden during the NSA leaks controversy or the congressional Republicans in the midst of the government shutdown. And it strikes at the heart of two core principles that have defined Obama’s administration: competence and credibility.

Before health care, the president wasn’t spending a lot of time apologizing or being accused of misleading the public and even his allies. On Wednesday, the Washington Post published a piece titled, “An image of trustworthiness frays.” Obama and his team had wound down two wars, killed Osama Bin Laden and successful handled hurricanes and other natural disasters, unlike the Bush administration. But the HealthCare.gov failures show an administration unable to build a website in three years.

Can Obama recover? Probably. But it’s getting harder to figure out how, barring another government shutdown or obvious mistake by the Republicans. The Obama administration’s hope, that millions of low and middle-income Americans would get health insurance while most Americans were barely affected and hardly noticed the ACA is in effect, is gone forever. Republicans and even some Democrats will blame any future problem with any American’s health insurance on the law, and Obama has very little credibility now to defend the ACA. The stories of hundreds of thousands of Americans who are likely to get health insurance have been drowned out by people forced to get more expensive coverage or not able to log on to the website.

Even if the website starts working perfectly on Nov. 30, this first month of Obamacare won’t be forgotten.

Ultimately, Obama can recover, but it must start with health care. If the website is working well, that will reduce the amount of criticism from congressional Democrats and the media about health care. Stories about people who are benefiting from the law will emerge. Attention will shift back to congressional Republicans and their low approval ratings, perhaps giving them an incentive to work with Obama on immigration reform in 2014. Obama’s pushes for appoint more federal judges, keep current food stamp funding in place and shift American education policy will get more attention.

But right now, Obama has a problem with Democrats, not Republicans in Congress. And that’s serious.

Every Democrat who proposes some kind of shift or weakening of Obamacare makes it easier for a Republican to propose the same and makes the GOP idea more legitimate. The health care law relies on a complex set of policies all working together, from the deadlines to the mandates to the rules about what insurance must cover. One slight policy change, pushed by a Democrat in Congress worried about losing re-election in 2014, could undermind the whole law.

That’s why the president and his team must have the health care law working very soon.