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WASHINGTON — Heading into a critical period in the debate over health-care reform, public approval of President Obama's stewardship on the issue has dropped below the 50-percent threshold for the first time, according to a new Washington Post-ABC News poll.

And with skepticism about the president's effort also mounting on Capitol Hill — even within his own party — the White House has launched a new phase of its strategy designed to dramatically increase public pressure on Congress: all Obama, all the time.

Senior White House aides promise "an aggressive public and private schedule" for Obama as he presses his case for reform, including a prime-time news conference on Wednesday, a trip to Cleveland, and heavy use of Internet video to broadcast his message beyond the reach of the traditional media.

"Our strategy has been to allow this process to advance to the point where it made sense for the president to take the baton. Now's that time," said senior adviser David Axelrod. "I don't know whether he will Twitter or tweet. But he's going to be very, very visible."

Today, his advisers say, he will do a round of interviews to drive the narrative for the week. Private meetings with lawmakers will become more frequent and urgent.

Since April, approval of Obama's handling of health care has dropped from 57 percent to 49 percent, with disapproval rising from 29 percent to 44 percent.

Obama's approval ratings on other front-burner issues, such as the economy and the federal budget deficit, have also slipped over the summer, as rising concern about spending and continuing worries about the economy combine to challenge his administration. Barely more than half approve of the way he is handling unemployment, which now tops 10 percent in 15 states and the District of Columbia.

But even as Obama returns to full-time campaign mode, he is facing increasing calls to show that his presidency can manage the tough, nitty-gritty of lawmaking by cutting deals with his allies to keep health-care legislation moving in the House and Senate committees.

Conservative Democrats in the House are promising to vote against reform as it now stands, and are preparing two dozen amendments, including measures aimed at lowering the effort's long-term cost. In the Senate, members from both parties are urging the president to break his campaign promise to preserve the tax-free status of health benefits. And a chorus of weary voices from Capitol Hill is urging him to abandon his demand for passage of bills in the House and Senate by Aug. 7.

"I don't think we should be bound by a timetable that isn't realistic," Sen. Olympia Snowe, R-Maine, a key swing vote on health care, told Obama last week as she reminded him that President Lyndon Johnson took 11/2 years to pass Medicare.

Obama has not officially budged on the timetable, although he and aides have notably failed to note the August deadline in recent remarks. But Obama is quietly working with conservative, Blue Dog Democrats in the House on an amendment to create an independent panel to govern Medicare reimbursement rates that could help reverse crippling health-care inflation.

The decision to vault Obama to the front carries huge risks.

The decades-long drive to reform the health-care system now rests largely on Obama's ability to quell revolts among his Democratic allies, many of whom have spent the past several weeks picking at pieces of his proposals.

If conservative House Democrats succeed in sowing fear of rising deficits, it will be seen as Obama's fault that he could not rein them in. If Democrats in the Senate fail to agree on financing, Obama must explain the failure despite his party's majorities in both chambers.

Approval of Obama's handling of the overall economy stands at 52 percent, with 46 percent disapproving, and, for the first time in his presidency, more Americans strongly disapprove of his performance on the economy than strongly approve. Last month, 56 percent gave him positive marks on this issue.

The president's overall approval rating remains higher than his marks on particular domestic issues, with 59 percent giving him positive reviews and 37 percent disapproving. But the poll is the first time in his presidency that Obama has fallen under 60 percent in Post-ABC polling, and he is six percentage points lower than he was a month ago.

A total of 1,001 randomly selected adults were interviewed for this poll; the margin of sampling error is plus or minus three percentage points.