This is a monumental week for health care reform. If the Congress wants to stick to the President’s perceived schedule and get a bill to his desk before the State of the Union address, they need to act this week.

The biggest outstanding issue, at least in recent days, has appeared to be the excise tax on high-end insurance plans. President Obama is meeting with union leaders later today to offer his take on why the excise tax is desirable. AFL-CIO President Richard Trumka gave a kind of pre-buttal to the President today at the National Press Club, in a speech that pressed national Democrats to show more courage in standing up to special interests. Much of the speech concerned financial reform, jobs, trade policy and other priorities, but on health care he did not hold back either:

Each of these initiatives should be rooted in a crucial alliance of the middle class and the poor. But today, as I speak to you, something different is happening with health care.

On the one hand we have the House bill, which asks the small part of our country that has prospered in the last decade—the richest of the rich—to pay a little bit more in taxes so that most Americans can have health insurance. And the House bill reins in the power of health insurers and employers by having an employer mandate and a strong public option.

But thanks to the Senate rules, the appalling irresponsibility of the Senate Republicans and the power of the wealthy among some Democrats, the Senate bill instead drives a wedge between the middle class and the poor. The bill rightly seeks to ensure that most Americans have health insurance. But instead of taxing the rich, the Senate bill taxes the middle class by taxing workers’ health plans—not just union members’ health care; most of the 31 million insured employees who would be hit by the excise tax are not union members.

The tax on benefits in the Senate bill pits working Americans who need health care for their families against working Americans struggling to keep health care for their families. This is a policy designed to benefit elites—in this case, insurers, hospitals, pharmaceutical companies and irresponsible employers, at the expense of the broader public. It’s the same tragic pattern that got us where we are today, and I can assure you the labor movement is fighting with everything we’ve got to win health care reform that is worthy of the support of working men and women.

This tough talk was buffeted by a labor liberal in Congress, Carol Shea-Porter, who over the weekend said she would vote against any bill which included the excise tax. While 190 Democrats have signed a letter rejecting the excise tax, I don’t recall any member of Congress making this claim before. Shea-Porter, while generally a liberal, won her seat in 2006, and faces a fairly tough re-election battle. This movement on the health care bill may be as much about November as it is about any firmness on the excise tax.

Trumka, in follow-up remarks on the health care bill, basically said that 2010 is on the line in the legislation:

Asked whether workers would stay at home in November if the health care bill doesn’t accomplish those goals, Trumka was blunt.

“I think there’s that chance,” he said. “I think the American public, and workers are out there and they’re looking for a couple things right now. Health care is an important issue to them. Jobs are an important issue. I think those people that don’t show a sense of urgency about both of them, I think they’re going to face the scorn of workers at the polls.”

Clearly, the financing of the bill is becoming the flashpoint which could actually sink health care reform. We will see if labor – and some shaky Dems – can be mollified.

UPDATE: Shea-Porter spokeswoman Jamie Radice just emailed a statement saying that the Congresswoman has NOT made an ultimatum on the excise tax:

“Both in private and in public, Congresswoman Shea-Porter has never said that she would vote for or against a final health care reform bill if it contained an excise tax. She has spoken out forcefully against this tax, which is contained in the Senate’s health care reform bill, but she is waiting to see what the conference report looks like before making any final decisions. She remains in support of the House version.”