Obama has moved just as cautiously, if not more so, on immigration and gays in the military. Supporters and some critics agree that he tries to walk a line that neither angers liberals who helped elect him, nor fires up conservatives hoping to defeat Democrats this fall and to oust Obama in 2012.

He seems to have struck that balance late Thursday, when he quietly began the process of requiring nearly all U.S. hospitals to allow patients to designate people who can visit and consult with them at crucial moments. Obama specifically cited gay men and lesbians, saying they "are often barred from the bedsides of the partners with whom they may have spent decades of their lives."

The directive made headlines nationwide. But it drew scarcely a whisper of complaints from Republicans or mainstream conservative groups.

Some gay rights activists, meanwhile, offered tepid praise, noting that it took Obama more than a year to fulfill a promise he made during his 2008 campaign.

Evan Wolfson, executive director of Freedom to Marry, called it "a small, but welcome step forward" that will help many people. But he added: "Piecemeal steps, addressing one protection at a time, will take up a lot more time than either the administration or American families can afford."

Activists noted that the administration is moving slowly to fully dismantle "Don't Ask, Don't Tell," the 17-year-old policy that has kept many gays and lesbians from serving openly in the military. And Obama continues to oppose same-sex marriage even as a few states have legalized it.

Obama's new announcement appeared to upset few hospitals, in part because many already follow the policy he described.

"Hospitals try to accede to a patient's wishes," said Jan Emerson, spokeswoman for the California Hospital Association. "So if the patient says 'I want so-and-so to be here,' unless there's some reason, like the patient has a communicable disease, the hospital is going to do what it can to abide by that."

At Washington Hospital Center in the nation's capital, Obama's order "is consistent with our policy," said chief nursing officer Elizabeth Wykpisz. "We have a non-discrimination policy" for visitors and patient representatives, she said, "and sexual orientation is part of that."

Some liberals see similar caution by Obama in other areas. In the long battle over revising health care laws, for instance, he quickly dropped a proposed public option for insurance, despite campaigning for it and seeing consistent liberal support for it.

Perhaps no constituent group is more frustrated than advocates of changing immigration laws to provide pathways to legal status for millions of illegal immigrants.

Last month, when up to 200,000 people marched in Washington for immigration reforms, Obama appeared in a video to say he would do what he can to forge a bipartisan consensus this year.

But lawmakers from both parties say far-reaching changes to immigration laws will be extremely difficult. Advocates are impatient.

"It's time to tell Congress that now that health care reform has passed, they have 200,000 good reasons to move immigration reform next," says the Web site of America's Voice, which supports an immigration overhaul.