U.S. Rep. Kathy Castor stood out for not standing out. Head down, she focused on the mountain before her — the 1,000-plus pages that make up America's Affordable Health Choices Act.

But when the meeting finally broke, Castor had added an amendment to the draft to increase funding for trauma centers like those in her hometown of Tampa.

While the struggle over the most complex changes to health care in a generation continues, Castor has been using what she calls a "pleasant persistence" to push for a number of Florida-driven provisions, including one to address the state's doctor shortage.

Perhaps more than any other member of the Florida congressional delegation, Castor has staked out a place in the debate. She is not at the forefront, arguing loudly for the government-run coverage option, though she favors it, but instead is pursuing rifle-shot ideas outside of the fray.

It is part of a political demeanor that is somewhat low-key, some might even say cautious. The 42-year-old lawyer is apt to stick to her issues and make broad statements about fixing a broken system. The approach is not unique, but it is partly why Democrats have had a hard time convincing the public that their solutions are best.

"She is not one of the ones obstructing things, but I wish she and the other Democrats were more forceful in supporting the agenda the American people voted for last November," said Tampa-area Democratic activist Susan T. Smith.

Majority Democrats are continuing to have trouble getting traction for their sprawling plan, and upheaval continued Tuesday. It's now almost certain that lawmakers will not vote before their August recess. President Barack Obama continued his offensive anyway, holding a town hall-style meeting at AARP headquarters. "We've got to have the courage to be willing to change things," he said.

The House bill remains stuck in the Energy and Commerce Committee that Castor sits on; the panel has not met since July 20. Castor, like Obama, wanted a vote by the summer break.

"The longer special interests and insurance companies have to delay and divide and conquer," she said, "the less likely it is we'll be successful."

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Though Castor has worked to promote herself alongside the legislation — on Monday she staged a news conference in Tampa to tout wellness incentives for businesses, one in a number of recent events — the issue has been on her screen for some time.

As a Hillsborough County commissioner, she fought efforts to water down the county's renowned indigent medical treatment program. Health care was a cornerstone of her 2006 campaign to replace retiring Rep. Jim Davis. And after Obama was elected, she swiftly moved to insert herself in the reform negotiations.

In a Dec. 3 letter to House Speaker Nancy Pelosi, Castor asked to be transferred to the Energy and Commerce Committee. To make her case, Castor noted that only one other Floridian (Republican Cliff Stearns of Ocala, who did not respond to requests for comment) sat on the panel, and yet the fourth-largest state has critical health care needs.

Pelosi said Castor has been a worthy addition. "She's been very constructive and very much understands the challenge. I'm so pleased she's able to have a seat at the table, bringing a new generation of thinking on health care to the debate."

As the talks began this spring, Castor again used a letter to assert herself. An eight-page memo she wrote to House leaders highlighted provisions that should be included, some like the doctor shortage bill Castor and other Florida lawmakers sponsored in 2007. She called for an emphasis on primary care and more community health centers.

"That was the most detailed letter I got from any member about what should be in the bill and how we should approach this problem," said Rep. Frank Pallone of New Jersey, who chairs the subcommittee on health. "When she wants something, she makes sure she tells you and she's very aggressive about following through."

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Castor's success partly owes to the mostly noncontroversial nature of the provisions she is seeking.

The plan to increase funding for more doctor-in-training, or residency, slots at hospitals is an example. But the issue matters greatly in Florida, which has seen young doctors complete their training in other states never to return. Florida ranks near the bottom of all states for hospital residency slots.

Additional funding for wellness programs and trauma centers also appear out of the line of fire. She is also working with others to curb shady marketing practices under Medicare Advantage plans, a problem in Florida.

Last Tuesday, Castor huddled behind the scenes with a half-dozen other Democrats to form a series of amendments that call for deeper prescription drug savings than the White House was able to negotiate. Castor's amendment would allow the government-run insurance plan to negotiate drug prices.

But now, it's increasingly doubtful she will get a chance to bring it up before summer vacation.