They led the most powerful forces in healthcare -- the trade groups representing doctors, insurance companies, hospitals and drug makers. Any one of them could stall, if not derail, President Obama's hopes of overhauling the U.S. healthcare system.
Instead, they stood with Obama before TV cameras at the White House and pledged their cooperation. For Obama, the show of unity gave momentum to perhaps his most ambitious domestic goal.
But the moment was a victory, as well, for another man invited to the event that morning in May. Andy Stern heads the SEIU, the union that helped corral the industry groups, and his presence at the White House was a fresh sign of his formidable clout with Obama.
When the president met privately with the health industry leaders that day, Stern and a second Service Employees International Union official were the only labor representatives in the room.
In a fractious labor movement fraught with rivalries and mutual suspicion, Stern's close association with Obama has given him cachet that may prove important in the fierce competition to lure new members.
But Stern's access to the White House has also provoked jealousies. His opponents paint him as a polarizing figure that Obama elevates at his own peril.
The Obama-Stern relationship has emerged as one of the most curious within the young administration.
The SEIU spent $60 million to help elect Obama, according to the union. Stern said the group deployed 100,000 volunteers during the campaign, including 3,000 who worked on the election full time.
Now in the White House, Obama has continued to derive political benefits from the union. It was the SEIU's health chief, Dennis Rivera, who helped bring industry to the table to start talks on a healthcare overhaul.
With nearly 2 million members, the SEIU says it has people in 13 states whose senators are considered important targets in the lobbying effort behind the emerging Democratic healthcare bill. The union wants to coax those senators into voting for the bill.
Stern can boast that union officials are scattered throughout the Obama administration. White House political director Patrick Gaspard is a former executive at an SEIU local based in New York. No other union has placed anyone at such a high level in the White House.
Anna Burger, SEIU secretary-treasurer, was appointed to Obama's economic recovery board. And union associate counsel John Sullivan was named to the six-member Federal Election Commission.
Moreover, Stern has enjoyed considerable entree to the new administration -- starting on Inauguration Day, when he joined Obama and the new president's family on the reviewing stand outside the White House to watch the inaugural parade.
Stern estimates he visits the White House once a week. SEIU officials talk to senior Obama advisor Nancy-Ann DeParle about healthcare -- a top priority for Stern -- and to Obama aide Cecilia Munoz about immigration, Stern said.
"We get heard," Stern said.
Stern's access is envied by some fellow union leaders. John Wilhelm, head of Unite Here, the apparel, hotel and food service union, said his perception is that Stern gets a steady stream of invitations to the White House that other union executives do not.
Wilhelm said he was disappointed, for example, that his union was not invited to a White House meeting that touched on travel to Nevada -- an important subject for his union, which represents hotel and culinary workers in Las Vegas. Part of the meeting was spent placating Nevada interests upset over comments Obama made that banks receiving bailout money should not take Las Vegas junkets.
The SEIU's access to the White House also has left California officials unsettled. Earlier this year, the Obama administration invited the SEIU to take part in a conference call centering on a dispute over pay cuts to home healthcare workers represented by the union. State officials said the union's involvement in a government-to-government conference seemed inappropriate.
Still, the labor movement's track record in the Obama presidency is mixed, which raises questions about the value of Stern's access. Labor's top priority has been a bill called "card check," which would make it easier for unions to organize. But the bill has stalled in the Senate, and Obama has done little to move it along.
For Stern, another setback concerned the California home health worker case. The SEIU had wanted the Obama administration to declare that California acted illegally in cutting the wages of home healthcare workers.
At first it seemed Obama would go along. A preliminary opinion from the federal government warned that California, in cutting wages, had violated terms of the stimulus package.
Emboldened, the SEIU issued a news release trumpeting a "major victory."
In the end, however, the Obama administration backed off its position, validating the wage cuts.
"Whatever clout was gained doesn't matter if you can't deliver for your members. If I get invited to dinner at the White House or what have you, if I can't use that to deliver for my members, I haven't succeeded," said Gregory Junemann, president of the International Federation of Professional and Technical Engineers.
The SEIU is mired in bitter fights with other union leaders -- feuds that carry the potential to scare off a White House that may not wish to offend Stern's rivals.
In California, the SEIU's national office ousted the leaders of the 140,000-member Oakland-based local. After they were dislodged, the leaders formed a rival labor group that is competing with the SEIU in organizing elections.
"It does sap the political legitimacy of someone like Stern when he finds himself embroiled in internal fights," said Nelson Lichtenstein, a UC Santa Barbara labor historian.
Stern counters that the SEIU's political loyalties are solid, reaching back to the 2004 Illinois Senate race, when Obama was a long shot but earned the union's endorsement.
"Our relationship was built in an earlier era," Stern said.
Times staff writer Paul Pringle in Los Angeles and Tom Hamburger in the Washington bureau contributed to this report.