Obama Details Plan to Expand Health Care to Uninsured

WASHINGTON President Obama on Monday laid out for the first time a detailed legislative proposal for overhauling health care. His plan sticks largely to the approach passed by the Senate with unified Democratic support, but it makes concessions to the House version, which was more expensive and would have covered more people.

Mr. Obama’s proposal is the opening act to a week of high drama around health care that will culminate on Thursday, when the president convenes Democrats and Republicans at an all-day televised health care “summit” at Blair House. The White House is hoping the session can jump start the stalled health bill.

“We view this as the opening bid for the health meeting,” Dan Pfeiffer, Mr. Obama’s communications director, told reporters Monday morning, adding, “We took our best shot at bridging the differences.”

The bill is intended to achieve Mr. Obama’s broad goals of expanding coverage to the uninsured while driving down health premiums and imposing what the White House calls “common sense rules of the road” for insurers, including ending the unpopular practice of discriminating against people with pre-existing conditions. The measure is posted on the White House Web site.

The White House projects that the bill would extend coverage to 31 million people who are currently uninsured, at a cost over 10 years of $950 billion — more than the $871 billion the Senate would have spent, but less than the $1.05 trillion for the version passed by the House. The administration estimates that its plan would reduce the federal deficit by $100 billion over the next 10 years — and about $1 trillion over the second decade — by cutting spending and reining in waste and fraud.

But the measure has not yet been evaluated by the non-partisan Congressional Budget Office, and White House officials said they were open to adjusting it if it cost substantially more than they have estimated.

The proposal would provide more money to help cash-strapped states pay for Medicaid over the next four years and eliminate the unpopular “donut hole” coverage gap in the Medicare prescription drug program.

In many respects, Mr. Obama’s measure looks much like the version the Senate passed on Christmas Eve — and indeed, senior White House officials acknowledged on a morning conference call that they had used the Senate bill as a template. But there are several critical differences that appear designed to appeal to House Democrats, who have voiced deep concerns about the Senate measure and its effects on the middle class.

To begin with, Mr. Obama would eliminate a controversial special deal for Nebraska — widely derided by Republicans as the “cornhusker kickback” — that called for the federal government to pay the full cost of a Medicaid expansion for that state. Instead, the White House would help all states absorb the cost of the Medicaid expansion from 2014, when it begins, until 2017.

And while the president adopts the Senate’s proposed excise tax on high-cost, employer sponsored insurance plans, Mr. Obama makes some crucial adjustments based on an agreement reached in January with organized labor leaders, while also trying to avoid the appearance of special treatment for unions. Most crucially, the president would delay imposing the tax until 2018 for all policies, not just for health benefits provided through collectively-bargained union contracts.

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