President unveils most detailed health plan to date

WASHINGTON - In a final effort to achieve historic health care changes, President Barack Obama unveiled his most detailed plan yet Monday.

The 10-year, $1-trillion plan, like the current Democratic version in the Senate, would bring health insurance to more than 31 million Americans who now lack it.

Government insurance wouldn't be included, a problem for Democratic progressives. Republicans are skeptical about where the money would come from - and about Obama's claim that the plan wouldn't raise the federal deficit.

Striking out in one fresh direction that should have wide appeal, Obama would give federal regulators new powers over the insurance industry, a reaction to a rash of double-digit premium hikes that have infuriated policy holders in California and other states.

The plan is supposed to be the starting point for Obama's televised, bipartisan health care summit Thursday, a new beginning after a year of wrangling and letting Congress take the lead.

Yet Republicans were quick to dismiss it as a meld of two Democratic bills the public doesn't want. Democrats, while reaffirming their commitment to major changes, reacted cautiously, mindful that Obama is asking them to stake their political fortunes in the fall elections.

White House spokesman Dan Pfeiffer called the proposal "an opening bid" for Thursday's summit. "One thing I want to be very clear about is that the president expects and believes the American people deserve an up-or-down vote on health reform," he said.

But privately, a senior White House official sought to lower expectations, saying a solid single is better than striking out swinging for the fences.

If Obama ultimately settles for a pared-down plan, the final bill could look a lot like what Republicans have been calling for over many years. It would include federal funding for high-risk pools that would extend coverage to people denied because of medical problems, a new marketplace for small employers and individuals buying their own policies, and tax credits for small businesses.

When Obama began his health care overhaul effort a year ago, he sought to avoid the problems former President Bill Clinton encountered when he issued Congress a detailed prescription in the 1990s, a plan that failed and contributed to the Democrats' loss of Congress in 1994. Now he is being criticized for having been too deferential to lawmakers.

In the new political order, Obama's plan builds on the legislation passed by Senate Democrats on Christmas Eve, while making several changes designed to make it more acceptable to House Democrats.

It would dramatically roll back a Senate tax on high-cost health insurance plans objected to by the House - and by labor unions. Instead of raising $150 billion over 10 years, the tax would bring in just $30 billion, the administration said.

To plug the revenue gap, Obama would raise Medicare payroll taxes on upper-income earners. For the first time, Medicare taxes would be assessed on investment income, not just wages.

What's in Obama's plan, and what's not

By and large, the new health proposal unveiled by President Barack Obama Monday follows the bill passed by Senate, with changes intended to make it acceptable to their House counterparts.

What's new

Regulate insurance costs: Would give the federal government the power to regulate the health insurance industry much like a public utility.

Scale-back tax on "Cadillac" plans: Would raise the threshold for the expensive health-care plans that would be hit with an excise tax, and would delay the imposition of that tax on any plan until 2018.

Axes the "Cornhusker Kickback." It would eliminate a deal that negotiators made with Sen. Ben Nelson to provide Nebraska with additional assistance for increased Medicaid costs his state might encounter under the legislation.

Close doughnut hole: It would gradually close the "doughnut hole" for prescription drug expenses for seniors who fall into the Medicare Part D coverage gap.

More subsidies: Low-income families and individuals who do not have insurance would receive higher subsidies from the federal government to buy the insurance than had been the case under the Senate plan.

What's the same as existing legislation:

Abortion restrictions: Includes Senate-passed restrictions on federal funding for abortion that have been adamantly opposed by abortion foes as well as abortion rights supporters.

Mandates insurance: Requires most Americans to carry health insurance coverage, with federal subsidies to help many afford the premiums.

No denial of coverage: Bars insurance companies from denying coverage to people with medical problems or charging them more.

Insurance exhanges: Creates competitive insurance markets in each state for small businesses and people buying their own coverage.

What's not there

No public option: Conspicuously omits a government insurance plan sought by liberals and viewed as a nonstarter by conservatives and some congressional moderates.

SOURCES: Washington Post, Associated Press