President Obama's Health Care Plan Proposes Fixes to Senate Bill

WASHINGTON, Feb. 22, 2010— -- The White House today unveiled President Obama's health care overhaul bill, which it says will expand health insurance to 31 million more Americans and reduce the federal budget deficit by $100 billion in the next 10 years.

The White House also released the changes Obama wants to see in the Senate Democratic health care bill. Even before its release, the White House's plan had already met with fierce Republican resistance.

The White House estimates the cost of their health care plan, with the proposals to fix the Senate bill, would be roughly $950 billion over ten years, but there is unlikely to be a cost estimate from the nonpartisan Congressional Budget Office. CBO director Douglas Elmendorf said today there is not yet enough information from the White House to create a detailed cost estimate yet and even if there was, the assessment wouldn't be done this week.

Administration officials call the health care bill a "starting point" point for Thursday's televised, bipartisan discussions on health care overhaul.

"I think it's a starting point in as much... as Republicans come to Thursday's meeting with constructive proposals that they're willing to discuss," White House Press Secretary Robert Gibbs said today.

Nancy-Ann DeParle, director of the White House Office of Health Reform, said this is "the Senate bill with some targeted and important changes that achieve the president's goal and bridge the gap between the House and Senate proposals."

A senior White House official said the proposal was "informed by our conversations from negotiations" before Sen. Scott Brown, R-Mass., was elected, thus depriving Democrats of their 60-vote majority, as well as from subsequent discussions.

The White House proposal doesn't just represent ideas, but a potential strategy -- to have the House pass the Senate bill, with fixes to come to make it more palatable.

With Brown's win in Massachusetts last month, Democrats no longer have a filibuster-proof majority, so they would pass the "fix" using a controversial maneuver that requires only 51 votes.

White House officials are thus signaling that Thursday's discussion won't be just a parlor meeting to chat about health care principles, though they insist their minds will be open to incorporate some Republican ideas.

"The president believes that we have done a lot of very good work on health reform over the last year, and starting from scratch doesn't make sense," Pfeiffer said. "However, we are coming to this meeting with an open mind to additional ideas and we hope the Republicans will do the same."

Pfeiffer said the White House hopes the Republicans will put forward their plan this week.

"There are a number of Republican plans out there," he said. "Hopefully, they can work together and consolidate."

House Speaker Nancy Pelosi, D-Calif., believes passing the bill is "possibly doable," a senior White House official said. "But she may ultimately decide the math is impossible."

If that does not work, the next plan is to push a more modest bill -- a smaller expansion of health insurance reform, some tax breaks for small businesses to help provide insurance for employees, a more modest expansion of Medicaid and the creation of the health insurance exchanges.

Among the fixes to the Senate bill that the president is proposing are "an additional series of measures proposed by Republicans to eliminate waste, fraud and abuse," a White House official said. "The president believes the bipartisan discussion on Thursday will be the most productive if Democrats come to the table with a consolidated proposal -- what he's releasing today -- and he hopes the Republicans will follow suit and come with their own unified proposal. He'll be open to Republican ideas, and he hopes they'll be open to ours."

The Democratic Senate bill includes a tax on insurance companies for high-cost health care, so-called Cadillac insurance plans. The White House is proposing to add a transition period for everyone, not just union members, who had opposed the tax. The tax wouldn't start until 2018; for family plans costing $27,500 and more, with exceptions for high-risk professions and others. At the same time, instead of raising $150 billion in 10 years, it would bring in just $30 billion, per the White House proposal.

Key changes that the White House wants to see removed include the so-called "Cornhusker compromise," the deal to win the vote of Democratic senator from Nebraska, Ben Nelson, by having the federal government pay for his state's Medicaid expansion.

For the president, the conversation starts with four key parts of the Senate health care bill, which passed on Christmas Eve after weeks of deadlock.

First are insurance reforms, such as prohibiting insurers from being able to deny coverage based on pre-existing conditions, a reform that Republicans have also said they would like to see happen.

Second, as proposed in both the House and Senate bills, the president wants to see health insurance exchanges created at the state level to ensure competition, a thorny point for Republicans.

Third, there would be no option of a government-run insurance plan that would compete with the private sector. The House health care bill includes a public option, but the Senate legislation does not, and even though the president initially pushed public option as part of a health care overhaul package, he has said that to achieve compromise it would need to be given up. Republicans are staunchly against any public option, saying it would hurt competition and the private sector.

Fourth, all Americans would be required to have health insurance coverage, and Medicaid would be expanded for low- and middle-income Americans to purchase health insurance. Both are points of contention for Republicans.