Obama health vision to include insurance 'exchange'

President Obama offered details to Congress and the American people Wednesday night on his prescription for the nation's health care system, including plans for an "exchange" in which the uninsured may shop for competitive prices.

Speaking before a packed U.S. Capitol and addressing House and Senate members and cabinet members, Obama outlined a proposal for a plan that would cost $900 billion over 10 years, "...less than we have spent on the Iraq and Afghanistan wars, and less than the tax cuts for the wealthiest few Americans that Congress passed at the beginning of the previous administration."

Obama also made reference to the late Sen. Ted Kennedy, D-Mass., who died last month of brain cancer and who'd fought for health-care reform before his death. Kennedy's widow, Vicki, who appeared visibly moved, and sons, Patrick and Ted Jr., looked on from the audience.

"On issues like these, Ted Kennedy's passion was born not of some rigid ideology, but of his own experience," Obama said. "It was the experience of having two children stricken with cancer."

Ted Kennedy Jr. lost a leg to bone cancer as a child. Another of the late senator's children, Kara Kennedy Allen, has battled lung cancer.

Some of the details of the plan the president shared Wednesday night:

• Those who already have insurance through jobs, Medicare, Medicaid or the VA will not be required to change.

• It will be illegal for insurance companies to deny coverage based on pre-existing conditions.

• Cap on out-of-pocket expenses.

• If you lose your job or change jobs, or start your own business, you can shop for new insurance via an exchange that allows you to shop at competitive prices.

"Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy," Obama told the crowd. "These are not primarily people on welfare. These are middle-class Americans. Some can't get insurance on the job. Others are self-employed and can't afford it ... Many other Americans who are willing and able to pay are still denied insurance due to previous illnesse or conditions that insurance companies decide are too risky or expensive to cover."

Obama added, "We are the only advanced democracy on earth — the only wealthy nation — that allows such hardships for millions of its people."

He shared horror stories of patients, including one man who lost his coverage in the middle of chemotherapy because his insurer learned he had not reported gallstones that he didn't know about. That man died, the president said. Another woman had her policy canceled as she was about the undergo a double mastectomy because she had not declared a case of acne. By the time she got her insurance back, her breast cancer had doubled in size, Obama said.

"That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America," the president said.

"Know this: I will not waste time with those who have made the calculation that it's better politics to kill this plan than improve it," the excerpts read. "I will not stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what's in the plan, we wil call you out. And I will not accept the status quo as a solution. Not this time. Not now."

Earlier in the day, ABC's Good Morning America aired an interview with the president in which he said that he wants to "make sure that Democrats and Republicans understand that I'm open to new ideas, that we're not being rigid and ideological about this thing, but we do intend to get something done this year."

A few hours before the president's speech, Congressional Democrats and Republicans appeared to remain on opposite ends of the spectrum when it came to the possibility of hashing out a bipartisan agreement anytime soon.

Senate Finance Committee Chairman Max Baucus, D-Mont., abandoned his earlier talk expressing the need for the broad outlines of an agreement after meeting on Tuesday with the half-Republican, half-Democrat "Gang of Six." Baucus said he hoped an agreement could be carved out by the end of the year, but added he plans to move forward in trying to work through a plan regardless.

"I very much hope and do expect Republicans will be on board," Baucus said. "I don't know how many, but if there are not any, I will move forward anyway."

Congressional Republicans, meantime, were sending out a message that everyone needs to slow down or start over on a health care plan. Some GOP members are calling for a slimmed-down version of the president's plan with a few stipulations staying in place, including one ensuring that insurance companies cannot deny coverage to people with pre-existing health issues.

"Our view is: Let's scale it back, target the problems and not have the government take over, in effect, all of American health care," Senate Minority Leader Mitch McConnell, R-Ky., said.

Democratic leaders who met with the president Tuesday came away extolling a public option as the best way to inject more choice and competition into the insurance market. "We're going to do our very best to have a public option or something like a public option before we finish this work," said Senate Majority Leader Harry Reid, D-Nev.

White House press secretary Robert Gibbs said Obama will be more specific than he has been in the past about what he favors and how he wants to pay for it.

"What the president will do is ... take the strands that exist, the ideas that are out there, and try to pull many of those together, outline in some specificity a plan moving forward," he said.

Tom Daschle, former Senate majority leader and Obama's initial pick for health secretary, said there will be "no surprises" in the address but added the president would likely offer more details about his plan.

"He'll be as specific as a president can be in 45 minutes," Daschle said.

The speech presents Obama with a series of conflicting expectations, experts say:

• He must get deeper into the nitty-gritty of five health care bills in Congress without being so specific that he confuses the millions watching on TV.

"This cannot be simply the speech he's given before," said Kathleen Hall Jamieson, professor of communication at University of Pennsylvania's Annenberg School for Communication. "There now has to be an outline of an Obama bill."

On the other hand, says Kenneth Thorpe, chairman of the Department of Health Policy and Management at Emory University, "it's got to be simple, it's got to be believable and compelling, and it's got to be powerful."

• He has to come across as tough and willing to stand up for his principles while appearing magnanimous toward his political opponents and willing to compromise.

Speaking before a joint session of Congress "is a dramatic and open invitation to be pluralistic and open-minded and extend an olive branch to the other side," says Roderick Hart, dean of the College of Communication at the University of Texas.

• He must try to satisfy his liberal base, which favors a public option and generous subsidies to the uninsured, without alienating moderates who want private health care cooperatives or a public option only as a last resort.

"I think he will make clear that his bottom line is to get it done, one way or another," says Ron Pollack, executive director of the liberal health advocacy group Families USA. "If it can't get done on a bipartisan basis, he is determined to get it through the Congress this year."