The White House this morning unveiled President Obama's health care plan and the changes he wants to make to the Senate Democratic health care bill. Even before the release of the proposal, it had already met with fierce Republican resistance.
The plan will reduce the deficit by $100 billion over the next decade, and more than $1 trillion in the years after that, and expand health care to 31 million more Americans, according to the White House.
"This is our take on the best way to merge the House and Senate bills," a senior White House official told ABC News. The 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.
"We thought it would be a more productive meeting if we brought one consolidated plan to use as jumping-off point," the official said. "We hope the Republicans do the same."
With Brown's win in Massachusetts last month, Democrats no longer have a supermajority, so they would pass the "fix" using a controversial maneuver that requires only 51 votes.
White House officials are 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.
"Maybe we'll sit across from each other and identify 10 things we can move forward on," the official said. "We hope new ideas come to the table. The proposal we're walking into the meeting with is not the same one we will walk out of the meeting with."
House Speaker Nancy Pelosi, D-Calif., believes passing the bill is "possibly doable," the 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."
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 denying coverage because of 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 a public option as part of a health care overhaul package, he has said that to achieve compromise that aspect 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.
White House to Unveil President Obama's Health Care Plan
The Democratic Senate bill includes a tax on insurance companies for high-cost health care -- so-called "Cadillac" insurance plans. The White House is not proposing as a "fix" the phased-out exemption for union members that had been worked out in post-Christmas negotiations to secure the support of labor unions.
Key changes that the White House wants to see removed include the "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.
The language regarding abortion, also from Nelson, would allow women who receive government subsidies to purchase insurance policies that cover abortion, but they would have to write separate checks. In some ways this is less restrictive than the House language from Rep. Bart Stupak, D-Mich., that would prohibit women who receive government subsidies from taking out plans that provide abortion coverage.
A brand new proposal would give Health and Human Services Secretary Kathleen Sebelius the power to block insurance company premium increases if they don't meet certain criteria, for states where regulators do not already have that authority. Sen. Dianne Feinstein, D-Calif., came up with the proposal after news surfaced that the largest insurer in her home state, Anthem Blue Cross, was proposing premium increases of up to 39 percent on individual health insurance plans.
Under the new proposal suggested by Feinstein, the Health and Human Services secretary would work with state regulators to develop an annual review of rate increases. A new body called the Health Insurance Rate Authority would be created and every year would issue a report setting guidelines for reasonable rate increases. If proposed premium increases are not justifiable per those Health Insurance Rate Authority guidelines, the Health and Human Services secretary or state regulators could block them.
Republicans are opposed to price-fixing measures and also argue that this proposal is an acknowledgement that the new health care plan itself will not keep premiums down.
Republicans Not Happy
Obama said he has the best of intentions for a substantive conversation with the GOP leadership later this week.
"I don't want to see this meeting turn into political theater, with each side simply reciting talking points and trying to score political points," Obama said in his weekly address. "Instead, I ask members of both parties to seek common ground in an effort to solve a problem that's been with us for generations."
But Republicans are not happy that the Democrats are not coming with anything other than a blank piece of paper.
"We can't help but feel like here is the Democrats spell summit S-E-T-U-P. And all this is going to be is some media event used as a preamble to shove through 'Obamacare 2.0.' And we're not going to have any of it," Rep. Mike Pence, R-Ind., said on NBC's "Meet the Press" Sunday. "He's challenging Republicans to present a bill at this so-called summit that's going to take place on Thursday. All the while, Democrats are in some back room, as we speak, cooking up another health care bill that they're going to reveal next week."
Republicans argue that there is no need for a large, comprehensive health care bill like the president proposed but, rather, smaller, piecemeal health insurance reforms. They argue that the plan itself will not lower premiums for Americans and cut overall costs.
In their weekly address, Republicans again called for Democrats to "scrap" their bill and start over on reform.
"Right now, Democrats are continuing to work behind closed doors, putting the finishing touches on yet another massive health care bill Americans can't afford and don't want," said Rep. Dave Camp, R -Mich., who delivered the Republican response to Obama's weekly address. "If the starting point for this summit is more of the same backroom deals and partisan bills, then this meeting will likely be a charade."
The White House argues that GOP ideas have already been incorporated into the Senate legislation, much of which was negotiated with three Senate Republicans -- Sens. Mike Enzi of Wyoming, Chuck Grassley of Iowa, and Olympia Snowe of Maine -- but clearly it is also a goal of Thursday's bipartisan summit for the public to see the president reaching across the aisle.
Even if Republicans and Democrats are not able to come together at this week's summit, the White House hopes to bring the GOP leadership into a "circle of accountability," holding it accountable for what happens on the health care front.
Even as the White House continues its push toward health care overhaul, despite resistance from Republicans, there is uncertainty over whether it will translate into legislation.
"It's nice to say, let's be bipartisan. But we're a partisan nation. We were raised as a partisan nation. The only bipartisanship you ever see is when they finally sign a bill and everybody says, gee, isn't that wonderful," former Secretary of State Colin Powell said on CBS' "Face the Nation" Sunday. "I don't think that they have yet figured out how to resolve these serious differences that exist between both sides or two sides of the political spectrum."
Nevertheless, Republican leaders, such as Sen. Mitch McConnell, R-Ky., say they will attend the event this week, even if they are skeptical.
The meeting will be televised live on CSpan. Obama promised as a candidate that all health care discussions would be open to the public, but that did not happen. The president has said he regrets that.
A senior White House official tells ABC News that one of the president's goals for this week is to "cleanse" the health care reform bill and the way it was processed.
"We had to make so many decisions quickly in a very difficult set of circumstances that after awhile, we started worrying more about getting the policy right than getting the process right," the president said. "But I had campaigned on process. Part of what I had campaigned on was changing how Washington works, opening up transparency and I think it is -- I think the health care debate as it unfolded legitimately raised concerns not just among my opponents but also among supporters that we just don't know what's going on. And it's an ugly process and it looks like there are a bunch of back room deals."
ABC News' Huma Khan contributed to this report.