WASHINGTON — President Barack Obama on Wednesday laid out a series of compromises he's willing to make to get a health care overhaul through a nervous Congress this year, including diluting his vision for a new public insurance program and embracing ideas floated by Republicans.
In a rare evening address to a joint session of Congress, Obama tried to seize control of the Democratic Party's highest domestic priority after months of party disarray and raucous public debate across the country. The president said that he'd require all individuals to have health insurance and would provide tax credits to people and small businesses that couldn't afford it.
"Well, the time for bickering is over. The time for games has passed. Now is the season for action," Obama said.
At one point, however, a South Carolina Republican congressman shouted out, "you lie" when Obama characterized reports that he'd insure illegal immigrants as false.
On perhaps the most controversial single plank in his program, Obama endorsed creating a "public option" government program to compete against private insurers, but he didn't insist that it be included.
Instead, he left room for alternatives that liberal Democrats in Congress are resisting. Those include creating nonprofit health care co-operatives; a "trigger" mechanism for a public option to kick in later if private insurers fail to meet benchmarks of coverage; or perhaps simply tightening regulations on private insurers.
He pledged that any "public option" wouldn't weaken coverage for those in Medicare or insured through their employers. He promised them "more security and stability."
In turn, Obama made it clear that he intends to work with congressional Democrats to push some health care plan through Congress this year — on a bare partisan majority if necessary.
"I am not the first president to take up this cause, but I am determined to be the last," Obama said in remarks that he hoped would breathe new life into Democrats' push to expand coverage to many of the roughly 46 million in the U.S. who now lack health insurance.
"We are the only advanced democracy on earth, the only nation, that allows such hardships for millions of people," he said.
Such an expansion is a goal that's eluded presidents since Harry Truman, and most recently, Bill Clinton 15 years ago.
Obama said that his plan would cost about $900 billion over a decade. He said it could be paid for mostly by eliminating "waste and abuse" from the existing health care system, but he wasn't specific. In addition, he'd charge insurance companies "a fee for their most expensive policies" to fund his plan. Beyond that, he failed to specify how his proposals would slow rising health costs.
Three House of Representatives committees have written legislation that would create a public option, raise taxes on the wealthy to help pay for the plan and mandate coverage for most people. The House is expected to combine three pending Democratic bills into one piece of legislation and attempt to pass it this month.
The Senate outlook is cloudier and likely to take longer. Even if both chambers pass versions of the legislation, they're all but certain to differ, requiring a House-Senate conference to draft a compromise version that each house then must pass.
"Our collective failure to meet this challenge — year after year, decade after decade — has led us to a breaking point," Obama said. "I will not waste time with those who have made the calculation that it's better politics to kill this plan than improve it."
He asked "progressives" to remember that before debate over the public option erupted, their central goals had been to make coverage more affordable and to better regulate insurers. "The public option is only a means to that end and we should remain open to other ideas that accomplish our ultimate goal," he said.
Obama also asked Republicans to work with him "rather than making wild claims about a government takeover."
He denounced as "a lie — plain and simple" — the widespread assertion that his plan would authorize bureaucratic "death panels" to order senior citizens to die. He said, too, that reports that he'd insure illegal immigrants are "false." At that assertion, Rep. Joe Wilson, R-S.C., hollered, "you lie."
Obama urged seniors not to believe "scary stories" about how their Medicare benefits would be cut, saying some spreading those charges had pushed Medicare cuts in the past or urged privatization. "That will never happen on my watch. I will protect Medicare," he said.
Fleshing out a framework that he's been advocating for months now, Obama called for creating a government health insurance exchange, or marketplace, to take effect by 2013. Through it many Americans could obtain lower-cost private coverage — or possibly coverage through some variation of a public plan if Congress creates one.
Until the exchange would take effect, Obama would borrow from a plan that his 2008 Republican rival, Arizona Sen. John McCain, proposed last year — to provide catastrophic coverage for those with pre-existing conditions.
In another olive branch to Republicans, Obama indicated that he'd support some "demonstration projects" to try setting experimental limits on medical malpractice lawsuits — long a Republican goal that Democrats typically oppose.
Sen. Orrin Hatch, R-Utah, said that while Obama's offer of a trial project for medical malpractice lawsuit restrictions sounded good, he was skeptical that it would go anywhere, because many Democrats rely heavily on campaign money from trial lawyers. He predicted that "when they get down to the hard work, there's not much effort to it."
Obama also called for new regulations on private insurers to protect patients. He told Americans that any plan he signs will:
_ Ban insurance companies from denying coverage because of pre-existing conditions.
_ Prevent insurers from dropping or watering down coverage during illness.
_ End arbitrary annual or lifetime coverage caps.
_ Limit out-of-pocket expenses.
_ Require insurers to cover routine check-ups, mammograms and colonoscopies.
Late in his address, Obama invoked the late Sen. Ted Kennedy, D-Mass., saying he'd gotten a letter from him written as he knew death was near, urging passage of comprehensive health care legislation because it's fundamental to "the character of our country."
Obama urged three of Kennedy's GOP friends, Sens. Orrin Hatch, John McCain and Charles Grassley, to support health care legislation in that spirit. And he compared the debate now to those that lead to the creation of Social Security under FDR and Medicare under LBJ.
Senate Republican leader Mitch McConnell of Kentucky didn't seem enthusiastic about prospects for GOP support for any plan.
"The status quo is unacceptable," McConnell said. "But if August showed us anything, it's that so are the alternatives that the administration and Democrats in Congress have proposed. That means sensible, step by step reforms, not more trillion-dollar grand schemes."
To deliver their rebuttal, Republicans tapped Rep. Charles Boustany of Louisiana, a physician who once questioned the legitimacy of the Hawaiian-born Obama's birth certificate. In his health care rebuttal, Boustany said that Republicans are ready to work with the president on "common-sense" measures but that "it's time to start over on a common-sense, bipartisan plan" and that "replacing your family's current health care with government-run health care is not the answer. In fact, it'll make health care much more expensive."
Boustany said Republicans agreed with Obama in four areas: That all Americans should have access to coverage regardless of preexisting conditions; small businesses should be able to access coverage at prices comparable to large companies and labor unions; government should provide some form of assistance to those who cannot afford coverage; and insurers should offer incentives for preventive behavior. As for the overture on lawsuit limits, Boustany said, "we hope he's serious."
One senior administration official who briefed reporters in advance of the speech said that "there will be a lot of bipartisanship in this plan, a lot of Republican proposals in this plan. At the end of the day, there may not be a lot of Republican votes for this plan because they have made a decision on the other side." The official spoke on the condition of anonymity because she wasn't authorized to make a statement ahead of the speech.
It wasn't immediately clear whether Obama's speech would break Congress' deadlock. Many liberals in the House continue to demand that any health care plan include a public option. Moderate-to-conservative Democrats disagree, however, fearful that a government program would cost too much and end up displacing the private insurance industry.
Leading Democratic lawmakers have signaled all week that final legislation need not include a public option.
Sen. Max Baucus, D-Mont., the chairman of the Finance Committee, said that it increasingly appears that "a public option cannot pass the Senate."
Baucus said he'd propose an alternative plan next week and have his committee begin writing it the week of Sept. 21.
The Senate Finance Committee is considering creating nonprofit health co-operatives instead of a public option, and fining adults who don't get coverage for themselves — an idea many liberals dislike.
Sen. Jay Rockefeller, D-W.Va., the chairman of the Commerce Committee, said: "If you're not going to do the public option, then you have to have an alternative. And you just say, 'well, we'll do co-ops,' and nobody knows what they are and nobody can explain them."
Some liberals warned that passing consensus-only legislation may not be sufficient.
"There are some things you can't do in isolation," said Rep. Bobby Scott, D-Va. To simply bar insurers from denying coverage to people with pre-existing conditions, an area of agreement, won't work without other protections. And mandates can't work without higher taxes, he said.
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