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Compromises on table in Obama health plan

President Barack Obama addresses a joint session of Congress at the U.S. Capitol in Washington on Wednesday. Behind him are Vice President Joe Biden and House Speaker Nancy Pelosi. (Associated Press / The Spokesman-Review)
President Barack Obama addresses a joint session of Congress at the U.S. Capitol in Washington on Wednesday. Behind him are Vice President Joe Biden and House Speaker Nancy Pelosi. (Associated Press / The Spokesman-Review)

Government program endorsed, not required

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 an 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, a South Carolina Republican congressman shouted, “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 cooperatives; 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. “Now is the season for action.”

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. How that will happen or what final terms it may contain aren’t clear.

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.

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 checkups, mammograms and colonoscopies.