President Obama officially released his own health care reform proposal on Monday in a last-ditch effort to unite the Democratic Party around some sort of comprehensive legislation.
Coming days before the much anticipated bipartisan health care reform summit this Thursday, the 11-page White House proposal is being pitched as a foundation upon which lawmakers can build. Presidential aides stressed repeatedly on a call with reporters Monday that Republicans will have opportunities to amend it.
"We view this as the opening bid for the health meeting," said Communications Director Dan Pfeiffer. "We took our best shot at bridging the differences. We think this makes some strong steps to improving the final product. It is our hope the Republicans will come together around their plan and post that online prior to the meeting so that the American people have a chance to go look at it... and be thoroughly informed heading into this meeting."
But it clearly remains a Democratic effort. Working off the Senate's bill while melding key provisions from the House's version, White House officials are proposing to add another $75 billion in costs to the legislation, bringing the total up to $950 billion over the next decade -- all of which will be offset by increased revenue.
Among the major changes in the president's proposal:
- It removes the $100 million in Medicaid funding that Sen. Ben Nelson (D-Neb.) had secured for his home state of Nebraska -- funding that, after intense criticism, even Nelson now wants removed.
- It adopts the House's more generous measures to help individuals purchase insurance, and adopts the Senate's approach when it comes to penalizing individuals who don't buy insurance -- basing the penalty on a reduced flat dollar assessment or percentage of income, and including a "hardship" exemption for families who simply cannot pay the fine. (This paragraph has been corrected.)
- It closes the Medicare prescription drug "donut hole" coverage gap by 2010 -- choosing the House's language rather than the Senate's (which would provide a 50 percent discount for only certain drugs in the hole). How this conforms to the deal that the White House cut with the pharmaceutical industry at the beginning of the health care reform process is unclear.
- It adopts the Senate's model for health insurance exchanges (virtual marketplaces for consumers to compare and buy coverage) making them state-based as opposed to national. One plugged-in activist told the Huffington Post that this could be because it would be impossible to pass national exchanges into law using the Senate's simple-majority reconciliation process.
- It adopts the Senate's abortion provisions, which are more moderate than the aggressively anti-choice measures adopted in the House.
- It uses the Senate's revenue provisions, though it goes a long way toward pacifying those concerned about the so-called "Cadillac tax". The threshold at which health care plans would be hit by that tax would be raised from $23,000 for a family plan to $27,500. And the provisions would not kick in at all until 2018.
- It includes a new wrinkle: establishing a national health insurance authority that would help states combat insurers that institute unreasonable premium increases. Sen. Dianne Feinstein (D-Calif.) introduced this same proposal last week.
- Finally, despite a late-stage push for the White House to include a public option for insurance coverage in the final bill, the president's proposal does not include any element of government-run insurance.
"There is not a public option in here," said Pfeiffer, before insisting that the president does support the provision.
READ THE FULL PROPOSAL
With the health care summit scheduled for this Thursday, the White House is hoping that this foundation will get even a sliver of support from the Republican caucus. But aides aren't holding their breath. Calling for an up-or-down vote on the bill, Pfeiffer nevertheless declined to surrender the idea that Democrats would pass the legislation in the Senate using reconciliation -- the parliamentary process that precludes filibusters.
"This package is designed to help us [use reconciliation] if the Republican Party decides to filibuster health care reform," said Pfeiffer. "That was certainly a factor that went in to how we put this proposal together."
Obama's proposal is designed to fill the role traditionally played by House and Senate negotiators in conference committee -- bringing together disparate factions around one cohesive reform package. White House aides said that they consulted and worked with members of Congress when drafting their approach. Whether they have the necessary support of the Democratic Caucus to get it passed, however, is still very much an open question.
"The proposal we are putting on line is informed by our discussions with the House and the Senate leadership," Pfeiffer said. "But it is the president's proposal."