WASHINGTON — The chairman of the Senate Finance Committee on Wednesday unveiled his long-awaited plan to remake the nation's health-care system and insure millions of Americans.
The chairman, Sen. Max Baucus, D-Mont., said the committee would start voting next week on his proposal, which embodies President Barack Obama's top domestic priority. His proposal is less costly and does not extend the reach of government as much as others moving through Congress.
The bill closely resembles what Obama said he wanted, except that it does not include a new government insurance plan to compete with private insurers.
Baucus described his plan as "a good balanced bill that can pass the Senate." But the prospects of delivering a comprehensive bill to Obama at the end of this year, as he has requested, are difficult to gauge.
In seeking a middle ground, Baucus alienated some liberal Democrats. Speaker Nancy Pelosi said the House bill, drafted by Democrats, was superior in many ways and "clearly does more to make coverage affordable for more Americans."
With the release of Baucus' proposal, a huge fight over the role of government in American life moves to a new phase, in which hundreds of lobbyists and millions of average citizens will be engaged.
The Congressional Budget Office said that Baucus' bill would still leave 25 million people uninsured in 2019. About one-third of them would be illegal immigrants. By contrast, the budget office said, 17 million people would be left uninsured under the House bill. At least 46 million people are now uninsured.
No nod from Snowe
For more than three months, Baucus has been negotiating with three Republican senators, and some of their ideas are incorporated in his bill. He predicted that some Republicans and most Democratic senators would eventually support a version of his bill.
Sen. Olympia J. Snowe, R-Maine, one of the senators with whom Baucus has been negotiating, said she was not ready to endorse the plan but would continue working with Baucus with the hope of getting a deal.
Baucus' bill is the least expensive of five major health-care bills moving through Congress. The Congressional Budget Office said the expansion of coverage would cost $774 billion over 10 years, compared with price tags of more than $1 trillion for the other measures.
The budget office said the cost of Baucus' bill would be fully offset by new taxes and fees, along with savings squeezed from Medicare, so it could reduce the cumulative total of federal budget deficits by $49 billion over the next 10 years.
Like the other bills, Baucus' proposal would require most Americans to have health insurance, with financial penalties for those who flout the requirement. But his plan differs from the others in significant ways:
Instead of creating a new government health plan, Baucus would set up nonprofit insurance cooperatives in every state. The CBO said the co-ops "seem unlikely to establish a significant market presence in many areas of the country." This finding provides ammunition to liberals who say the co-ops could not compete effectively with big insurance companies.
The Baucus plan, like the other bills, offers subsidies to help low- and middle-income people buy insurance. But eligibility is more limited, and the subsidies appear to be less generous than in the other proposals , causing some Democrats to suggest that many people could still find insurance unaffordable.
The plan would impose a new excise tax on insurance companies that sell high-end policies costing more than $8,000 for individuals and $21,000 for families. Baucus hopes the tax would put downward pressure on health costs.
The bill would not require employers to offer coverage. But employers with more than 50 full-time workers would have to reimburse the government for some or all of the cost of federal subsidies provided to employees who buy insurance on their own.
The bill would create new state insurance marketplaces, or exchanges, where consumers could shop for insurance and compare plans. Plans offered through the exchanges would have to meet strict new requirements. Insurance companies could not deny coverage or charge higher premiums because of a person's health status or pre-existing medical conditions. In setting premiums, insurers could take account of several factors, like age and tobacco use, but variation in premiums would be limited.