WASHINGTON -- President Barack Obama issued his own blueprint for a health care overhaul on Monday, challenged Republicans to come forward with their ideas and laid the groundwork for an aggressive parliamentary maneuver to pass the legislation using only Democratic votes if this week brings no progress toward a bipartisan solution.
In laying out for the first time the details of what he wants in the legislation, Obama set in motion a new round of maneuvering intended to bring a bitterly divisive yearlong clash to a conclusion. With the two parties scheduled to meet Thursday for a televised session on the health care overhaul, Obama appeared intent on forcing the Republicans into a choice: either put a specific alternative on the table, giving Democrats a chance to draw pointed contrasts between the parties' approaches, or be cast as obstructionist and not serious about addressing an issue of great concern to voters.
The initial Republican response suggested that the two parties are more likely headed toward a showdown than toward a deal. Rep. John A. Boehner of Ohio, the House Republican leader, said Obama had "crippled the credibility" of Thursday's meeting by proposing "the same massive government takeover of health care" that, he said, Americans had already rejected.
The bill, which the White House estimates would cost $950 billion over a decade, aims to fulfill Obama's goals of expanding coverage to millions of people who are uninsured, while taking steps to control soaring health care costs. It sticks largely to the version passed by the Senate in December, but it offers some concessions to House leaders who have demanded more help for middle-class people.
Obama's measure would, for example, eliminate a highly criticized special deal to help Nebraska pay for a proposed Medicaid expansion, and would instead provide more help for all states to pay for their new Medicaid enrollees. It would delay enactment of a controversial tax on high-cost employer-sponsored insurance plans and, in a nod to the concerns of older Americans, do away with the unpopular "doughnut hole" in the Medicare prescription drug program.
But more than a specific policy prescription, the measure is a gamble by a president trying to keep his top legislative priority alive. The White House signaled that, barring a bipartisan breakthrough, Democrats would try a legislative maneuver known as reconciliation to pass the bill through the Senate on a simple majority vote, avoiding the 60-vote supermajority requirement that is necessary to avert a Republican filibuster.
By using the existing Senate bill as the basis for his proposal, Obama made it easier for Democrats to try to execute that parliamentary tactic, though the maneuver would bring vehement Republican opposition and remains subject to all kinds of procedural challenges.
"The president expects and believes the American people deserve an up or down vote on health reform," Dan Pfeiffer, Obama's communications director, said in a morning conference call with reporters. "And our proposal is designed to give us maximum flexibility to ensure that, if the opposition decides to take the extraordinary step of filibustering health care."
But leading Republicans - including Sen. Olympia J. Snowe of Maine, whose vote Obama courted assiduously, and unsuccessfully, last year - called on the president to publicly renounce reconciliation. In a brief interview on Capitol Hill on Monday, Snowe said using the procedure would be "a huge mistake."
The White House projects that Obama's bill would extend coverage to 31 million people who are currently uninsured, at a cost over 10 years of $950 billion. The administration estimates that its plan would reduce the federal deficit by cutting spending and reining in waste and fraud.
