President Barack Obama on Monday plowed ahead with his politically risky plan to resuscitate his healthcare overhaul agenda, for the first time offering his own blueprint that tracks closely with stalled congressional efforts.
Democrats embraced the sweeping plan, which seeks to shore up popular support by tackling hefty insurance premium increases and extending coverage to 31 million Americans.
Republicans immediately rejected it, backed up by public polls that show the majority of Americans want Congress to start over on healthcare reform and work together.
The $1 trillion, 10-year plan is meant to be the starting point for Obama's healthcare summit Thursday, which is touted as a chance for Republicans and Democrats to negotiate on live television. But the plan is structured so that it could pass Congress through reconciliation, a complicated procedural tool that circumvents a Senate filibuster by the Republican minority.
White House officials said the public deserved a straight up-or-down vote on a healthcare bill, but added that they were prepared to use the reconciliation route if necessary.
The administration is making the effort as polls show Obama's personal job approval rating plunging. A Rasmussen Reports daily tracking poll said Monday that 22 percent of Americans expressed "strong approval" of the president's performance, compared with 41 percent voicing "strong disapproval."
Obama's proposal raises the threshold at which high-cost insurance plans are taxed, eliminates special Medicaid payments to Nebraska in favor of more funding for all states, and introduces a Medicare tax on the non-wage incomes of wealthy Americans.
It includes many of the ideas in the previous bills, such as insurance industry reforms, a requirement that nearly all Americans carry coverage, the creation of state-based insurance exchanges and incentives for employers to provide coverage.
Republicans dismissed the bill as nothing more than what Democrats tried — unsuccessfully — to pass.
"It's disappointing that Democrats in Washington either aren't listening or are completely ignoring what Americans across the country have been saying," said Senate Minority Leader Mitch McConnell, Kentucky Republican. He called the plan "another partisan, backroom bill."
Republicans favor starting the overhaul from scratch. Zogby International and the University of Texas Health Sciences Center found that 57 percent of Americans agreed with the idea that Congress should start over.
White House officials rejected that idea.
"The president believes we've done a lot of very good work on health reform over the last year and starting from scratch doesn't make sense," White House Communications Director Dan Pfeiffer said. "However, we are coming to this meeting with an open mind to additional ideas and we hope the Republicans will do the same."
He challenged Republicans to post their own bill online, just as Democrats did on Monday at whitehouse.gov. House Republicans say their plan has been on gop.gov for months.
White House officials said they think the estimated $1 trillion, 10-year plan will be fully funded and that they are ready to make tweaks if the Congressional Budget Office — the nonpartisan budget monitor — says otherwise. But the CBO on Monday said Obama's outline doesn't contain enough information for a complete cost analysis.
Democrats said they welcomed the president's plan, but some said they would have been more enthusiastic had it included the so-called public insurance plan or more subsidies to help low-income Americans purchase coverage.
House Speaker Nancy Pelosi said the plan includes "positive elements" from the House and Senate bills, but she did not immediately endorse the measure.
"I look forward to reviewing it with House members and then joining the president and the Republican leadership at the Blair House meeting on Thursday," she said in a statement.
Senate Majority Leader Harry Reid said the plan "brings together the best of the Senate bill and the best of the House bill in a fiscally responsible way."
Republicans said that the proposal will merely set up Thursday's much-touted televised summit for failure.
"The president has crippled the credibility of this week's summit by proposing the same massive government takeover of healthcare based on a partisan bill the American people have already rejected," said House Minority Leader John A. Boehner, Ohio Republican.
Some Democrats say they've given Republicans and moderate Democrats enough time to reach an agreement. Rep. Anthony Weiner, New York Democrat, said seeking Republican support is an exercise in futility.
"This will simply not happen. We need to stop bargaining against ourselves. Who are we making concessions to?" he said. "Republicans have shown over and over again that they have no interest in real reform. They are the 'party of no' and the status quo."
A year ago, Obama outlined his main goals on healthcare reform but said he wanted to leave the details of the bill largely up to Congress. Work on Capitol Hill stalled last month when Republican Scott Brown scored an upset election victory in Massachusetts, stripping Democrats of their 60th vote in the Senate and sending the healthcare bill to the legislative back burner.
Pfeiffer said the president's bill was "informed" by the House-Senate negotiations that got under way when Brown's election upset the political calculation.
The Democratic chairmen of the three House committees that passed pieces of the healthcare bill — Reps. Charles B. Rangel of New York and Reps. George Miller and Henry A. Waxman, both of California — said the plan, "keeps us moving in the right direction."
The legislation addresses a number of Democrats' concerns with the House and Senate bills.
It eliminates funding for Nebraska's Medicaid expansion, dubbed the "cornhusker kickback," for instance. Instead, all states will get help with their Medicaid bills. Sen. Ben Nelson, Nebraska Democrat, got the home-state money inserted in last-minute Senate negotiations just before pledging his vote for the bill but later said he made the deal with the hope of extending the funding to all states during the House-Senate conference.
"The president's plan would significantly shrink a $35 billion unfunded federal mandate set to hit all states in health reform, which had gone unnoticed until I blew the whistle," Nelson said Monday.
In an attempt to stem public backlash against dramatic insurance premiums — such as a 39 percent increase that Anthem Blue Cross warned of for some policyholders in California — Obama's proposed new "Health Insurance Rate Authority" would be able to stop or stall premium increases that it determines are excessive. It is similar to the way public utilities are regulated.
Insurers already have to run their premiums past state regulators, which ensure that the companies can remain solvent.
Insurers warned, however, that they are merely passing on their own increases in medical costs and are not the cause of the problem.
"If you look at the underlying data on how premiums are built, that is not going to be a route to actually containing costs," said Karen Ignagni, president and chief executive officer of America's Health Insurance Plans, an industry group. "We're a small part of the health cost equation."
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