WASHINGTON — His calls for compromise rebuffed by Republicans, the Democratic chairman of the Senate Finance Committee unveiled sweeping legislation Wednesday to remake the nation's costly health care system largely along the lines outlined by President Barack Obama.
Sen. Max Baucus' proposal, months in the making, drew quick criticism from liberals who said his vision was too cramped and from Republicans who deemed it overly expansive. Yet whatever its fate, its mere release marked a critical turning point in Congress' long and tumultuous debate over Obama's top domestic priority.
The Finance Committee is to meet next week to vote on the plan, and after combining it with another panel's bill, Majority Leader Harry Reid intends to begin debate on the Senate floor late this month or early October. Across the Capitol, Speaker Nancy Pelosi has been waiting to see Baucus' health care prescription before advancing companion legislation toward a vote by the House.
"We cannot let this opportunity pass," Baucus, D-Mont., said as he outlined a $856 billion plan designed to protect millions who have unreliable insurance or no coverage at all, at the same time restraining the explosive growth of medical costs.
Congressional budget experts estimated the proposal would reduce the ranks of the uninsured by 29 million over a decade. They also predicted the plan would trim federal deficits by $49 billion over the same period and suggested savings in the range of hundreds of billions of dollars might result for the decade that follows.
Many of the bill's major provisions would be delayed until 2013, after the next presidential election.
But the impact of one of the key concessions Baucus made in a so-far-unsuccessful search for Republican support – allowing cooperatives, rather than the federal government, to sell insurance in competition with private industry – was judged harshly.
"They seem unlikely to establish a significant market presence in many areas of the country," wrote Douglas W. Elmendorf, head of the Congressional Budget Office.
Supporters claim the co-ops would compete effectively with private companies and help hold down the cost of insurance, but CBO's assessment is likely to re-energize advocates of direct government competition.
White House press secretary Robert Gibbs called the overall legislation an "important building block" that "gets us closer to comprehensive health care reform."
Reid, too, described it as "another important piece to the puzzle" on the road to health care legislation.
Pelosi said that while the bill would do less than House legislation to make coverage more affordable, its emergence "will move this historic debate forward."
Senate Republican leader Mitch McConnell of Kentucky, who has labored to keep his rank and file united in opposition, called it a partisan proposal that "cuts Medicare by nearly a half-trillion dollars and puts massive new tax burdens on families and small businesses, to create yet another thousand-page, trillion-dollar government program. Only in Washington would anyone think that makes sense, especially in this economy."
Baucus' legislation reflected nearly a year of preparation by the 67-year-old Montanan, a partially successful attempt to gain support from outside interest groups, and months of painstaking private negotiations with two other Democrats and three Republicans on the Finance Committee.
With White House backing, the nation's drug makers and hospitals have agreed to defray part of the expense of the eventual bill, and the Pharmaceutical Research and Manufacturers of America is underwriting a television advertising campaign at a cost of tens of millions in favor of health care legislation. The AARP generally supports the effort as well, despite the cuts in planned Medicare spending, and even opposition from the insurance industry has been somewhat muted.
Even so, the private negotiations involving Republican Sens. Chuck Grassley of Iowa, Mike Enzi of Wyoming and Olympia Snowe of Maine came up short, at least for the time being.
Baucus told reporters he expected he would gain bipartisan backing before the bill emerges from committee, probably next week, an evident reference to Snowe. "This is a first step in the process," Snowe said in a written statement, and she promised to continue to work with Baucus and Democrats on drafting a bipartisan bill.
The other Democrats in the talks were Kent Conrad of North Dakota and Jeff Bingaman of New Mexico.
Like other proposals in circulation, Baucus' plan would require insurance companies to sell coverage to all seeking it, without exclusions for pre-existing medical conditions or prohibitively expensive premiums.
The legislation would create so-called insurance exchanges in the states where companies could sell policies that meet criteria set by the government, with federal subsidies available for lower-income individuals and families who would otherwise be unable to afford coverage. Any policy offered for sale in the exchanges would have to cover preventive and primary care as well as dental, prescription drug, mental health and vision services. In general, consumer copays on preventive coverage would be banned.
Additionally the plan envisions cutting a coverage gap in Medicare prescription drug program in half over a decade, although not as deeply as Obama called for in last week's prime-time speech.
To hold down costs, Baucus included only one year of a 10-year, $230 billion increase in doctor fees under Medicare.
The legislation calls for a new tax on high-cost insurance plans, a series of fees and taxes on insurance companies, the pharmaceutical industry and other health care providers, and penalties assessed on people who refuse to purchase coverage or large companies that refuse to offer it to their employees.
Planned Medicare spending would be cut by roughly $500 billion over a decade, with about one-quarter of that money coming from private plans sold as an alternative to traditional government coverage. The House bill calls for far deeper cuts in the alternative program, to the point that industry officials say it could disappear.
Among Baucus' critics were liberals in the House and labor leaders who have been among Obama's strongest supporters.
Sen. Ron Wyden, D-Ore., who has long been involved in health care issues, said the proposal doesn't go far enough to control costs or guarantee a greater choice among health plans for consumers.
Chuck Loveless, the director of legislation at the American Federation of State, County and Municipal Employees, said, "Chairman Baucus has made what I would characterize as a herculean effort to produce this, but we think that the cost has been too high, and we want to see major changes."
In the House, Rep. Anthony Weiner of New York, who favors a government-run program, said, "I think I speak for many members of Congress in saying that the Senate proposal simply will not pass muster in the House of Representatives and fails on very basic levels to satisfy the objectives of the president and the citizens of the United States of America."
Like authors of competing bills in the House and in the Senate Health, Education, Labor and Pensions Committee, Baucus worked his way through numerous controversial issues. Unlike them, though, his reflected a desire to seek bipartisanship.
Thus, the bill includes provisions to keep illegal immigrants from obtaining health coverage through the new insurance exchanges.
The bill also would prevent federal funds from being used to pay for abortions except in cases of rape, incest or if the life of the mother would be endangered. It would leave in place state laws that protect health care workers who refuse to participate in abortion coverage.
Associated Press writers Ricardo Alonso-Zaldivar, Erica Werner and Julie Hirschfeld Davis contributed to this report.