President Barack Obama offered his much-anticipated new health care plan Monday in an 11th-hour bid to rally Democrats behind sweeping legislation that would expand coverage, tighten insurance industry rules and make the nation's medical system more efficient.
The White House, releasing the $950 billion blueprint ahead of Thursday's health care summit with congressional Democrats and Republicans, in effect challenged GOP leaders to offer an alternative.
But with the GOP firmly against any major health care overhaul, the president's primary task is unifying House and Senate Democrats behind legislation they could send to his desk in coming weeks.
In all likelihood, given the loss of a filibuster-proof majority in the Senate, that means firing up House Democrats to approve the bill that has already passed the Senate - along with separate legislation incorporating changes to address concerns by House Democrats.
"The real goal here has to be to resolve differences among Democrats," said veteran Democratic strategist Paul Begala. "The Republican leadership is more likely to perform in a gay marriage than they are to work with Democrats on health care."
GOP leaders swiftly condemned the latest proposal, which House Minority Leader John A. Boehner, R- Ohio, called a "new Democrats-only backroom deal" that "doubles down on the same failed approach."
Obama has repeatedly expressed his resolve to move ahead with an overhaul, even in the face of public anxiety about a large bill and Republican calls to scrap it and pursue more limited legislation.
Monday, senior Democrats on Capitol Hill echoed the president's rallying cry. "The cost of inaction is too great for our nation and for every family facing the heartbreaking reality of skyrocketing health care costs and denied care or coverage," House Speaker Nancy Pelosi, D-Calif., said in a statement.
Pelosi met with rank-and-file House Democrats Monday evening to discuss the president's proposal and the way forward. Senate Democrats are slated to discuss health care when they meet for their weekly luncheon today at the Capitol.
White House officials and Democratic congressional leaders have been working on a two-stage legislative strategy in which the House would vote on the Senate bill and both chambers would separately pass a package of changes, likely along the lines of the ones proposed by the president.
The package could also include traditional Republican health care priorities, including new efforts to clamp down on waste and fraud in federal health care programs.
The extent to which GOP ideas were incorporated into the changes could depend on the outcome of Thursday's summit.
Like the Senate bill, the crux of the president's plan to expand coverage to some 31 million people over the next decade are new state insurance exchanges in which people who do not get coverage through work would be able to shop for plans.
The federal government would oversee the plans, as it now does for members of Congress and other federal employees.
Additionally, the president would give the federal government new authority to regulate premiums charged by private insurers, a new proposal that the White House unveiled over the weekend in response to steep rate increases in California and elsewhere in recent months.
Under Obama's plan, the secretary of health and human services would be able to block premium increases deemed excessive under standards to be developed by a new expert panel. That idea drew fire Monday from insurance industry officials, who said rising medical costs are the primary cause of rate increases nationally.
"Regulating premiums won't do anything to reduce the soaring costs of medical care," said Karen Ignagni, president of America's Health Insurance Plans, the industry's Washington-based lobbying arm.
Following the Senate's lead, the president did not include a new government insurance plan in his health care outline, reflecting the political delicacy of the concept.
Obama's plan also makes several other substantial changes to the Senate bill, paralleling agreements hammered out by House and Senate Democratic leaders.
It boosts subsidies to help low- and moderate-income people buy insurance on the new state exchanges, a key demand of House Democrats. (The plan also includes a national exchange).
During the next decade, it would phase out the coverage gap in Medicare's drug benefit, known as the "donut hole."
It would also help states expand their Medicaid insurance programs for the poor and eliminate a provision in the Senate bill that provided special assistance to Nebraska in response to demands from that state's Democratic senator, Ben Nelson.