Deep divisions over long-awaited health care plan

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WASHINGTON — President Barack Obama's call for an overhaul of the nation's health care system gained fresh momentum with the introduction of long-delayed Senate legislation to rein in spiraling medical costs and require nearly everyone to be carry health insurance.

The proposal by Senate Finance Committee Chairman Max Baucus "will move this historic debate forward," House Speaker Nancy Pelosi said, although she quickly added that Baucus' plan was less desirable than a bill taking shape in the House.

Other Democrats were less enthusiastic, and not a single Republican announced support when Baucus introduced the measure Wednesday after months of closed-door talks and numerous missed deadlines.

A vote in the Finance Committee could occur as early as next week, and Majority Leader Harry Reid intends to begin debate on the Senate floor as early as late this month or early October. The House also is aiming for action this fall.

The hope is to meet Obama's goal of signing legislation this year. White House press secretary Robert Gibbs called Baucus' plan overall an "important building block" that "gets us closer to comprehensive health care reform."

To help keep the overhaul on track, Obama was to hold a campaign-style rally Thursday at the University of Maryland, appear on five Sunday morning talk shows and visit David Letterman's late-night show Monday on CBS.

"We cannot let this opportunity pass," Baucus, D-Mont., said as he outlined his $856 billion plan, designed to protect millions of Americans who have unreliable insurance or no coverage at all while restraining the explosive growth of medical costs.

Congressional budget experts estimate the proposal would reduce the ranks of the uninsured by 29 million over a decade, and trim federal deficits by $49 billion over the same period. Many of the bill's major provisions would be delayed until 2013.

Baucus' legislation reflected nearly a year of preparation, a partially successful attempt to gain support from outside interest groups and months of painstaking negotiations with two other Democrats and three Republicans on the Finance Committee — the so-called Gang of Six.

But when Baucus stood in front of the cameras Wednesday, he was alone. Republicans withheld their support, claiming the measure was still too costly and intrusive, and liberals reacted bitterly, too, saying it didn't go far enough to make health insurance affordable for lower-income people. Others said the middle class would take a hit.

"Many middle-class people would pay more than they are paying today and would face the prospects of a penalty if they don't comply," said Sen. Ron Wyden, D-Ore., a member of the Finance Committee who wasn't involved in the negotiations.

Not carrying insurance could result in a steep fine under Baucus' bill, as much as $3,800 per family, or $950 for an individual. People who can't afford their premiums would be exempted from the fine.

Wyden said he would try to amend the bill to make it more affordable to the middle class, one of a host of amendments sure to be offered from both sides in the Finance Committee next week. Another worry for some lawmakers, including Sen. Jay Rockefeller, D-W.Va., is that a proposed new tax on high-value insurance plans would hurt middle-class workers, particularly union members with generous benefits packages.

Of the three Republicans involved in the Gang of Six talks — Chuck Grassley of Iowa, Mike Enzi of Wyoming and Olympia Snowe of Maine — Democrats hold out most hope that Snowe ultimately will vote "yes."

Snowe promised to continue to work with Baucus and Democrats on drafting a bipartisan bill.

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 insurance companies could sell policies that meet criteria set by the government, with federal subsidies available for lower-income individuals and families who otherwise would be unable to afford coverage.

To pay the cost, the legislation calls for a new tax on high-cost insurance plans and a series of fees and taxes on insurance companies, the pharmaceutical industry and other health care providers, plus the penalties on people who refuse to purchase coverage or on large companies that refuse to offer it to their employees.

Planned spending in Medicare and other government programs would be cut by roughly $500 billion over a decade.

In place of a government-run insurance plan to compete with the private market, a feature of the other health care bills in Congress, Baucus included nonprofit co-ops.

The Congressional Budget Office said Wednesday that co-ops "seem unlikely to establish a significant market presence in many areas of the country," providing ammunition to critics on the left who've pushed for a public plan instead.

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