Obama Delivers Specific Health Proposals to Congress, Insurers

President Barack Obama made what may have been his most important health reform speech yet, delivering some specific proposals directly to an unusual joint session of congressional lawmakers he hopes will work the ideas into legislation. Though the rhetoric was often targeted at the practices of the health insurance industry, there were also elements in Obama's rundown of proposals that the industry likes.

The president pitched a mandate for individuals to be covered, saying, "Individuals will be required to carry basic health insurance," comparing it to automobile coverage. That could potentially provide insurers tens of millions of customers they didn't have before. "It lets them compete for new customers," Obama pointed out. And if people can't afford it, the government would help with tax credits.

Large businesses would also be required to provide coverage to their employees or pay a fee.

But the speech also fell back on some of the elements, such as the "public option," that the industry opposes. Obama pointed out the dominance of a handful of companies -- or even just one -- in certain insurance markets. "It makes it easy for insurance companies to treat their customers badly," he said. "Insurance company executives are not bad people. They do it because it's profitable."

So, he again pitched the establishment of a government-run insurer to compete for uninsured customers with private companies, though he said that any final bill that insists on competition and on choice for consumers would satisfy him. He advocated that an insurance exchange be established within the next four years to provide a place for potential customers to shop for the best deal.

The public insurer idea is still criticized by the industry. "New health insurance reforms and consumer protections will solve the problem without creating a new government-run plan that will disrupt the quality coverage that millions of Americans rely on today," said Robert Zirkelbach, spokesman for America's Health Insurance Plans.

"I have no intention of putting insurance companies out of business." Obama said, "I just want to hold them accountable." However, another element of Obama's plan is to charge insurance companies fees for their most expensive plans.

"New taxes on health care coverage will have the opposite effect by making coverage less affordable for families and small businesses across the country," said Zirkelbach, suggesting the expense of fees would be passed to customers.

There was one point the industry and president agreed on: "The nation cannot afford to let this historic opportunity pass us by," said Zirkelbach.

"I am not the first president to take up this cause, but I'm determined to be the last," Obama said. The president also attempted to lift the debate from the realm of incivility. "The time for bickering is over. The time for games has passed," he said.

The president did add another promise that may be welcomed by his political opponents: He would agree to more spending cuts in the future if expected savings don't materialize from the reforms, which he promised would not add to the deficit. But it remains to be seen whether Obama's plan -- costing about $90 billion a year -- will become the central plan debated in Congress in the coming weeks.

Sen. Max Baucus, D-Mont., chairman of the Finance Committee that has hosted the most-watched bipartisan negotiation on reform, said his committee will press forward with a legislative markup on a reform bill the week of Sept. 21 -- whether the Republicans he's been negotiating with are ready or not. His bill, as proposed, would not include the government-run insurer, though it would include fees charged to insurers. "I'm moving forward," Baucus told reporters, adding that there is "quite a bit of time left for bipartisan support." Still meeting with the bipartisan "Gang of Six," Baucus said he welcomes Republican ideas for changing the bill that the committee will consider.

His committee is the last relevant congressional panel that would still need to pass a health reform bill before the full Congress can consider the legislation. But if the Senate's 60-vote requirement for bypassing a potential filibuster can't be achieved, Democrats may still resort to a parliamentary process called "reconciliation" that would need only a simple majority. Senate Majority Leader Harry Reid said after a White House meeting this week: "We do not want to do reconciliation unless we have no alternative."