HEALTH CARE PLANS BEGIN TO CRYSTALLIZE

BY NAFTALI BENDAVID and JANET ADAMY

WASHINGTON — House leaders outlined a health-care overhaul plan that would create a national health-insurance “exchange” for consumers and include a government-run plan as one option, while Sen. Edward Kennedy introduced a similar bill in the Senate.

The draft House plan, presented to House Democrats at a meeting Tuesday, would require almost all Americans to have health insurance and provide subsidies to those with annual incomes as high as four times the poverty level. People without insurance could find a plan on an insurance exchange that would be set up by the government.

Pointed questions came both from lawmakers favoring a single, government-run plan, as well as those uncomfortable with any public option. Opposition from the liberal and the moderate wings of the Democratic Party doesn’t appear strong enough to derail the plan in the House.

“We have to recognize that there are going to be compromises,” said Rep. Henry Waxman (D., Calif.), chairman of the House Energy and Commerce Committee.

Mr. Kennedy’s 615-page bill proposes many of the same changes as in the House version. It would require individuals to carry health insurance except for those who couldn’t afford it, and would establish federal or state “health benefit gateways” to allow Americans to buy it. Mr. Kennedy had earlier called for a new public insurance plan and a requirement that employers help pay for coverage, and while they are mentioned in the bill, there are few details, suggesting those policies are still being negotiated.

The Massachusetts Democrat’s bill would provide subsidies for buying health insurance to families with annual incomes as high as five times the poverty level, a slightly more generous benefit than the one outlined in the House. Aid would be provided on a sliding scale, but it could cover more than half of all Americans.

House leaders said they planned to release a formal copy of their bill next week, with final wording completed in July. They hope to work out differences with the Senate over its version of a health bill in September and pass a final product in October.

Democrats are postponing a decision on the contentious issue of how to pay for the health plan. The delay will give lawmakers time to get a better handle on cost estimates. It could also give them a chance to sell the public on the benefits of expanded health care before talking about how to pay for them.

The plan presented Tuesday by Mr. Waxman and other key House Democrats is likely to define the liberal end of the negotiating spectrum. It would expand Medicaid by basing eligibility solely on income, said a House aide who helped draft the proposal. Currently, someone must be both poor and a parent, or meet some other criteria, to qualify.

Businesses could either provide insurance for their employees or contribute funds for their coverage, with small companies that pay low wages exempted. Individuals who aren’t covered would have to buy a plan on the Health Insurance Exchange, as it is being called in the House outline, with the government subsidizing those with annual incomes of up to 400% of poverty levels. Based on current standards, individuals making as much as $43,320 a year, or a family of four with an annual income up to $88,200, would qualify.

Also Tuesday, about 25 Democrats on the House Ways and Means Committee met with President Barack Obama, who urged quick action on health care. The president said he wanted to reduce the nation’s sharp, regional variations in medical spending, control outlays for people at the end of life and emphasize primary care, according to participants.

Laura Meckler and Greg Hitt contributed to this article.

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