In a Lean Budget Year, A Pledge for Research

Bush's approach to slowing health care spending builds on a controversial form of insurance, known as health savings accounts, that became available nationwide in 2004 as a result of a law that was mainly designed to help Medicare patients pay for medicine. Under HSAs, people can set aside money -- this year, up to $2,700 for individuals and $5,450 for families -- tax-free for health care they use now or in the future. In order to open such an account, they must have a limited health plan that features a high deductible and pays for major medical expenses after that.

So far, about 3 million people have created such accounts, according to new insurance industry figures. Last night, Bush proposed several steps that the administration believes would motivate more people to choose this form of insurance. The president proposed giving two additional tax breaks for such insurance: allowing deductions for insurance premiums for high-deductible health plans that people buy individually rather than through their jobs, and allowing people with such insurance to write off all the health care expenses they pay for out of their own pockets.

In addition, Bush asked Congress to create refundable tax credits of $3,000 for poor families that buy high-deductible plans to go along with a health savings account. The heavy reliance on health savings accounts immediately drew clashing reactions. Karen Ignagni, president of the trade group America's Health Insurance Plans, said: "Boosting contribution limits and making HSAs more flexible will enable more consumers to access these innovative products."

But Ron Pollack, executive director of Families USA, a consumer health lobby, said: "I think this will be a very difficult package to pass."

Bush's biggest obstacle may be a budget deficit expected to rise to around $360 billion this year, and lawmakers of his own party who have used a widening corruption scandal and GOP turmoil to revive the conservative cause of shrinking the federal government. Last year, heeding Bush's demand to reduce non-security discretionary spending, Congress cut many of his pet programs.

This year, conservatives are likely to resist not only the cost of his proposals but also their emphasis on a federal role on research, development and education.

At a closed-door retreat for conservative House members Monday, Rep. John A. Boehner (R-Ohio) -- campaigning to be elected House majority leader -- boasted that he refused to comply with Bush's push to expand the testing requirements of the No Child Left Behind law into high school.

Now Bush is asking for $380 million to train 70,000 new teachers for Advanced Placement courses in math and science, to encourage 30,000 math and science professionals to take up teaching, and to promote new methods of math instruction and intervention for students having difficulty with math.

That initiative was welcomed by a bipartisan group of senators who had proposed the same program as part of their Protecting America's Competitive Edge Act.

But conservatives have increasingly chafed at the expanding federal role in education under Bush, and they are showing signs that they have had enough.