Health-Care Overhaul 2010

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Obama Warms to Idea of Requiring Health Insurance

Discussing health care with President Obama are, from left, Sens. Tom Harkin (Iowa), Max Baucus (Mont.), Christopher J. Dodd (Conn.) and Kent Conrad (N.D.).
Discussing health care with President Obama are, from left, Sens. Tom Harkin (Iowa), Max Baucus (Mont.), Christopher J. Dodd (Conn.) and Kent Conrad (N.D.). (By Marvin Joseph -- The Washington Post)
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By Ceci Connolly
Washington Post Staff Writer
Thursday, June 4, 2009

One day after signaling a fresh willingness to consider taxing employer-sponsored health insurance, President Obama indicated yesterday a new openness toward a nationwide requirement that every American have health coverage.

In his push to enact sweeping health-care reform legislation this summer, Obama previewed what could be the outlines of a compromise on two of the thorniest issues confronting Congress. He said he could support mandates on both individuals and employers to contribute to the cost of health insurance if the bill provides protections to certain small businesses and poor people.

"If we do end up with a system where people are responsible for their own insurance, we need to provide a hardship waiver to exempt Americans who cannot afford it," he wrote in a letter to top Senate Democrats.

During the presidential primaries last year, Obama attacked then-Sen. Hillary Rodham Clinton's proposed individual mandate as a scheme to "go after people's wages."

In the letter, however, he said he understands that key committees are "moving towards a principle of shared responsibility -- making every American responsible for having health insurance coverage, and asking that employers share in the costs."

The approach tracks closely with a universal health program enacted in Massachusetts three years ago in which individuals must have coverage and businesses must either offer insurance to employees or pay into a state fund that provides coverage. In Massachusetts, individuals can receive free or subsidized care based on income.

Broadly speaking, the business community has opposed requirements to "pay or play," as the employer mandate is often known. But a survey conducted by the Main Street Alliance, a small-business coalition advocating reform, found that 77 percent of 1,200 small firms interviewed are willing to pay a portion of workers' health-care costs.

"Do we feel a responsibility to help our employees afford health care? Yes, we do," Freddy Castiblanco, owner of La Terraza Cafe in Queens, N.Y., said in congressional testimony yesterday. "Are we willing to contribute? Yes."

Castiblanco, who employs 11 people, said any health-care overhaul should include the option of a government-sponsored insurance policy for people having trouble buying coverage on the private market.

That idea got a boost from Obama, who said in the letter that he "strongly" believes in giving Americans the choice of a public option.

"This will give them a better range of choices, make the health-care market more competitive, and keep insurance industries honest," he wrote.

Obama also pledged -- without providing details -- to trim an additional $200 billion to $300 billion out of Medicare and Medicaid spending over the next decade. That would be on top of the $309 billion in Medicare reductions in his budget, though Congress has not embraced the specifics.

For the first time, the president also said he is considering proposals that would empower the Medicare Payment Advisory Commission to implement cost controls on the health program for seniors and the disabled. The idea is similar to legislation sponsored by Sen. John D. Rockefeller IV (D-W.Va.), who wants to make the commission an independent agency in the executive branch functioning along the lines of the Federal Reserve Board. Obama, however, suggests following the model of the military base closing commission, with Congress still involved in Medicare's coverage and price decisions.

Senate Finance Committee members were told privately yesterday that the panel will probably see draft legislation on June 17 and begin marking up the bill the following week.


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