A first-ever tax on employer-provided health benefits also figures prominently among options under consideration in Congress, but Obama campaigned against that last year and its inclusion in the bill would require him to reverse course.
Given the uncertainty as well as the political sensitivity over raising taxes or cutting Medicare, Senate Republicans prodded Democrats to fill in the blanks before the scheduled beginning of committee work next week.
At their core, a 316-page partial draft bill released by Democrats on the Senate Health, Education, Labor and Pensions Committee and a three-page outline circulated by senior House Democrats were largely identical.
Individuals would be able to purchase insurance from new exchanges operated by the states or federal government. Private companies would be barred from denying coverage or charging higher premiums because of pre-existing conditions.
Both bills would require individuals to purchase insurance if they could afford it, with waivers available in hardship cases. The Senate measure provides for an unspecified penalty for anyone refusing to obey the so-called mandate, and House Democrats are considering a similar approach.
Similarly, the House approach would require employers to purchase insurance for their workers or pay a penalty. Senate Democrats left that issue for a final decision later this week or next week, but it is expected to be included.
Additionally, both approaches include steps to emphasize preventive care, an attempt to reduce the cost of treating disease.
To cut down on the ranks of the uninsured, the Senate bill stipulates that children up to the age of 26 could remain on their parents' insurance policies.
On a hotly contested issue, the emerging House plan would give individuals the option of buying insurance provided by the federal government.
Democrats on the Senate committee embraced a similar provision last week, but omitted it from the draft released Tuesday in what Sen. Chris Dodd, D-Conn., said was a gesture to Republicans who oppose it.
Sen. Mike Enzi, R-Wyo., the top Republican on the health committee, responded derisively. He said Democrats did so "because they know we're not going to like what they've written and they don't want us to have any time to comment."
His remarks were not the only evidence of partisan maneuvering during the day, and an industry group, America's Health Insurance Plans, issued a statement saying that "a government-run plan would dismantle employer-based coverage, significantly increase costs for those who remain in private coverage and add additional liabilities to the federal budget."
While that suggested the White House's goal of a bipartisan bill was growing more distant, there were attempts to seek a compromise on the issue. Sen. Kent Conrad, D-N.D., floated a proposal for nonprofit cooperatives to offer insurance without direct government backing.
Senate Republicans on two committees most involved with health care urged Democrats not to move ahead without detailed cost information. "Paying for health reform in a responsible and sustainable way may be the most single difficult element of our efforts," they wrote.
But after months of preliminary effort, Democrats made clear they intend to move ahead on their own timetable, one that calls for passage of legislation in the House and Senate by early August. A final compromise would wait for September or later in the fall, according to a schedule the party's leadership established weeks ago.
"This is the year we have to do it," said Rep. Henry Waxman, the California Democrat who chairs the House Energy and Commerce Committee. Waxman was one of several senior Democrats who outlined proposed legislation to the party's rank and file during the day.
Numerous senior Democrats now aging and ailing have worked their entire careers on health care, but no one is more identified with the issue than Sen. Edward M. Kennedy, the Massachusetts Democrat first elected to the Senate in 1964. But in a poignant announcement during the day, Dodd said Kennedy, diagnosed a year ago with a brain tumor, will be unable to attend the working sessions of the health committee he chairs.
Obama has made an overhaul of the health care system a top priority of his first year in office, both to assure coverage for the uninsured and also to slow the rate of growth in health care nationally. Outside groups representing hospitals, doctors, drug companies and others have pledged to work with the White House on that objective, but it is not clear how much money their efforts would yield in savings to the government.
That leaves lawmakers with the difficult chore of agreeing on a series of tax increases and spending reductions if they are to cover the costs of the legislation.
Obama met with a group of House Democrats at the White House during the day, and Orszag said the discussion centered on the administration's recent announcement that it is willing to try to find as much as $600 billion in Medicare savings, double what the president requested in his budget last winter.
"What I want to be very clear about is, at worst this will be deficit-neutral," the president said. "And then to the extent that these changes succeed in altering the practice of medicine in the way that experts have long believed that they will, the result will be much better than that."
In both the House and Senate, Democrats want to provide subsidies to families with incomes of up to about $88,000 a year to help them pay for insurance.
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