Pelosi, D-Calif., wants to have the legislation on the floor next week, with a final vote before Veterans Day, Nov. 11, that would give President Barack Obama a bill to sign by year's end, numerous Democratic officials said. She planned a formal announcement of the bill Thursday in front of the Capitol.
The bill would require nearly everyone by 2013 to sign up through their employer, a government program or a new kind of purchasing pool called an exchange. Tax credits would be available for most of those buying coverage through the exchange. They would have the option of picking a new government plan or private insurance.
During the transition years from 2010-2013, a temporary government program would help people turned down by private insurers because of medical problems, lawmakers said. After that, insurers no longer could refuse to provide coverage to the sick, nor could they charge more because of poor health of the insured.
The plan also calls for a significant expansion of Medicaid, the federal-state health program for low-income people. And it would impose a requirement on employers to offer insurance to their workers or face penalties.
A concession to Democratic moderates appears to have cleared a path for Pelosi to move forward. Democratic leaders agreed to the moderates' demand that the new government insurance plan must negotiate payment levels with hospitals and doctors, instead of imposing its rates, as liberal lawmakers would have preferred.
"This has always been a matter of trying to pull together 218 votes," said Rep. Xavier Becerra, D-Calif., referring to the number needed to guarantee passage on the House floor. "There is growing confidence that we can pass it with strong Democratic support."
No Republicans are expected to vote for the sweeping legislation, which would raise taxes on upper-income earners and cut Medicare payments to insurers, hospitals and other providers to cover a price tag that tops $1 trillion over 10 years.
"Americans' health care is too important to risk on one gigantic bill that was negotiated behind closed doors," said Rep. Dave Camp, R-Mich. "The Medicare cuts will hurt seniors, the tax increases will kill jobs and the government takeover of health care will increase premium costs.
The bill's rollout caps months of arduous talks to resolve differences between liberals and moderates and blend health care overhaul bills passed by three committees over the summer.
The House package reflects many of Obama's priorities, but plenty of work remains to be done before Congress can send him a bill to sign. The House bill differs markedly from legislation taking shape in the Senate, where Majority Leader Harry Reid, D-Nev., is trying to round up support among moderate Democrats for a modified government insurance option that states could opt out of.
One change expected to be revealed Thursday is that some of the benefits in the bill, which mostly were set to take effect in 2013, have been moved up so that Americans would see the benefits of the legislation more quickly, according to Pelosi spokesman Nadeam Elshami.
Pelosi has also said the bill would strip the health insurance industry of a long-standing exemption from antitrust laws covering market allocation, price fixing and bid rigging. Democratic officials said the bill also would give the Federal Trade Commission authority to look into the health insurance industry at its own initiative. The officials spoke Wednesday on condition of anonymity, saying they were not authorized to pre-empt a formal announcement.
"I'm pretty confident that we've got the right pieces in place," said Rep. George Miller, D-Calif., chairman of the House Education and Labor Committee, one of the three panels involved in writing the bill. "We can quibble over parts of it, but the fact is when you're taking a 60-year-old system that grew up in a rather haphazard fashion and you're trying to bring some coherence to it, these are sort of the things you have to do at the beginning of that process."
If Obama does get to sign a health overhaul bill, he will have bucked decades of failed attempts by past administrations, most recently by former President Bill Clinton in the 1990s. There's still no guarantee that Congress can complete the legislation before year's end, as the president wants.
Democratic leaders in the House still face disputes over prohibiting taxpayer money for abortions and health care for illegal immigrants, issues they hoped to resolve after the bill's unveiling.