IOWA CITY, Iowa, May 29 — Senator Barack Obama proposed a major overhaul of the nation’s health care system today, aimed at covering the nearly 45 million uninsured Americans, reducing premium costs for everyone else, and breaking what he asserted was “the stranglehold” that the biggest drug and insurance companies have on the health care market.
Mr. Obama, the Democratic presidential candidate, in a long-awaited speech on a signature issue for his party, acknowledged that similar efforts to create universal coverage had failed in the past, “crushed under the weight of Washington politics and drug and insurance industry lobbying.”
But he added, “This cannot be one of those years.”
Mr. Obama would pay for his plan by allowing President Bush’s tax cuts for the most affluent Americans — those making over $250,000 a year — to expire. Officials estimated that the net cost of the plan to the federal government would be $50 billion to $65 billion a year, when fully phased in.
The Obama proposal includes a new requirement that employers either provide coverage to their employees or pay the government a set proportion of their payroll to provide it. Similar requirements have proven intensely controversial in the past, notably in 1993-94, when the health care plan proposed by President Bill Clinton went down largely because of a small business backlash.
Obama advisers said the smallest businesses would be exempt from this requirement. The advisers said that those business might have under 15 employees, but that no number has been set.
Mr. Obama would create a new public plan open to individuals who cannot get group coverage through work or the existing government programs, like Medicaid or the State Childrens Health Insurance Program. He would also create a National Health Insurance Exchange, a regulated marketplace of competing private health plans that would aim at “reforming” the private insurance market and giving individuals other, more affordable options for coverage.
Under the Obama plan, the federal government would reimburse employer health plans for the cost of catastrophic health expenditures, to break the cycle of one seriously ill employee driving up the premium costs of what is often a small group. Because of this and other cost-containment proposals, Mr. Obama estimated his plan would save the typical family up to $2,500 a year in their health insurance costs.
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