Obama to make concessions

WASHINGTON — President Obama plans to address a joint session of Congress next week in an effort to rally support for health-care legislation as White House officials look for ways to simplify and scale back the major Democratic bills, lower the cost and drop contentious but nonessential elements.

Administration officials said Wednesday that Obama would be more specific than he has been about what he wants included in the plan. Doing so amounts to an acknowledgment that the president's prior tactic of laying out broad principles and leaving Congress to fill in the details did not work and that Obama needed to become more personally involved in shaping the outcome.

The officials said Obama, who's spending the long Labor Day weekend at Camp David, Md., was unlikely to unveil a detailed legislative plan of his own, and they insisted he had not given up on the provision that has attracted the most fire from the right, a proposal for a government-run competitor to private insurers, although many Democrats say the proposal may be jettisoned.

Rahm Emanuel, the White House chief of staff, said Obama would be "more prescriptive than he has been to date," adding, "We have a tremendous amount of consensus in Congress to build off of."

In his address Wednesday night, Obama is expected to emphasize areas of potential agreement. One is the need for federal regulation of health-insurance companies to prohibit them from denying coverage, or charging higher premiums, because of a patient's medical history or current condition. Another is the need for federal subsidies to make insurance affordable to millions of lower-income people.

By signaling that they would seek to revise existing versions of legislation moving through the House and Senate, administration officials and Democratic leaders in Congress — many of whom had said they saw no need to scale back their ambitions — made clear their political calculations had changed.

With congressional Republicans almost unanimously opposing the Democratic approach, the target for Obama is primarily a handful of moderate Democrats and the one Republican who seems open to a deal, Sen. Olympia Snowe of Maine.

"It's so important to get a deal," a White House official said, speaking on the condition of anonymity. "He will do almost anything it takes to get one."

In scheduling a speech for Wednesday before members of the House and Senate and a national television audience, Obama chose to put his political standing on the line more directly than he has so far on health care, his signature domestic initiative.

He will deliver the address 16 years after President Clinton outlined his plan for universal insurance coverage in a speech to Congress on Sept. 22, 1993. A year later, in September 1994, the legislation was declared dead, after withering attacks by Republicans and insurance companies. Some Obama advisers, wary of parallels between that effort and Obama's push for an overhaul of the health system, had argued that the president should give a televised speech from the Oval Office instead of the House chamber.

Timed to coincide with Congress' return from its summer recess, the president's address follows a tumultuous month in which opponents of sweeping health legislation disrupted lawmakers' town-hall-style meetings and the White House struggled to regain control of the debate.

Obama is also scheduled to travel to Cincinnati on Monday to speak at a large Labor Day picnic organized by the AFL-CIO. He will have a receptive audience, as labor unions have been among the strongest supporters of his effort to expand coverage and rein in health costs.

So far, the administration's ideas of concessions are likely to fall short of the fundamental changes in the legislation sought by congressional Republicans.

White House officials said Obama remains committed to the goal of insuring all Americans and still prefers to foster competition for insurance companies by creating a government insurance program, commonly referred to as the public option.

Three House committees have written bills that include a public option. House leaders expect to combine them into one bill and have it ready for a floor vote this month.

The Senate health committee has finished writing a similar bill. The Senate Finance Committee is struggling to come up with an alternative plan. Talks among six committee senators, three from each party, have gone on for weeks in search of a bipartisan compromise.

White House officials are combing the versions of health-care legislation approved by four of the five congressional committees with jurisdiction on the issue, to find common ground and to jettison provisions — some relatively minor — that have drawn fire from critics on the political right.

To avoid some of the most heated criticism voiced in recent weeks, White House officials said they would have no objection if Congress scrapped proposals to have Medicare pay for counseling on end-of-life care.

Critics said such counseling could lead to pressure on patients to forgo expensive treatments for terminal illnesses. Obama has said it is ludicrous to suggest "we want to set up death panels to pull the plug on Grandma."

White House officials said Congress could also drop proposals requiring the government to create school-based health clinics and collect nationwide data on health and health care by race, sex, sexual orientation and "gender identity."

Supporters of the House bill said such data would help reduce "health disparities," but critics said they feared the government could assemble a database that posed a threat to privacy. If Obama does not gain traction by making these concessions, his allies on Capitol Hill said, they may have to consider bigger changes. For example, they said, rather than requiring all Americans to carry health insurance, Congress might start by requiring coverage of children, or families with children.

Republicans' reactions showed that they had become emboldened in their opposition since Congress last met.

The House Republican leader, Rep. John Boehner of Ohio, said: "House Republicans want to hear what the president has to say, but after the public outcry this August, it's clear the American people don't want a new speech. They want a new plan."

Boehner said the Democrats should scrap their current proposals and start over.

Material from McClatchy Newspapers and The Associated Press is included in this report.