Obama Open to Plan Requiring Everyone to Get Insurance

President Obama said Wednesday that he was receptive to Congressional proposals that would require every American to have health insurance and that would force employers to offer health insurance to their employees. But he said there should be exemptions for people who cannot afford coverage and for small businesses in general.
Mr. Obama set forth his views in a letter to the chairmen of the two Senate committees writing health legislation, Max Baucus of Montana and Edward M. Kennedy of Massachusetts, both Democrats.

He did not use the terms “individual mandate” or “employer mandate,” which suggest a degree of coercion that Democrats try to avoid. Still, the letter is the first time that Mr. Obama, as president, has opened the door to an individual mandate or amplified his views on health care overhaul.

In the presidential primaries last year, Hillary Rodham Clinton called for an individual mandate, while Mr. Obama said the requirement for coverage should at first apply only to children. But that proposal has not found any significant support in Congress, where Democrats favor an individual mandate, with federal subsidies or tax credits to help defray the cost of insurance for people with low or moderate income.

In the letter made public on Wednesday, Mr. Obama wrote, “If we are going to make people responsible for owning health insurance, we must make health care affordable.”

He added, “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.”

Moreover, the president said, “while I believe that employers have a responsibility to support health insurance for their employees, small businesses face a number of special challenges in affording health benefits and should be exempted.”

Mr. Obama also confirmed his strong support for a public health insurance option as part of any reform package “to keep insurance companies honest.”

To help pay for coverage of the uninsured, Mr. Obama called for additional cutbacks in the growth of Medicare and Medicaid, beyond the savings he proposed in February as “a down payment on health care reform.”

In his earlier request, Mr. Obama proposed savings of $316 billion in the two programs over 10 years. On Wednesday he said he wanted to work with Congress to reduce projected spending on Medicare and Medicaid by an additional $200 billion to $300 billion over the next 10 years.

Such proposals are sure to face stiff resistance from health care providers, who were already alarmed at the president’s initial proposals to cut payments to hospitals, drug companies, H.M.O.’s and home care agencies, among others.

Mr. Obama said he was “committed to working with the Congress to fully offset the cost of health care reform,” by curbing the growth of Medicare and Medicaid and “by enacting appropriate proposals to generate additional revenues.”

The president did not comment on proposals to tax some employer-provided health benefits, an idea favored by Senator Baucus but strongly opposed by labor unions and many employers.