Obama throws down gauntlet on health care

Democratic leaders also are asking their members to go against the majority of voters, who polls show are leery of the price tag and its long-term impact on their health care and their own budgets. Republicans are fully united against it, and the lone Republican to vote for the plan initially, Rep. Anh “Joseph” Cao of Louisiana, now opposes it.

Dismissing Republican calls to restart the process, Mr. Obama has spent the past two weeks preparing the American public for another battle in the yearlong effort that stalled in the wake of Scott Brown’s unexpected victory in January for a Senate seat from Massachusetts. His victory gave Republicans the votes needed to sustain a filibuster of the overhaul in the Senate, and left Democrats scrambling for a way forward.

Last week, Mr. Obama for the first time offered his own blueprint that tracks closely with stalled congressional efforts. The $1 trillion, 10-year plan includes many of the ideas in the previous bills, such as insurance industry reforms, a requirement that nearly all Americans carry coverage, the creation of state-based insurance exchanges and incentives for employers to provide coverage.

On Wednesday, Mr. Obama challenged Republicans to vote against his plan - which appeared to differ only slightly from the proposal he unveiled last week - saying they should do so if they support less regulation of the insurance industry, which Democrats have repeatedly held up as the chief antagonist in the nation’s health care system.

He also took aim at the minority party for advocating an incremental approach, contending that only a comprehensive bill could bring down health care costs and improve quality.

Mr. Obama’s proposal threw a few bones to Republicans by including ideas on combating waste and fraud, as well as additional funding for state pilot projects aimed at resolving malpractice cases outside of court.

In addition, he said that he took out two of the special carve-outs, for Florida and Nebraska, which he acknowledged were included only to secure votes from those states’ Democratic senators. However, he left in the $300 million for Louisiana that Sen. Mary L. Landrieu secured to help the state cover Medicaid costs.

Republicans have vowed to make every election race this fall a referendum on the health care reform bill, but Mr. Obama on Wednesday urged his colleagues not to consider the political consequences of their votes.

“We can’t just give up because the politics are hard,” he said. “I do not know how this plays politically, but I know it’s right.”

Mrs. Pelosi said Mr. Obama’s speech Wednesday, to a room that included doctors in lab coats, was “a call to action.”

She said that by including some ideas Republicans mentioned in last week’s health care summit at the White House, Mr. Obama has produced a bipartisan effort, even if it doesn’t win any Republican votes.

But Mrs. Pelosi said they’re also confident voters will see “there are key differences between our two parties.”

“Democrats believe we must hold insurance companies accountable in order to rein in premiums, insure 30 million more Americans, and protect patients and consumers nationwide. Congressional Republicans disagree.”

• Jennifer Haberkorn contributed to this report.