WASHINGTON — Cheered by President Barack Obama, House Democrats rolled out landmark legislation Thursday to extend health care to tens of millions who lack coverage, impose sweeping restrictions on the insurance industry and create a government-run option to compete with private insurers.
But even as party leaders pointed toward a vote next week, there were fresh questions that went to the heart of their campaign to remake the health care system.
Congressional budget experts predicted that the government insurance option probably would cost consumers more than private coverage. At the same time, rank-and-file conservative Democrats sought more information about the bill's overall impact on federal health care spending.
There was no official estimate on the total cost of the legislation. The Congressional Budget Office said the cost of additional coverage alone was slightly more $1 trillion over a decade. But that omitted other items, including billions for disease prevention programs.
An extra $230 billion or more in higher fees for doctors treating Medicare patients was stripped out of the bill and will be voted on separately.
The measure "covers 96 percent of all Americans, and it puts affordable coverage in reach for millions of uninsured and underinsured families, lowering health care costs for all of us," said Speaker Nancy Pelosi, D-San Francisco, at a ceremony attended by dozens of Democratic lawmakers.
Pelosi said the legislation would reduce federal deficits over the next decade by $104 billion, and congressional budget experts said it would probably reduce them even more over the next decade.
Democratic leaders were careful not to claim they had rounded up enough votes to pass the legislation. Still, the day's events capped months of struggle and marked a major advance in their drive to accomplish an overhaul of the health care system that has eluded presidents for a half-century.
The Democrat-controlled Senate is expected to begin debate within two weeks on a bill crafted by Majority Leader Harry Reid, D-Nev. It, too, envisions a government-run insurance option, although states could opt out, unlike in the bill the House will vote on.
That portion of the Senate version appears likely to be weakened further, as moderates press for a standby system that would not go into effect until it was clear individual states were experiencing a lack of competition among private companies.
Obama called the House legislation "another critical milestone in the effort to reform our health care system."
Republican reaction was as swift as it was negative. "It will raise the cost of Americans' health insurance premiums; it will kill jobs with tax hikes and new mandates, and it will cut seniors' Medicare benefits," said the party's leader in the House, Rep.John Boehner of Ohio. He carried a copy of the 1,990-page measure to underscore his claim that it represents a government takeover of the health care system.
Republicans have signaled their determination to make health care a key issue in next year's congressional elections, when all 435 House seats will be on the ballot.
But their ability to block passage in the current House is nonexistent as long as Pelosi and her leadership can forge a consensus among the Democratic rank and file. The party holds 256 seats in the House, and 218 makes a majority.
Broad in scope, the House Democrats' bill attempts to build on the current system of employer-provided health care. It would require big companies to cover their employees and include federal subsidies to help small companies provide insurance for theirs, as well. Most individuals would be required to carry insurance, and much of the money in the legislation is dedicated to subsidies for those at lower incomes to help them afford coverage.
For those at even lower incomes, the bill provides for an expansion of Medicaid, the state-federal health program for the poor. Adults who make up to 150 percent of the poverty level — individuals making up to $16,245 and a family of four up to $33,075 — would be covered, a provision estimated to add 15 million to Medicaid.
One of the bill's major features is a new national insurance market, in which private companies could sell policies that meet federally mandated benefit levels, the government would offer competing coverage and consumers could shop for the policy that best met their needs.
In a bow to moderates, Democrats decided that doctors, hospitals and other providers would be allowed to negotiate rates with the Department of Health and Human Services for services provided in the government insurance option.
Liberals had favored a system in which fees would be dictated by the government, an approach that would have been less costly, and would have moved closer to a purely government-run health care system.