WASHINGTON – President Barack Obama issued his own blueprint for a health care overhaul on Monday and laid the groundwork for an aggressive parliamentary maneuver to pass the legislation using only Democratic votes if this week brings no progress toward a bipartisan solution.

In laying out for the first time the details of what he wants in the legislation, Obama set in motion a new round of maneuvering intended to bring a bitterly divisive yearlong clash to a conclusion.

With the two parties scheduled to meet Thursday for a televised session on the health care overhaul, Obama appeared intent on forcing the Republicans into a choice: either put a specific alternative on the table, giving Democrats a chance to draw pointed contrasts between the parties' approaches, or be cast as obstructionist and not serious about addressing an issue of great concern to voters.

The initial Republican response suggested that the two parties are more likely headed toward a showdown than a deal. House Minority Leader John Boehner, R-Ohio, said Obama had "crippled the credibility" of Thursday's meeting by proposing "the same massive government takeover of health care" that Americans had already rejected.

The bill, which the White House estimates would cost $950 billion over a decade, aims to fulfill Obama's goals of expanding coverage to millions of people who are uninsured, while taking steps to control soaring health care costs. It sticks largely to the version passed by the Senate in December but offers some concessions to House leaders who have demanded more help for middle-income people.

But more than a specific policy prescription, the measure is a gamble by a president trying to keep his top legislative priority alive.

The White House signaled more clearly than it had until now that, barring a bipartisan breakthrough, Democrats would try a legislative maneuver known as reconciliation to pass the bill through the Senate on a simple majority vote, avoiding the 60-vote supermajority requirement that is necessary to avert a Republican filibuster.

By using the existing Senate bill as the basis for his proposal, Obama made it easier for Democrats to try to execute that parliamentary tactic, though the maneuver would bring vehement Republican opposition and remains subject to all kinds of procedural challenges.

"The president expects and believes the American people deserve an up-or-down vote on health reform," Dan Pfeiffer, Obama's communications director, said in a morning conference call with reporters. "And our proposal is designed to give us maximum flexibility to ensure that, if the opposition decides to take the extraordinary step of filibustering health care."

But leading Republicans – including Sen. Olympia Snowe of Maine, whose vote Obama courted unsuccessfully last year – called on the president to publicly renounce reconciliation. In a brief interview Monday on Capitol Hill, Snowe said using the procedure would be "a huge mistake."

Reconciliation had once been seen as a risky maneuver that Republicans could use against Democrats in the fall midterm elections, portraying it as a partisan move. Now, White House officials say, it is the likeliest outcome if they hope to advance anything resembling the health care proposals already on the table.

"This is our last, best hope for comprehensive health care reform," said a senior administration official, speaking on the condition of anonymity to talk frankly about the Thursday summit.

As one senior administration official put it, "This is like the 'last exit for gas' sign on the interstate."

Even if the reconciliation maneuver is used, the legislative math, especially in the House, remains a challenge for the administration. Vacant seats and unresolved disputes over issues such as restrictions on abortion funding have left the White House short of the votes it needs in the House, meaning Obama has his work cut out for him in assembling even simple majorities in both chambers.

The White House projects that Obama's bill would extend coverage to 31 million people who are uninsured, at a cost over 10 years of $950 billion – more than the $872 billion the Senate would have spent, but less than the $1.05 trillion for the version passed by the House. The administration estimates that its plan would reduce the federal deficit by $100 billion over the next 10 years – and about $1 trillion over the second decade – by cutting spending and reining in waste and fraud.

But the measure has not been evaluated by the nonpartisan Congressional Budget Office, whose analyses are widely considered the final word on Capitol Hill. The office's director, Douglas Elmendorf, posted a blog entry Monday that said he would need more detail than the White House has provided to conduct an analysis – and even with such details, "analyzing the proposal would be a time-consuming process that could not be completed this week."

In one sense, the release of the bill marks an extraordinary reversal for a president who has long said he would leave legislating to the legislators. But with the House and Senate unable to reconcile their differences, Obama, who had promised to post a Democratic bill on the Internet 72 hours in advance of Thursday's meeting, was left with little choice but to issue a plan of his own.

Even Democrats seemed uncertain Monday where the process would lead. But some said that if Obama has done nothing else, he has revived the public debate over health care and created a political climate that allows Democrats to talk about it again – something that seemed impossible just a few short weeks ago, after a Republican Senate victory in Massachusetts threw the bill off track.

"It was like calling a timeout in basketball," said John Podesta, who ran Obama's transition team and served as chief of staff to another Democratic president, Bill Clinton. "Everybody came back to the sides; now they can go back on the court."

HOW MANY ARE COVERED

Like the Senate bill, Obama's proposal would cover 31 million uninsured Americans.

INSURANCE MANDATE

Like the bills approved last year by the House and Senate, the proposal would require most everyone to be insured or pay a fine. There is an exemption for low-income people. The Senate bill exempted people with incomes under the federal poverty level ($21,200 for a family of four) whereas Obama's plan, like the House version, would exempt people under the tax-filing threshold ($45,295 for a family of four). But the fines levied under the insurance mandate would be higher than the Senate proposed. Obama also keeps a "hardship exemption" that excuses anyone from buying insurance if it would cost more than 8 percent of their income.

INSURANCE MARKET CHANGES

Like the House and Senate bills, Obama's proposal would stop unpopular insurance industry practices such as denying coverage to people with pre-existing conditions or charging women more. In response to a recent 39 percent rate hike announcement by Anthem Blue Cross in California, Obama would give the federal government the authority to block rate hikes, roll back premium prices and force insurance companies to give rebates to consumers.

MEDICAID

Like the Senate bill, Obama's proposal would expand the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level, or $29,327 a year for a family of four. The federal government would pick up more of the tab, paying 100 percent of the cost for newly eligible individuals through 2017. Obama eliminated a special deal that would have given Nebraska 100 percent federal funding for newly eligible Medicaid recipients in perpetuity. A one-time deal negotiated by Sen. Mary Landrieu for her state, Louisiana, worth as much as $300 million, stayed in.

TAXES

Obama scaled back a tax on high-cost insurance plans that was opposed by House Democrats and labor unions. The tax would be delayed from 2013 until 2018 and the thresholds at which it is imposed would be moved up from policies worth $8,500 for individuals and $23,000 for families to $10,200 for individuals and $27,500 for families. Those changes mean $120 billion in lost revenue over 10 years that Obama would replace mostly by applying an increased Medicare payroll tax to investment income as well as wages for individuals making more than $200,000 or married couples above $250,000. The Senate bill had applied the tax only to wage income.

PRESCRIPTION DRUGS

Obama would close the "doughnut hole" coverage gap in the Medicare prescription drug benefit that kicks in once seniors have spent $2,830. The Senate bill would have provided a 50 percent discount on the cost of brand-name drugs in the doughnut hole, but Obama would close the gap entirely by 2020. The added cost, which the White House did not disclose, would be paid for in part by an additional $10 billion in fees on the drug industry.

EMPLOYER RESPONSIBILITY

Obama keeps the approach in the Senate bill, which doesn't require businesses to offer coverage but charges fees to companies with more than 50 employees if the government subsidizes employees' coverage. Obama increases the fees to $2,000 per worker instead of $750, but grants companies an allowance that was not part of the original Senate plan.

SUBSIDIES

Obama provides more generous subsidies overall for purchasing insurance than the Senate bill did. The aid is available for households making up to four times the federal poverty level, or $88,000 for a family of four.

CHOOSING HEALTH INSURANCE

Small businesses, the self-employed and the uninsured could pick a plan offered through new state-based purchasing pools called exchanges. Liberals hoped Obama would go with a national exchange like the House bill did, but he stuck with the Senate's state-based approach. People working for big companies would not see major changes.

GOVERNMENT-RUN PLAN

Obama did not include the government-run insurance plan sought by some Democrats. He kept the Senate approach, which gives Americans purchasing coverage through new insurance exchanges the option of signing up for national plans overseen by the federal office that manages the government health plan available to members of Congress. Those plans would be private, but one would have to be nonprofit.

ABORTION

Obama did not change the abortion language in the Senate bill, which is opposed by anti-abortion groups that say it allows federal funding of abortion. The bill tries to maintain a strict separation between taxpayer funds and private premiums that would pay for abortion coverage. No health plan would be required to offer coverage for the procedure. In plans that do cover abortion, beneficiaries would have to pay for it separately, and those funds would have to be kept in a separate account from taxpayer money. States could ban abortion coverage in plans offered through the exchange. Exceptions would be made for cases of rape, incest and danger to the life of the mother.

The Associated Press