The health care overhaul under development by House Democrats would subsidize insurance premiums for families earning as much as four times the poverty level, while expanding Medicaid and improving its payments to health providers.

    Staff of the three House committees with jurisdiction over the emerging bill - Ways and Means, Energy and Commerce, and Education and Labor - have compiled a three-page outline of the legislation, which they call a "tri-committee" proposal. The plan would require individuals to obtain insurance and employers to help pay for it, and would create a government-run insurance plan that would compete with private insurers, according to the outline.

    Leaders of the three committees briefed the full House Democratic Caucus on their outline Tuesday. "We will continue to seek input and work closely with our colleagues, outside stakeholders, and the administration and are on track to introduce legislation shortly, the trio said. "We anticipate committee action on health reform in the coming weeks, with legislation on the House floor prior to the August district work period."

    The plan would make major changes to Medicare, including replacing a much-criticized formula for determining physician payment rates. The formula has required cuts in doctor's rates most years since 2000, forcing Congress to intervene to block the cuts under pressure from physicians. The outline calls the formula "flawed," but replacing it to avoid the annual payment cuts will cost billions of dollars a year.

    The legislation would eliminate "overpayments" to Medicare Advantage plans, which are operated by private insurers. President Obama has called for lower payments to the plans, which are paid on average about 13 percent more per beneficiary than traditional Medicare costs.

    The House plan would expand Medicaid "for the most vulnerable, low- income populations" and increase its payment rates to providers, the outline says, but without specifics. Many doctors will not accept Medicaid patients because of the program's notoriously low payment rates.

    Across the Capitol, where the Finance Committee and Health, Education, Labor and Pensions Committee are drafting the Senate's health care overhaul, HELP Chairman Edward M. Kennedy, D-Mass., has proposed expanding Medicaid to cover families earning as much as 1.5 times the poverty level, or about $33,000 for a family of four.

    Few Clues on Taxes, Savings

    The House outline does not include specific proposals to raise money for a health overhaul, and it is not clear how House Democrats will pay for their legislation. Many of them are leery of an option under consideration in the Senate - taxing some employer-sponsored health benefits. The outline suggests that provisions aimed at controlling the growth of health care costs will "generate savings for reform and fiscal sustainability," but the provisions are not explained.

    Many Democrats, including Obama, have hoped that measures to reduce the growth of health care costs - currently increasing about 7 percent per year - will produce money that can be used to expand insurance coverage. But they have had difficulty convincing Congress' official budget scorekeeper, the Congressional Budget Office, that meaningful savings from such measures can be applied to a health overhaul.

    The House Democratic plan would reorganize the private insurance market, creating a national Health Insurance Exchange where individuals or employers could obtain coverage, including from a government-run "public plan" if they wish. States would have the option of creating their own exchanges, instead of participating in the national exchange. Insurers would be prohibited from denying coverage based on pre-existing conditions and could not charge higher premiums based on gender, health status or occupation. Premiums would be higher for older people, but the increase would be limited.

    The plan would cap out-of-pocket spending by patients to prevent bankruptcies due to medical costs. Some studies suggest that more than half of all personal bankruptcies are due to medical bills.

    An independent advisory board would recommend different benefit packages for insurance plans, with more expensive plans offering increased benefits.

    The senior Republicans on the three committees sent the chairmen letters Tuesday asking for hearings on the Democratic plan, focused on whether it would cause people to lose their coverage, limit their choices of doctors and treatments, or raise costs for families and employers.