WASHINGTON — Senate Finance Committee Chairman Max Baucus (D-Mont.) released the crucial moderate alternative Wednesday in the struggle to refashion America's healthcare system, a $856-billion bill that includes a mix of sweeping new insurance regulations but no government-run plan.
Under his proposal, nearly everyone would be required to get coverage or pay a penalty. Insurers, in turn, would not be able to deny policies to people with preexisting medical conditions or to cancel coverage after people got sick. And the federal government would provide hundreds of billions of dollars in subsidies to help lower-income people buy coverage.
The legislation fell short of Baucus' goal of charting a course that could bring Republicans and Democrats together for the most ambitious overhaul of the health system since the 1960s.
Three key GOP lawmakers who had been working with Baucus for months have rejected his bill. The proposal also drew fire from liberals who insist that any overhaul must contain a "public option" insurance plan administered by the government.
But the Baucus plan still could serve as a template for a final Senate bill because it was designed to attract moderate and conservative Democrats.
"There are some on both sides of the aisle that think I've gone too far," Baucus said in a news conference.
"This is . . . an effort to get balance again," he added. "It's an effort to get a bill that can pass."
He called it "probably one of the largest pieces of social legislation in American history since the Depression."
Responding to widespread concern about the effect on the federal budget deficit, Baucus produced a bill that would cost significantly less than a $1-trillion-plus version pending in the House. It would also impose less-stringent requirements on business.
All of that drew praise from centrist Democrats whose support has been elusive, especially those from relatively conservative states.
"It's a strong step in the right direction," said Sen. Mary L. Landrieu (D-La.).
But liberals argued Wednesday that the Baucus bill did not provide generous enough subsidies for families of modest means and did not stop insurance companies from charging exorbitant premiums.
"I continue to be concerned about affordability for hardworking, middle-class families," said Sen. Ron Wyden (D-Ore.). "A lot of them can't get by now. And the prospect of paying significantly more . . . or being penalized -- that is not going to meet their test of healthcare security."
Baucus' plan would not go as far as other leading proposals toward reducing the ranks of the uninsured. According to a preliminary analysis by the Congressional Budget Office, the bill would leave about 25 million people without insurance, compared with 17 million under the House version.
Nor was there much evidence that establishing nonprofit cooperatives -- Baucus' alternative to the public option in legislation proposed by the House and by the Senate health committee -- would work to compete with private insurers and bring costs under control.
The cooperatives "seem unlikely to establish a significant market presence in many areas of the country," the nonpartisan budget office concluded.
The Baucus legislation, like the other two health bills, was designed to largely preserve the current system of employment-based health coverage. Layered on top of that system, the legislation would create highly regulated, state-based insurance marketplaces, or exchanges, where millions of people who do not get coverage from their employers or from the government would be able to shop for insurance.
These people would be able to select from a range of private insurance plans, as well as one potentially offered by a member-owned cooperative.
Despite major concessions, the bill did not win the endorsement of a single Republican -- not even Sen. Olympia J. Snowe of Maine, one of the bipartisan group of six finance committee members who met for months to discuss the bill.
Snowe called the bill a "step in the right direction," but said that she was still worried that it would be too costly to the government and consumers, and that it did not do enough to ensure a competitive insurance market.
Most other Republicans were far less charitable.
"This partisan proposal cuts Medicare by nearly a half-trillion dollars, and puts massive new tax burdens on families and small businesses, to create yet another thousand-page, trillion-dollar government program," said Senate Republican leader Mitch McConnell of Kentucky.
"Only in Washington would anyone think that makes sense, especially in this economy," he added.
Baucus' bill would substantially expand eligibility for Medicaid, the federal-state insurance program for the poor. Under all of the Democratic bills, Medicaid would be opened to America's poorest residents, regardless of their family status. In some states, the program now covers only poor children and their families.