Sen. Max Baucus says the government should set up an “exchange” that consumers could use to buy health coverage on a guaranteed-issue basis.

Baucus, D-Mont., chairman of the Senate Finance Committee, discusses the proposal in a white paper.

The health insurance exchange would be a “sort of government-administered shopping center where people could go to buy coverage,” Baucus says.

Baucus says he would require everyone who can afford to buy health insurance to buy it, once affordable options were available.

Ending the practice of having the insured pay for care for the uninsured through cost shifting will bring down the cost of coverage and make individual health insurance premiums more affordable, Baucus says.

“Coverage of all Americans will also make reforms work better, from insurance market reforms to a cost-saving focus on preventive care,” Baucus says.

The plan would include help for individuals who cannot afford to buy coverage, Baucus says.

Another lawmaker, Rep. Pete Starks, D-Calif., chairman of the House Ways and Means Health Subcommittee, announced several narrower health finance goals earlier this week.

Stark said he will propose a State Children’s Health Insurance Program expansion measure similar to the bill vetoed by President Bush.

SCHIP expansion could be introduced early in 2009, or attached to any legislation that might be enacted in a lame-duck session, Stark said.

Stark said he also will seek changes in Medicare physician compensation rules and passage of health information technology legislation.

Stark said he would defer to the incoming administration of President-elect Obama on broad health coverage reform efforts.

Stark and Rep. Charles Rangel, D-N.Y., chairman of the House Ways and Means Committee, have issued a statement welcoming the Baucus proposal but indicating that there may be differences between his approach and their approach.

“We are heartened to see Baucus adding his voice to the chorus calling for health reform to be a top priority,” Stark and Rangel say in the statement. “His paper supports a number of principles we have pursued over time, including many of those on which President-Elect Obama campaigned. We are optimistic that we can reach a consensus on this critical issue.”

America’s Health Insurance Plans, Washington, believes Baucus’s general calls for reforming the health finance system are consistent with what AHIP would support, but the devil will be in the details, according to AHIP spokesman Robert Zirkelbach.

“We need to have a system so that everyone in this country, regardless of pre-existing conditions has access to healthcare coverage, Zirkelbach says.

But HIP “hasn’t taken a position on how a program that guaranteed coverage to everyone would be created and administered,” Zirkelbach says.

In AHIP’s own health finance reform proposal, “we said that, if there is a requirement that everyone purchase coverage, health insurance plans could provide coverage to everyone on a guaranteed basis,” Zirkelbach says.