"If we do end up with a system where people are responsible for their own insurance, we need to provide a hardship waiver to exempt Americans who cannot afford it," Mr. Obama wrote to Senators Ted Kennedy (D-Mass.) and Max Baucus (D-Mont.). "In addition, while I believe that employers have a responsibility to support health insurance for their employees, small businesses face a number of special challenges in affording health benefits and should be exempted."
He also said in his letter he agrees with the proposal to create a health insurance exchange through which Americans can compare the benefits and prices of various health care plans, as members of Congress are currently able to do.
"None of these plans should deny coverage on the basis of a preexisting condition, and all of these plans should include an affordable basic benefit package that includes prevention, and protection against catastrophic costs," the letter said.
The president also said, "I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans."
Liberal advocates of health care reform have called the public option a critical part of reform.
"We are thrilled to see President Obama's strong, unambiguous commitment to reform that includes the choice of keeping private health insurance or joining a new public health insurance option," Richard Kirsch, national campaign manager for Health Care for America Now, said in a statement in reaction to the letter. "The choice of a new public health insurance plan is the only way to control costs, guarantee coverage, ensure quality and transparency, and set a benchmark by which patients will know whether their private health insurance is truly giving them what they're paying for."
Mr. Obama sent the letter after meeting with Kennedy and Baucus and other senators on Tuesday to discuss health care reform. In his letter, he called the meeting productive and said he looks forward to discussing more details of the health care overhaul with the two senators. He also reiterated his interest in building bipartisan support for reform.
Health care reform is "one of the most urgent and important challenges confronting us as a nation," he said.
As he stated publicly Tuesday, the president stressed in his letter that health care reform must address the causes of rising costs. He also reasserted that Medicare and Medicaid "are among the main drivers of enormous budget deficits that are threatening our economic future."
"The status quo is broken, and pouring money into a broken system only perpetuates its inefficiencies," he said.
The president also said he is open to the idea of giving special consideration to the recommendations of the Medicare Payment Advisory Commission (MedPAC), a commission created by a Republican Congress. Under such an approach, MedPAC's recommendations for cost reductions would be adopted unless opposed by a joint resolution from Congress.