March 27 (Bloomberg) -- A consensus on divisive issues in the debate over health-care reform, including whether to require Americans to purchase insurance, failed to emerge from six months of private meetings among insurers, consumer advocates, hospitals and other health-interest groups.

The 18 groups said in a report released today that all Americans should be covered by health insurance and urged the government to use its powers to meet the goal, Ron Pollack, executive director of the consumer advocacy group Families USA and a participant in the talks, said in a telephone interview. Tax incentives for low-income individuals and an expansion of the Medicaid health program for the poor were among the ways the group suggested the U.S. may boost medical coverage.

President Barack Obama’s pledge to overhaul the U.S. health system to provide coverage for everyone has spurred lawmakers, insurers and advocates to develop plans to accomplish it. Today’s report avoids some of the most divisive questions, such as whether the government should create a new public plan to compete with insurers or require a mandate forcing Americans to buy health insurance. Still, the groups’ agreement on some health-care changes is an important step, participants said.

“We didn’t use the ‘m’ word,” Pollack said, referring to mandate. “But we are clear that we have to have a system that brings everyone in.”

Baucus Plan

The conclusions mirror some of what was proposed last November by Senate Finance Committee Chairman Max Baucus, a Montana Democrat, who is working with Massachusetts Democratic Senator Edward Kennedy, on legislation to get everyone covered.

Medicaid, the health insurance plan funded jointly by the states and the federal government, should be expanded to cover everyone at the federal poverty level, which is $22,050 for a family of four, or $10,380 for an individual, the groups said. The proposal is similar to the plan offered by Baucus. Many states now exclude single men and women or provide coverage to those whose annual income is less than the poverty level.

Baucus didn’t propose a new government-run plan to compete with private insurers, which Democrats in the U.S. House of Representative will include in their legislation, House Speaker Nancy Pelosi, a California Democrat, said yesterday.

This effort by the Health Reform Dialogue, as the groups call themselves, will help Congress figure out what to do, Baucus said today in an e-mail.

“You can bet I’ll be working closely with these groups, and everyone who brings ideas to the table, as we put pen to paper on health care reform in the coming weeks and months,” Baucus said.

No Recommendation on Mandate

The groups sidestepped whether the government should require that people have health insurance. Instead, the report says “reforms” are needed so that everyone gets quality coverage. It didn’t define this further. About 46 million people in the U.S., or 15 percent of the population, don’t have medical coverage.

Insurers support a mandate, warning that otherwise people will wait until they’re sick to buy coverage, driving up costs. Republicans generally don’t like forcing people to buy something, while consumer advocates say they want to ensure that coverage is affordable if people must purchase it.

“Employers, consumers and providers are united about the need for reform, and we’re committed to unite on solutions,” said an e-mail from John Rother, executive vice president of AARP, a Washington-based advocacy group for people 50 and older, which took part in the talks. “Several significant questions remain, but this progress should encourage everybody with a stake in fixing the health-care system.”

Mediator Used

The meetings were held with the help of a mediator, the Keystone Center, of Keystone, Colorado, to keep outside pressure to a minimum. The groups, which have long disagreed publicly on the issue, decided last summer they needed to work to see if they could reach consensus, participants said.

The Keystone Center, according to its Web site, “works with a broad array of stakeholders to develop consensus solutions to complex health and social policy challenges.”

Using a mediator didn’t solve all conflicts. The American Federation of State, County and Municipal Employees, pulled out of the talks last month. Steve Kreisberg, director of collective bargaining and health-care policy for the 1.4 million-member union, said it left for a “variety of reasons” that won’t be made public.

The Service Employees International Union, whose members include health-care workers and janitors, didn’t sign on to the report. The union didn’t want to tie Congress’s hands in any way, said spokeswoman Lori Lodes.

The participants include America’s Health Insurance Plans, a trade group for the publicly traded insurance companies; the Pharmaceutical Research and Manufacturers of America, the drugmakers lobbying group in Washington; and the Chicago-based American Medical Association, the largest trade group for U.S. doctors.

To contact the reporter on this story: Aliza Marcus in Washington at amarcus8@bloomberg.net

Last Updated: March 27, 2009 18:54 EDT