WASHINGTON — President Obama’s budget would make a down payment toward his goal of covering the uninsured, and he would pay for it in part by cutting federal payments to hospitals, insurance companies and drug companies.

Mr. Obama requested more than $6 billion for cancer research at the National Institutes of Health, up from $5.6 billion last year, and he announced a “multiyear plan to double cancer research.”

奥巴马总统请求总共超过60亿美元的资金用于美国国立卫生研究院开展的癌症研究，2008年美国国立卫生研究院开展的癌症研究的预算是56亿美金。

In addition, Mr. Obama said he would speed the approval of low-cost generic versions of expensive biotechnology drugs by establishing “a new regulatory pathway” at the Food and Drug Administration.

此外，奥巴马总统说，他将加快批准在美国食品和药物管理局低成本仿制昂贵的生物技术药物。

And he said he would increase access to family planning services for low-income women by expanding eligibility under Medicaid. A similar proposal was dropped from the recent economic stimulus bill after it provoked an outcry from Republicans.奥巴马总统说，他将增加低收入妇女获得计划生育服务并扩大医疗补助。

Mr. Obama asked Congress to set aside $634 billion in a “reserve fund for health care reform.”
奥巴马总统要求国会搁置预留的六千三百四十〇点零亿美元作为医疗保健改革专项基金

He provided no new information about how to cover the uninsured, saying he would work out the details with Congress later this year. But he did propose specific changes to save money, and many of his ideas face opposition from Washington lobbyists and the interests they represent.

Mr. Obama would, for example, require drug companies to give bigger discounts, or rebates, to Medicaid, the health program for low-income people.

Drug makers now must provide Medicaid with a discount equal to at least 15.1 percent of the average manufacturer price for a brand-name product. Mr. Obama wants to require discounts of at least 22.1 percent. Pharmaceutical companies have resisted such proposals in the past.

Mr. Obama said he would save $176 billion over 10 years by cutting Medicare payments to health insurance companies that provide comprehensive care to more than 10 million of the 44 million Medicare beneficiaries.

Medicare pays private insurers an average of 14 percent more than it would cost to care for the same people in the traditional fee-for-service Medicare program. “It’s time to stop this waste,” the White House said.

Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group, denounced the proposal. It would, she said, require people in private Medicare Advantage plans to bear “a disproportionate share of the costs to reform the health care system.”

The president also proposed cutting Medicare payments to hospitals that re-admit a large proportion of patients within 30 days after they are discharged. Such re-admissions sometimes indicate that hospitals provided poor care or did not properly coordinate care.

Under the proposal, hospitals would receive “bundled payments” that cover not only their own services, but also any care provided by nursing homes and home health agencies in the month after patients left the hospital.

The White House said this proposal would save $26 billion over 10 years.

Mr. Obama also proposed squeezing $37 billion out of the payments to home health agencies over the next decade.

William A. Dombi, vice president of the National Association for Home Care and Hospice, a trade group, said this proposal would directly affect frail, sick older people.

“Patients would lose access to care very quickly,” Mr. Dombi said. “Over 70 percent of all home health agencies would be operating in the red.” President George W. Bush made a similar proposal last year, but it died in Congress.

Doctors praised one aspect of Mr. Obama’s budget. He assumes that Congress will protect doctors from cuts in Medicare payments scheduled to occur under current law — cuts of 21 percent in 2010 and about 5 percent in each of the next few years.

“We are very pleased,” said Dr. Nancy H. Nielsen, president of the American Medical Association. “All previous budgets assumed cuts in doctor payments.”