WASHINGTON -- The Bush administration has come under growing preessure from its own advisers and from four of the most powerful health-care organizations to propose ambitious, potentially expensive changes in the nation's health-care system to protect uninsured people.
A report drafted for an advisory panel appointed by the administration recommends expanding Medicaid to cover doctors' services and hospital care for 10 million people below the poverty level with no health insurance.
Various health policy experts estimated that the cost to the federal government would be at least $4 billion a year. Medicaid, a state-federal program, already finances health care for 27 million poor Americans.
The panel has not voted on the report, prepared by its staff to reflect a consensus of its members' views.
But the recommendation suggests that the panel is willing to consider new investments in health care that are much more substantial than anything proposed by President Bush.
More than 33 million people lack health insurance; about 80 percent are workers or their dependents.
Emphasizing that the panel's work was far from complete, Deborah L. Steelman, chairwoman of the 13-member group and director of domestic policy for Mr. Bush's 1988 campaign, said:
"We've got millions of people under the poverty level with no access to health insurance. This really isn't acceptable. It's not socially acceptable, it's not morally acceptable, and it's not economically smart."
The administration has said that it will be guided by her panel's recommendations in developing its own health policy proposals.
The panel was appointed by Dr. Louis W. Sullivan, the secretary of health and human services, and includes a wide variety of business executives, labor leaders and health care experts.
The panel does not specify how to pay for its recommendations.
But an overriding theme of its report is that the best way to ease the burden of paying for future health and retirement benefits is to "increase the productive capacity of the economy," thereby creating jobs and generating additional revenues through taxes.
Even as the panel prepared its report for submission to Mr. Sullivan later this year, chief executives of four powerful organizations -- the American Medical Association, the American Hospital Association, the Blue Cross and Blue Shield Association and the Health Insurance Association of America -- adopted a joint statement of principles last month, endorsing "universal access to health-care services for all Americans."
The organizations also call for expansion of Medicaid to cover the 10 million uninsured people below the official poverty level, $13,360 for a family of four, and they say this change should be financed with "broad-based taxes."
The four trade associations have sent their joint statement, a broad agenda for national health-care reform, to John H. Sununu, the White House chief of staff, and have asked for a meeting.
Because of budget constraints, Congress is unlikely to approve a significant expansion of Medicaid this year.
But liberals and conservatives alike say that it is virtually certain that, in the next few years, Congress will pass legislation to help poor people get health insurance coverage through the government or the private market.