A major Senate health reform bill would cost the federal government $1 trillion over the coming decade while reducing the number of uninsured Americans by a net of only 16 million, according to a preliminary analysis released yesterday.

President Obama and congressional Democratic leaders are pressing for passage of legislation that they say would extend health care insurance to the majority of the 46 million Americans currently without insurance. The Congressional Budget Office analysis immediately prompted Republican criticism that the Democrats’ policies would waste taxpayers’ money and provide far less insurance coverage than had been projected.

“These early reports from CBO show that this bill will cost too much, cover too few, and cause too many to lose the coverage they enjoy now,” said Sen. Mike Enzi of Wyoming, the ranking Republican on the Health, Education, Labor and Pensions Committee, which is drafting the bill.

A spokesman for Sen. Edward Kennedy, D-Mass., chairman of the committee and the primary author of the bill, said that the CBO numbers do not reflect the impact of the final bill. “As the CBO letter indicates, this is an incomplete statement of an incomplete bill,” said Kennedy spokesman Anthony Coley. “We look forward to a complete CBO estimate of a complete bill.”

Kennedy’s bill is missing important sections, but the committee needed to get a CBO analysis before it begins marking up the measure this week. The Senate Finance Committee is working on a separate that will be unveiled later this week.

The CBO analysis concluded that once the Kennedy bill was fully implemented, about 39 million Americans would obtain coverage through new health insurance. At the same time, CBO estimated, the number of people who had coverage through an employer would decline by about 15 million and coverage from other sources, including Medicaid, the Children’s Health Insurance Program and the non-group market, would fall by about eight million. Medicaid is the state-federal program for the poor.

In a letter to Kennedy, CBO Director Douglas W. Elmendorf said the analysis does not include several factors that would influence the assessment of the bill’s impact. They include expanding eligibility for Medicaid to individuals whose incomes are up to 150 percent of the federal poverty level and the effect of a government-run public health insurance plan that is favored by many Democrats.

Elmendorf cautioned that further changes to the bill could alter the ultimate number of people covered and the price tag — “although probably not by substantial amounts relative to the net costs already identified.”

Hours earlier yesterday, Obama defended his health care proposals, including creation of a government-sponsored insurance plan to provide affordable insurance to millions of Americans, in a speech before the American Medical Association in Chicago.

Critics of the plan charge that the so-called public option would undermine private insurers, drive down payments to hospitals and doctors and mark the first major step toward the federal takeover of the health care industry.

Obama dismissed the claims of “fear mongers” and “naysayers” that the public option approach was a “Trojan horse for a single-payer (government) system. What I am trying to do – and what a public option will help do – is put affordable health care within reach for millions of Americans.”

Two in three Americans support Obama’s call for creation of a public plan to compete with private insurers, but more than half are unwilling to pay more to help extend coverage to the uninsured, according to a new survey.

Just over half of those surveyed by the Kaiser Family Foundation oppose taxing the most generous employer-sponsored health benefits to help finance a major overhaul of the nation’s health care system, a huge revenue-raiser that is almost certain to be included in legislation being drafted in the Senate this week, according to a survey released today. (Kaiser Health News is a part of the foundation.)

Senate Finance Committee Chairman Max Baucus, D-Mont., is expected to unveil his version of the health care package as early as tomorrow, including an alternative to a federally administered health insurance plan along the lines of a cooperative, an idea advanced by Sen. Kent Conrad, D-N.D.

The Finance package is also expected to propose a tax on employer-provided health insurance in excess of the projected cost of insurance packages provided to federal employees, according to sources. The measure could raise about $418 billion over 10 years, according to the Joint Committee on Taxation, which would be critical to financing a plan that could cost as much as $1.5 trillion in the coming decade.

While taxing employer-provided health benefits for the first time would be unpalatable for unions, who are Democratic allies, Baucus and a wide range of lawmakers and health policy analysts have said this step would be essential to containing health care costs and preventing overuse of health care services.

One of the people surveyed by the Kaiser poll, Kayla Brewer, 25, of Lincoln, Neb., said yesterday she was opposed to taxing the most generous health benefits because people shouldn’t be punished for having good health care. “I agree there needs to be reform, but I don’t think that because you have a better plan, that you should be the one that suffers in some way,” she said in an interview. “I’m not opposed to a general increase in taxes, but I don’t think taxing individuals (who) already have health care is fair.”

The poll, conducted June 1 to June 8 among 1,205 adults, found that Americans are less concerned about health care reform than the impact of the recession, and that their views are easily influenced by strong arguments or new information.

Analysts say that the seeming malleability of public opinion on health care is especially important as the congressional debate on legislation accelerates and special interest groups take stands. Already, hospitals, doctors, pharmaceutical companies and other medical industry groups unhappy with Obama’s proposals for cutting government health care spending over the coming decade are beginning to voice their criticism.

“It’s not hard to push people off their initial positions,” said Mollyann Brodie, Kaiser’s chief pollster.

KHN staff membersJordan Rau, Jennifer Evans and Andrew Villegas contributed to this report.