Republican John McCain wants to change how people get their health insurance, shifting away from job-based coverage to an open market where people can choose from competing policies.

McCain said Tuesday he would offer families a $5,000 tax credit to help buy insurance policies. Everyone would get the credit, whether he or she keeps a policy through an employer or shops for a new one.

"You simply choose the insurance provider that suits you best," McCain said in a speech Tuesday at the H. Lee Moffitt Cancer Center & Research Institute in Tampa.

"The health plan you chose would be as good as any that an employer could choose for you. It would be yours and your family's health care plan, and yours to keep," he said.

Advisers called the speech a major policy address though McCain has talked about the same ideas for several months.

Still missing: The total cost of the plan and an estimate of how many people it would help. There are more than 40 million people in the United States who don't have health insurance. An adviser said that specifics will come later.

"So, a little more detail, but remember, it is April, and the election's in November, so not everything will happen tomorrow or this week," McCain adviser Doug Holtz-Eakin told reporters Monday.

Also Tuesday, his campaign began airing a health care commercial in Iowa, where McCain plans to hold a town hall-style meeting Thursday in Des Moines. In it, McCain makes the case for his market-oriented plan.

Under McCain's plan, anyone could get the credit, and those who like their company health care plans could choose to stay in them. The credit would be available as a rebate to people at lower income levels who have no tax liability, Holtz-Eakin said.

To pay for the tax credit, McCain would eliminate the tax exemption for people whose employers pay a portion of their coverage, raising an estimated $3.6 trillion in revenues, Holtz-Eakin said. Companies that provide coverage to workers still would get tax breaks. McCain would also cut costs by limiting health care lawsuits.

The goal is to move the health care industry away from job-based coverage toward competition among health insurance companies on the open market.

Critics of McCain's approach say it could leave sicker or older people without coverage as younger, healthier workers leave employer-based plans for cheaper ones; McCain's campaign says there would be a safety net to protect high-risk people.

Democratic rival Hillary Rodham Clinton said under McCain's plan, millions of Americans would lose their health care coverage through their jobs.

"The McCain plan eliminates the policies that hold the employer-based health insurance system together, so while people might have a 'choice' of getting such coverage, employers would have no incentive to provide it. This means 158 million Americans with job-based coverage today could be at risk of losing the insurance they have come to depend upon," Clinton said in a statement.

A spokesman for Democrat Barack Obama said McCain was "recycling the same failed policies that didn't work when George Bush first proposed them and won't work now. Instead of taking on the big health insurance companies and requiring them to cover Americans with preexisting conditions, Senator McCain wants to make it easier for them to reject your coverage, drop it, or jack up the price you pay." McCain also would let people buy health insurance across state lines instead of limiting them to companies in their own states. He said companies that do business in multiple states have greatly reduced health care costs because they are able to offer policies in many states.

Democrats worry about this idea because it could exempt insurers from stricter state regulations, such as requiring coverage of mammograms.

McCain issued his own criticism of Democratic plans for health care, saying Barack Obama and Hillary Rodham Clinton want government-run health care because they seek mandatory health care coverage, Obama for children and Clinton for everyone.

"They urge universal coverage, with all the tax increases, new mandates, and government regulation that come along with that idea," McCain said. "The key to real reform is to restore control over our health care system to the patients themselves."

-------------------------------------------------------------------------------------

By LIBBY QUAID, Associated Press Writer