U.S. House Speaker Nancy Pelosi announced a new health care reform bill, backed by most House Democrats, that she said will boost competition by including a public option.

The 1,990-page bill, expected to go to the full House for action in early November, brings together components of three bills passed by separate House committees over the last few months, yet differs from a Senate reform bill.

Nancy Pelosi

Pelosi (D-Calif.) said the House Democratic Caucus’ bill will insure about 36 million more people and enable health care to reach about 96% of all Americans.

“The drive for health care reform is moving forward,” Pelosi said, speaking outside the Capitol with many House members standing behind her.

The bill includes a Health Insurance Exchange, which will compete with private insurers, and is a concession by Pelosi and others. The exchange would negotiate rates, rather than using government-mandated rates.

Pelosi said the Affordable Health Care for America Act falls $6 billion below the $900 billion cap imposed by President Barack Obama for any reform bill to win his approval. Pelosi said the bill will reduce the deficit, although its true cost will not be determined until the Congressional Budget Office evaluates its components.

“The bill is fiscally sound, and will not add one dime to the federal deficit,” Pelosi said.

Pelosi said the bill “closes up the doughnut hole,” the gap between what Medicare pays for prescription drugs and when catastrophic coverage is implemented. The bill also prohibits withholding coverage for pre-existing conditions.

Majority Leader Steny Hoyer (D-Md.), who Pelosi credited with negotiating the caucus’ bill, said the proposed legislation moves America “one step closer” to reform.

“This is an idea we will enact,” Hoyer said. “This is an idea that will lift up all Americans.”

Speaking on CNN, House Rep. Mike Pence (R-Ind.) called the bill “another freight train of big government” and “a government takeover of health care.”

At one point, Pelosi’s comments appeared to be interrupted by hecklers. Pelosi said, “Thank you insurance companies of America.” Her comment elicited applause from the House members standing behind her.

The new bill is likely to win House approval because of the Democratic majority, yet could face a battle when consolidated with a Senate bill.