President Obama is following up on his marathon Feb. 25 health summit with a letter telling congressional leaders there are "at least four policy priorities
" proposed by Republicans that he would consider including in the overall plan he is pushing Congress to pass in the next few weeks. The letter came the day before Obama is slated to lay out how he wants Congress to proceed, and possibly how quickly.
Obama said he is exploring and "open to" four ideas:
- A suggestion by Sen. Tom Coburn of Oklahoma that medical professionals "conduct random undercover investigations of health care providers" to uncover fraud in Medicare, Medicaid, and other federal programs.
- An appropriation of $50 million for health courts and other alternative ways of resolving medical malpractice disputes, as proposed by a number of Republicans. Obama said the money would be in addition to $23 million his Department of Health and Human Services will soon award for the same types of demonstration projects.
- A "fiscally responsible" increase in Medicaid reimbursements to doctors in states where reimbursements are inadequate, a concern raised by Sen. Chuck Grassley of Iowa at the summit.
- Making clear in the final bill that insurance companies could offer high-deductible health plans in the new exchange, or competitive marketplace, that is a cornerstone of the reform effort. Sen. John Barrasso of Wyoming had pushed for such plans, which cover catastrophic expenses but not routine procedures, saying they make consumers more cost-conscious. Use of health savings accounts would also be encouraged.
Obama also reiterated that his plan -- a merger of the bills passed by the Senate and House, with a few twists -- removes the most objectionable special deals in the Senate bill. "There are provisions that were added to the legislation that shouldn't have been," he said in the letter.
The president noted that his proposal does not include special treatment for seniors in Florida and other states that have expensive, private "Medicare Advantage" plans within Medicare. Rather, he said, his plan gradually reduces Medicare Advantage payments across the country "in an equitable fashion." Similarly, Nebraska would lose its "Cornhusker kickback" under which the federal government would have permanently picked up the cost of expanded Medicaid coverage. That is replaced with "additional federal financing to all states for the expansion of Medicaid," Obama wrote.
Still, Obama noted that "no matter how we move forward" there remain fundamental disagreements over how tightly to regulate the insurance industry and whether to proceed in a piecemeal fashion. "We must hold the insurance industry to clear rules, so they can't arbitrarily raise rates or reduce or eliminate coverage," Obama said. He added that "I also believe that piecemeal reform is not the best way to effectively reduce premiums, end the exclusion of people with pre-existing conditions or offer Americans the security of knowing that they will never lose coverage, even if they lose or change jobs."
He did not mention an even more fundamental disagreement over whether to try to cover most of the 46 million people who don't have insurance. Both the House and Senate bills would cover more than 30 million people; Republicans say the country can't afford to do that and have proposed covering 3 million.
In the absence of GOP support for the pending health care bills, Obama is expected to endorse a process to finish the work without getting thwarted by a GOP filibuster in the Senate. The House would pass the Senate bill, then each chamber would pass a package of fixes involving the level of subsidies for lower-income people, many of whom would be required to buy coverage; the mix of savings and taxes to pay for the reforms; the changes Obama has proposed, and possibly the GOP ideas he suggested Tuesday.
The fixes would be pursued under a budget procedure called reconciliation, which is not subject to the filibusters that Republicans are using at a record rate
this year to block Senate business. While it takes 60 votes to stop a filibuster, it only takes 51 to pass a reconciliation bill. Democrats control 59 votes in the chamber, and they have Vice President Joe Biden as a fallback to break a tie.
: House Minority Whip Eric Cantor weighs in
. "If the president simply adds a couple of Republican solutions to a trillion-dollar health care package that the American people don't support, it isn't bipartisanship – it's political cover," he said in a statement.
Senate Minority Leader Mitch McConnell responds to Obama with a letter of his own
. He says that "we were surprised and disappointed with your latest proposal to simply paper a few of these commonsense proposals over an unsalvageable bill. The American people are asking us for step-by-step reforms that target cost and expand access, not a couple of commonsense ideas layered over a rewrite of one-sixth of the economy..."