WASHINGTON — President Barack Obama embraced a handful of Republican health care ideas Tuesday to lure Democratic votes as he prepared to spell out his final package for a sharply divided House and Senate, where its fate is unsure.
In a bit of political sleight of hand, Obama said he might include four GOP-sponsored ideas in his plan, even though virtually no one in Congress or the White House thinks it will procure a single Republican vote.
The move is aimed instead at wavering Democrats, especially in the House. Some of them might find it easier to vote for the health care package if they can tell constituents that it had bipartisan elements that Republicans should have supported.
Yet there is no guarantee Democratic leaders will incorporate Obama’s suggestions in revised legislation.
Senate Republican leader Mitch McConnell warned that Democrats will enact their health care plan at their own political peril, vowing to make it an issue in every congressional race this fall.
Obama to speak today
In remarks at the White House today, the president is expected to describe the final elements of his proposal and then ask Congress to enact it, aides said.
He is expected to leave no doubt that, barring an unexpected change in Republican tactics, he wants Congress to pass the legislation using budget reconciliation rules, which prohibit Senate filibusters. Obama is unlikely to use those exact words, as Democratic leaders are emphasizing they want to pass a bill with simple-majority votes in the House and Senate.
It takes 60 votes to halt a filibuster, and Democrats control 59 in the 100-member Senate.
In a letter to congressional leaders Tuesday, Obama said he would consider four ideas floated by Republican lawmakers: sending investigators disguised as patients to uncover fraud and waste in Medicare and Medicaid, expanding pilot programs to bring more predictability to medical malpractice lawsuits, increasing payments to Medicaid providers, and expanding the use of health savings accounts.
“I said throughout this process that I’d continue to draw on the best ideas from both parties, and I’m open to these proposals in that spirit,” Obama wrote.
In a nod to his 2008 presidential rival, he said he had eliminated a special deal for Medicare Advantage beneficiaries in Florida and other states — a deal that drew criticism from Sen. John McCain, R-Ariz.
But Obama again rejected Republican appeals to restart the health care debate or sharply scale back his proposals.
“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,” his letter said.
House Speaker Nancy Pelosi said the letter “brings us just another step closer to passing the bill.” She said she hopes to incorporate some of the GOP ideas.
Republicans, meanwhile, made it clear the president’s overtures will not win their hearts or votes.
Sen. Tom Coburn, an Oklahoma Republican who proposed some of the notions Obama is weighing, said that “merely incorporating these ideas into the deeply flawed House and Senate bills will not bring us any closer to real reform.” In a letter to Obama, Coburn noted that opinion polls show extensive opposition to the Democratic plan.
“An all-or-nothing reconciliation strategy will give the American people nothing,” Coburn wrote.
White House chief of staff Rahm Emanuel, after meeting with top Democrats in the Capitol, told reporters: “Reconciliation is a vehicle that’s been used many times. This is a normal procedure.”
Extending coverage
The Democratic package would extend health coverage to 30 million uninsured Americans over 10 years, with a first-time mandate for nearly everyone to buy insurance. It would provide subsidies to help low-income people buy insurance, and it would impose several new requirements on insurers and employers.
It will be less expensive than the health care bill the House narrowly passed in November and will contain no government-run insurance program to compete with private insurers.
Those changes might appeal to some of the three dozen Democratic House moderates who opposed the November version of the bill. The revised bill may die if none of those Democrats vote for it, because some Democrats appear likely to switch from yes to no because of a dispute over restrictions on abortion funding.
Four Republican ideas embraced by Obama
• Conduct undercover investigations of Medicare and Medicaid providers to search for waste, fraud and abuse, an idea put forth by Sen. Tom Coburn, R-Okla., at last week’s health care summit.
• Experiment with specialized health courts as an alternative to jury trials in medical malpractice cases to cut down on doctors practicing defensive medicine. The approach calls for an expert judge — not a jury — to hear the evidence and make a final determination in cases where a patient has suffered harm. Trial lawyers are strongly opposed to the concept.The idea has been promoted both by Democrats and Republicans, including Coburn and Sen. Mike Enzi, R-Wyo., who attended the summit.
• Offer health savings accounts in new markets established for individuals and small business to purchase insurance coverage. The tax-sheltered accounts go hand in hand with high-deductible health insurance policies. Premiums on those policies are lower than for regular health insurance, and people who have them use the health savings accounts to pay their out-of-pockets costs. Sen. John Barrasso, R-Wyo., brought up the idea at the health care summit.
• Increase reimbursements to Medicaid providers, a concern raised by Sen. Charles Grassley, R-Iowa.
The Associated Press
