WASHINGTON — President
Obama offered Tuesday to address some of the concerns expressed by
Republicans in the health care debate as the two parties maneuvered for
advantage heading into the legislative end game.
In a letter to Congressional leaders of both parties, Mr. Obama said he was
open to four specific ideas raised by Republicans at the daylong health care
forum last week, including encouraging the use of tax-advantaged medical savings
accounts and increasing payments to doctors who treat Medicaid
patients.
By signaling that he is open to the oppositionfs ideas, Mr. Obama struck a
bipartisan tone even as the White House prepared the ground for Democratic
efforts to pass comprehensive legislation on a party-line vote. Mr. Obama is
scheduled to speak about his strategy for passing the bill in remarks at the
White House on Wednesday.
Democrats are planning to use a parliamentary device known as reconciliation
that would allow them to complete the process with a simple majority vote in the
Senate rather than subjecting the bill to the 60-vote requirement to overcome a
filibuster.
Republicans have denounced the use of the device on the health bill as
short-cutting the regular process.
In response, the Senate minority leader, Mitch
McConnell of Kentucky, warned that Republicans would use the health issue to
bludgeon Democrats in this yearfs midterm elections. If the Democrats gjamh an
expansive bill through Congress, Mr. McConnell said, git will be the issue in
every single race in America this fall.h
In his letter, Mr. Obama said he was interested in four suggestions offered
by Republicans at last weekfs health care summit meeting, including an idea put
forward by Senator Tom
Coburn, Republican of Oklahoma, to have health care professionals pose as
patients in undercover stings to root out fraud.
Mr. Obama also said he believed that high-deductible insurance policies, used
in conjunction with health care savings accounts, could be offered to consumers
in new federally regulated exchanges, or marketplaces, that would be created by
his legislation.
The president said he also supported providing $50 million in grants to
states to help them test alternatives to the current system of resolving medical
malpractice claims. But Mr. Obama stopped far short of endorsing Republican
proposals to impose hard limits on damage awards in medical malpractice
lawsuits.
To answer Republican criticism of a proposed expansion of Medicaid, he said
he agreed that it would be helpful to increase payment rates to doctors gin a
fiscally responsible manner.h
But the president again rejected calls by Republicans for Democrats to
discard the bills adopted by the House and Senate late last year and to start
over with a step-by-step approach.
gPiecemeal 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,h Mr. Obama wrote.
In the letter, he said Democrats and Republicans agreed about the need to fix
the health care system, even if they disagreed on the remedies, and he seemed to
be trying to build on the public display of bipartisanship at last weekfs
meeting and to blunt Republican criticism that Democrats are pursuing a partisan
bill.
gMy ideas have been informed by discussions with Republicans and Democrats,
doctors and nurses, health care experts and everyday Americans — not just last
Thursday, but over the course of a yearlong dialogue,h Mr. Obama wrote. gBoth
parties agree that the health care status quo is unsustainable. And both should
agree that itfs just not an option to walk away.h
Republicans said they welcomed the presidentfs interest in their ideas, but
said it was a meaningless gesture if Democrats remained intent on pushing
through expansive, and expensive, legislation, which the Republicans assert
would unwisely raise taxes and reduce federal spending on Medicare.
Mr. Coburn, in a statement, said Democratic leaders could continue to work
with Republicans on areas of agreement — gor they can attempt an all-or-nothing
reconciliation strategy based on the deeply flawed Senate and House bills and
most likely accomplish nothing.h
Mr. McConnell, at a news conference, cited the Republican victory in the
Massachusetts special Senate election in January as an example of what could
happen to Democrats if they succeed in adopting sweeping health care legislation
gover the objections of the American people.h
The bills passed by the House and the Senate would expand Medicaid to cover
some 15 million people who are now uninsured. But in most states, payment rates
are so low that many doctors do not accept Medicaid patients, a point that
Senator Charles
E. Grassley, Republican of Iowa, raised at the forum on Thursday.
gTherefs no question Medicaid wonft be able to provide adequate access,h Mr.
Grassley said in response to Mr. Obamafs letter. gItfs good if the White House
has figured that out.h
Higher Medicaid payment rates could substantially raise the cost of the bill,
even as Democratic leaders try to hold down the price tag to secure the support
of fiscal conservatives in their own party.
As they begin a final push to round up votes, Democrats are also struggling
to figure out how to orchestrate the intricate legislative maneuvers that will
be needed to complete their bill.
Under the tentative plan, they said, the House would adopt the bill passed by
the Senate on Dec. 24, and both chambers would approve a package of revisions in
a separate budget reconciliation bill. The changes would bridge differences
between the House and the Senate and incorporate some of Mr. Obamafs proposals.
Senator Kent
Conrad, Democrat of North Dakota and chairman of the Budget Committee, said
it might be possible to use the reconciliation procedure for ga set of
relatively minor matters that have a budget impact.h
Coordinating the work of the two chambers could be gextraordinarily
complicated,h he said.
In addition, the budget reconciliation process could be time-consuming in the
Senate, where Republicans said they would raise procedural objections and offer
numerous amendments.
Mr. Conrad said the budget bill might be used to gincrease the affordabilityh
of health
insurance, by increasing subsidies for some people, and to increase federal
payments to states for people newly eligible for Medicaid.
But to comply with reconciliation requirements, Mr. Conrad said, the budget
bill would have to reduce the deficit over the next five years, taken together,
and must not increase the deficit in any year thereafter.
The budget bill could probably not be used to establish restrictions on
insurance coverage of abortion,
an issue that deeply divides the House and the Senate, Mr. Conrad said.
Senator Olympia
J. Snowe, Republican of Maine, said she was not impressed by the concessions
Mr. Obama offered in his letter. gItfs always welcome, inserting Republican
ideas,h Ms. Snowe said. gBut it does not ameliorate other issues. The basic
legislation is not going to change. That continues to be troubling.h