Obama open to four Republican healthcare ideas

President Obama has informed congressional leaders that he’s open to several Republican ideas on healthcare reform from last week’s bipartisan summit.

In a letter Tuesday to the top Democrats and Republicans in the House and Senate, Mr. Obama listed four healthcare ideas he says he is “exploring”:

1. Having healthcare professionals conduct “random undercover investigations of healthcare providers that receive reimbursements from Medicare, Medicaid, and other federal programs.”
2. Additional grants totaling $50 million for pilot programs aimed at reforming the medical malpractice system.
3. Ways to boost Medicaid reimbursement to doctors, which is seen as inadequate in many states, especially if Medicaid is expanded to cover more people.
4. Expanding health savings accounts, which could be used in conjunction with high-deductible plans offered in a new insurance “exchange,” or marketplace.

Obama also noted that his healthcare proposal does not include the so-called Medicare Advantage provision that gave extra transitional benefits to Florida and other states. Sen. John McCain (R) of Arizona had raised the issue at the healthcare summit.

Republican House whip Eric Cantor reacted sharply to Obama’s letter.

"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.

Obama’s proposals do not come close to giving the Republicans what they want – for the Democrats to tear up their plan and start with a much more modest, step-by-step approach to reform. On Wednesday, Obama will announce his next steps on reform, both in terms of policy and process.

But it’s already clear what the endgame looks like: Obama is making a bow toward bipartisanship by incorporating small ideas put forth by Republicans, but is making no major concessions. No Republican in the House or Senate was expected to sign onto the Obama plan on the basis of Tuesday’s announcement. But it may help the president in his public relations battle to show Americans he is working across the aisle on his main domestic policy initiative. That, in turn, may make it easier for Democratic leaders to twist arms among their own members. Many lawmakers are locked in tough reelection battles, and getting majorities in both houses presents a tall task.

The White House is fighting the perception that it plans to “ram through” healthcare reform using a controversial procedure known as reconciliation, which requires only a simple majority. In fact, somewhat different versions of health reform have already passed both houses. What’s changed is that the Democrats no longer have their 60-vote filibuster-proof majority with which to pass a final version. So the plan now is to gain passage of the Senate version in the House, then pass fixes via reconciliation in both houses.

Obama and the Democrats aim to finish healthcare reform by the end of the month. If they head home for Easter recess without a completed reform, contact with constituents could seal its fate.

Norman Ornstein, a resident scholar at the American Enterprise Institute in Washington, suggested that Obama consider putting his own healthcare proposal released last week – plus the Republican ideas he touted Tuesday – to a vote before going the reconciliation route.

“If they reject it and decide to filibuster [in the Senate], then you say, 'It’s with a heavy heart, my hand in friendship having been slapped away, that we have to go to reconciliation,' " Mr. Ornstein said.