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President to Accommodate GOP Ideas in Health Care Plan

By Alex Wayne, CQ Staff

March 2, 2010 -- President Obama told congressional leaders Tuesday that he was willing to include at least four Republican proposals in a final health care bill, in a gesture to a minority party that has steadfastly opposed his top domestic priority.

In a letter to the top leaders of both parties in each chamber, Obama said that he was "exploring" provisions to address the four issues: combating waste and abuse in health programs by using undercover investigators posing as patients; finding new ways to stem medical malpractice lawsuits; increasing Medicaid reimbursement rates to providers; and expanding the use of health savings accounts in conjunction with high-deductible insurance plans. He did not say outright that he would include them in legislation, however.

"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.

The gesture comes a day before Obama lays out an endgame on health care and as congressional Democratic leaders discuss how they might finish the legislation without any Republican support. Both chambers have passed a bill (HR 3590 in the Senate, HR 3962 in the House), but Democrats are unable to clear a conference report for Obama to sign because they lost their 60th Senate vote in January, when Republican Scott P. Brown was elected to the seat formerly held by Massachusetts Democrat Edward M. Kennedy (1961-2009).

In remarks Tuesday afternoon, House Speaker Nancy Pelosi, D-Calif., applauded Obama for reaching out to Republicans, in what she described as an effort to seek bipartisan accord on the health bill.

"For one solid year he has been striving for that bipartisanship," she said. "What we will do is to hope that he can still find 60 votes [in the Senate], but if not we're going to have to go with the simple majority."

For both procedural and political reasons, Democrats would prefer to simply win the votes of one or two Senate Republicans for a final bill. But that seems unlikely in a polarized political environment in which public opinion has turned against the majority party and November midterm elections are fast approaching.

The concessions Obama offered to Republicans, however, are a far cry from the demands by GOP leaders that he start from scratch on the health bill.

Early Republican reaction was negative. Both of Maine's Republican senators, Olympia J. Snowe and Susan Collins, say they wouldn't support "an amalgamation of the House and Senate bills," as Collins called it, with a few GOP ideas thrown in.

In the absence of any GOP votes, the anticipated Democratic strategy is to use expedited budget reconciliation procedures to pass a bill through the Senate that would amend the earlier Senate-passed bill with changes desired by House Democrats. The House would then clear both measures.

That strategy faces considerable obstacles. House Democrats would like the Senate to pass the reconciliation bill first, but Senate Budget Chairman Kent Conrad, D-N.D., says that is impossible. Republicans, meanwhile, threaten to fight the reconciliation bill, and would be expected to offer hundreds of amendments that could delay its passage indefinitely.

In his letter, Obama said that he would consider supporting a suggestion from Sen. Tom Coburn, R-Okla., that medical professionals be engaged to conduct "random, undercover investigations of health care providers" receiving payments from federal programs, to combat fraud.

He said he would also consider adding an additional $50 million to the health care bill to fund state experiments to reduce medical malpractice lawsuits, such as special "health courts." Medical malpractice lawsuits are a top concern of Republicans, but Obama and his party do not support the GOP's primary policy prescription for the issue — capping damages in the lawsuits.

Sen. Charles E. Grassley, R-Iowa, suggested at the health care summit Obama hosted on Feb. 25 that if Medicaid is expanded, as the Democratic health bills propose, its payments to health providers should be increased. Obama endorsed the idea in his letter, but without detail and with the condition that it be "addressed in a fiscally responsible manner."

And Obama said he was willing to include language in the bill to clarify that insurance plans employing health savings accounts could be sold in new government-run exchanges that the legislation would create. The Senate bill already would allow the exchanges to offer HSA plans.

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