Obama offers to include GOP ideas in health bill

WASHINGTON — President Barack Obama offered Tuesday to include four Republican initiatives in his health care bill, but GOP leaders were unenthusiastic as Democrats prepared a last big push to get legislation passed.

Obama plans to unveil his latest proposal Wednesday, starting at 1:45 p.m., at a White House ceremony, an administration official said, speaking anonymously under White House ground rules.

Health care professionals from around the country, as well as Secretary of Health and Human Services Kathleen Sebelius, are to be on hand as Obama plans to discuss his support for a comprehensive bill aimed at lowering premiums and barring insurers from denying coverage to people with pre-existing conditions.

According to the official, Obama plans to "reiterate why reform is so crucial and what it will mean for American families and businesses: they'll have more control over their own health care, they'll see lower costs, and they'll see an end to insurance company abuses." And he'll push Congress to act "swiftly."

By telling Republicans he wants to incorporate some of their suggestions, Obama can argue that the Democrats' approach is bipartisan regardless of whether any Republicans vote for it in the end — and few if any were signaling Tuesday that they're inclined to do that.

Among the Republican ideas Obama said he's considering — ideas that GOP leaders offered at last week's bipartisan health care summit — one involves medical professionals conducting undercover investigations of health care providers that receive reimbursements from Medicare and Medicaid.

Another would provide $50 million for states to pursue alternatives to medical malpractice litigation, a major Republican initiative.

A third would consider higher doctor reimbursement "in a fiscally responsible manner" under Medicaid, the state-federal health insurance program for lower income people. A fourth would encourage the use of Health Savings Accounts in conjunction with high-deductible health plans.

Obama also suggested that he wants a comprehensive health reform bill, not a series of incremental steps. "Piecemeal reform is not the best way" to make coverage more affordable, he said.

Congressional Democratic leaders agree, and are seriously considering using the controversial "reconciliation" process to get the bill through Congress by the end of this month. It was unclear whether Obama would recommend that approach on Wednesday. Reconciliation is a way to expedite Senate passage of legislation with 51 votes instead of the 60 usually required to shut off debate. Democrats now control 59 seats in the 100-member Senate.

Under one popular scenario being seriously discussed by Democratic leaders, the House of Representatives would pass the health care bill that the Senate adopted on Dec. 24. A simple House majority, which next week would be 216 votes, would be needed to pass. Democrats control 254 of the 431 filled seats; four seats will be vacant.

In addition, both houses would take up separate reconciliation legislation that would make changes to the Senate bill sought by Obama and House Democrats. That bill also would require only simple majorities in both chambers to pass.

However, that process could create political problems.

It would require the House to vote on an $871 billion Senate bill that includes ideas many Democrats dislike, notably the lack of any government-run program, or public option. The House-passed version had a public option.

The Senate version also contains somewhat less restrictive abortion language. About 20 House Democrats are adamant that any bill contain strict limits.

The other political problem concerns how Democratic lawmakers, especially those from more conservative states and congressional districts, would explain to constituents why they voted for a process that Republicans say is simply "ramming the bill through Congress."

"I don't prefer reconciliation," said Sen. Joseph Lieberman, I-Conn. "This is so big a change that affects every American. This ought to be bipartisan."

Sen. Mark Pryor, D-Ark., said most people don't understand the reconciliation process, and "they don't really want to know about it."

There are also questions about how broad reconciliation could be under Senate rules. Senate Budget Committee Chairman Kent Conrad, D-N.D., said that the process can be used only for what he called "modest" changes.

Senate Majority Whip Dick Durbin, D-Ill., said such changes would be "budgetary in nature." Spending would have to be offset by budget cuts or higher taxes.

Conrad said two issues that could be addressed in such a bill are affordability and Medicaid funding.

The House version provides federal aid that would make premiums for lower-income people less expensive than the Senate version. Obama last week proposed a compromise.

The bills generally agree on some key points. Both would create health exchanges, or marketplaces where consumers could shop for coverage. Both would require most people to obtain health care coverage, and penalize employers who don't offer policies.

They differ on taxation, but the House has signaled it can accept the Senate's plan to impose an excise tax on high-end policies. Obama last week proposed delaying the tax until 2018, and applying it only to policies that cost more than $10,200 for individuals and $27,500 for families.

House Democrats, prodded by labor unions, had wanted the higher limits, fearing the lower Senate amounts would affect middle class families.

(William Douglas contributed to this article.)


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