In a letter to congressional leadership on Tuesday, President Barack Obama did not explicitly advocate the use of reconciliation to pass health care reform into law. But he did weigh in heavily in favor of having a comprehensive bill, rather than "piecemeal reform" sent to his desk. And in a last gambit to lure Republican support, he said he is exploring the inclusion of four GOP principles into the final health care reform package
Writing to House Speaker Nancy Pelosi, Senate Majority Leader Harry Reid, Senate Minority Mitch McConnell, and House Minority Leader John Boehner, Obama laid the groundwork for the more detailed proposal he will unveil on Wednesday. He described the bipartisan summit on Thursday as a productive affair and insisted that the two parties stand closer to agreement than had been portrayed.
Then he called for four distinct Republican proposals to be considered in the final package:
1. Engaging "medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs."
2. An additional $50 million in funding to states "for demonstrations of alternatives to resolving medical malpractice disputes, including health courts."
3. Additional funds for Medicaid reimbursements to doctors to correct the problem that those reimbursements are currently "inadequate in many states."
4. An expansion of Health Savings Accounts (HSAs).
The president also pledges to eliminate one of the more glaring back-room deals that was crafted to ensure the bill's passage in the Senate: a provision that would have exempted Florida from Medicare Advantage cuts.
The letter is the most recent step in a continued effort by the administration to push for Republican support for the final health care bill. The likelihood of success seems slim, considering the broader objections the GOP has to passing comprehensive legislation. But the president makes no overt threat to go it alone -- at least not in this letter. There is no mentioning of reconciliation and no strong demands for the GOP to allow an up-or-down vote.
"Admittedly, there are areas on which Republicans and Democrats don't agree," Obama writes. "While we all believe that reform must be built around our existing private health insurance system, I believe that we must hold the insurance industry to clear rules, so they can't arbitrarily raise rates or reduce or eliminate coverage. That must be a part of any serious reform to make it work for the many Americans who have insurance coverage today, as well as those who don't."