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Moving Forward

March 2, 2010 - by Donny Shaw

President Obama today sent a letter to leaders in Congress outlining his take-aways from last week’s bipartisan health care summit and what new Republican ideas he wants to include in the final bill:

1. Although the proposal I released last week included a comprehensive set of initiatives to combat fraud, waste, and abuse, Senator Coburn had an interesting suggestion that we engage medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs.

2. My proposal also included a provision from the Senate health reform bill that authorizes funding to states for demonstrations of alternatives to resolving medical malpractice disputes, including health courts. Last Thursday, we discussed the provision in the bills cosponsored by Senators Coburn and Burr and Representatives Ryan and Nunes (S. 1099) that provides a similar program of grants to states for demonstration projects. Senator Enzi offered a similar proposal in a health insurance reform bill he sponsored in the last Congress. As we discussed, my Administration is already moving forward in funding demonstration projects through the Department of Health and Human Services, and Secretary Sebelius will be awarding $23 million for these grants in the near future. However, in order to advance our shared interest in incentivizing states to explore what works in this arena, I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants will be funded.

3. At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states, and that if Medicaid is expanded to cover more people, we should consider increasing doctor reimbursement. I’m open to exploring ways to address this issue in a fiscally responsible manner.

4. Senator Barrasso raised a suggestion that we expand Health Savings Accounts (HSAs). I know many Republicans believe that HSAs, when used in conjunction with high-deductible health plans, are a good vehicle to encourage more cost-consciousness in consumers’ use of health care services. I believe that high-deductible health plans could be offered in the exchange under my proposal, and I’m open to including language to ensure that is clear. This could help to encourage more people to take advantage of HSAs.

Obama will officially unveil a final package of changes, including these four ideas, tomorrow. After that, we’re not likely to see many more of these packages of changes to the bill coming from the White House or the Democratic leadership. The negotiating appears to be over, dozens of Republican ideas have been included in the bill, and the areas where Democrats and Republicans differ have been clearly identified. As Greg Sargent put it, in his letter today to the congressional leaders, Obama’s message to the GOP is, “I’m thinkin’ of ya, but we’re moving forward.”

As the newly leaked health care timeline makes clear, The next step will be to shape Obama’s compromise ideas — both form today’s letter and last week’s 11-page proposal into legislative language that can pass under budget reconciliation rules. The challenge there will be twofold: craft a bill that can get at least 51 votes in the Senate and 216 in the House, and make sure it all qualifies under the 6 points of the Byrd Rule. If that can be done, the House can simply accept the Senate health care bill, since it has already passed the Senate.

The votes appear to be lining up. According to the AP, at least nine House Democrats who voted against the House health care bill are considering switching to “yeses” for passing the Senate bill. And some conservative Senate Democrats who were generally assumed to be “no” votes for the slightly more liberal bill that will be represented by the reconciliation sidecar are now indicating that they may actually vote “yes.”

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