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Obama Adds Some GOP Ideas to Health Reform Plan

President Barack Obama said Tuesday he was open to four new Republican proposals on health care legislation, in a gesture of bipartisanship meant to jump-start his stalled overhaul drive.

Cost of healthcare
Lilli Day | Photodisc | Getty Images
Cost of healthcare

Obama detailed the ideas, all of which were raised at a bipartisan health care summit last week, in a letter to congressional leaders.

He also called for eliminating a special deal for Medicare Advantage beneficiaries in Florida and other states that drew criticism at the summit from Sen. John McCain, R-Ariz.

The proposals Obama mentioned are: sending investigators disguised as patients to uncover fraud and waste; expanding medical malpractice reform pilot programs; increasing payments to Medicaid providers and expanding the use of health savings accounts.

"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," wrote Obama, who will make remarks Wednesday at the White House on a path forward for his legislation.

He rejected the GOP's preferred approach of scrapping the existing sweeping overhaul bills and starting afresh with step-by-step changes.

"I also believe that piecemeal reform is not the best way to effectively reduce premiums, end the exclusion of people with pre-existing conditions or offer Americans the security of knowing that they will never lose coverage," Obama wrote.

Obama's announcement is not likely to win any votes from Republicans, who want the president to tear up the existing bills and start over. Nor is there any guarantee that Democratic leaders will agree to incorporate the administration's suggestions in revised legislation.

But it could give wavering Democrats political cover by showing the White House has been willing to compromise in the wake of last week's televised bipartisan health care summit.

Obama's letter was in keeping with the spirit of the summit. As expected, Republican leaders continued to assail the president's health care agenda, with Senate Minority Leader Mitch McConnell of Kentucky arguing that "Americans don't want the one-party bill Democrats in Washington are planning to force on them, or any variation of it -- and they certainly don't want Democrats to push it through with even more backroom deals."

Democrats said it furthered their argument that Republicans have been unreasonably opposed to almost any compromise, justifying the White House decision to push for passage with no GOP help at all.

Obama is also expected to offer more details Wednesday on how he wants Congress to proceed, though White House press secretary Robert Gibbs indicated that the president wouldn't delve too deeply into the process of passing the legislation.

A small number of House Democrats who opposed the legislation on the first go-round may be Obama's most important constituency when he unveils his revised proposal.

At least nine of the 39 Democrats who voted "nay" when the House passed sweeping overhaul legislation 220-215 in November are now undecided or withholding judgment until they see Obama's final product, according to an Associated Press survey.

"Do I think there's a possibility of some people changing? Yes, I do," House Majority Leader Steny Hoyer, D-Md., said Tuesday. "I think that's because it'll be a different bill than either the House or the Senate bill; it will hopefully take some strengths of both."

It may seem improbable that any lawmaker would want to switch his or her vote on the measure, courting the flip-flopper label after a year of controversy over legislation that's slid ever downward in polls.

But it will almost certainly have to happen in order for House Speaker Nancy Pelosi, D-Calif., to round up the votes necessary to pass the Senate's version of the legislation, along with a package of changes that Obama proposes. The changes -- designed to make the Senate bill more palatable to House Democrats by rolling back a tax on high-value insurance plans, among other things -- would get through the Senate under controversial rules allowing for a simple majority vote.

That's the only option for Democrats because they no longer control a filibuster-proof 60 votes in the Senate, and Republicans are unanimously opposed.

With four vacancies in the House, Pelosi will need 216 votes. She would command exactly that many if all the remaining Democrats who voted "yes" in November did so again. But many lawmakers expect defections, especially of members who oppose federal funding for abortion and feel the Senate language is too permissive in that regard.

For every yes vote that switches to no, Pelosi and the White House must persuade one of the 39 Democrats who voted no in November to switch to yes.

Some of the top targets may be the nine lawmakers who told The Associated Press directly or through spokesmen that they're undecided or undeclared. Three are retiring and don't have to worry about getting punished by voters, and five others are freshmen, mostly in competitive districts -- lawmakers whom Pelosi will give a pass on tough votes when she can, but might call on when a major piece of legislation hangs in the balance.

At its core the Democrats' legislation would extend coverage to 30 million uninsured Americans over 10 years with a first-time mandate for nearly everyone to buy insurance and a host of new requirements on insurers and employers.

However, the package soon to reach the House will be less expensive than the one that passed in November and will contain no government-run insurance program to compete with private insurers, making it more appealing to some moderates.