President Obama has written a letter to Congressional leaders outlining the areas of agreement between Democrats and Republicans on health care reform. Obama also listed at least four Republican ideas that he wants to include in the package of fixes he is expected to unveil tomorrow afternoon.
Obama’s proposals are mild in nature and are unlikely to please start-over Republicans or offend progressive Democrats. The four ideas strengthen bipartisan provisions that are already part of Obama’s proposal and the Senate health care bill. The big ticket item is Obama’s support for increasing Medicaid rates to Medicare levels. That provision, which was included in the House health care bill, could cost north of $57 billion over 10 years and will certainly catch the eye of the American Medical Association and generate praise from both Democrats and Republicans:
1. Undercover waste/fraud/abuse investigations: “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.” EXISTING PROVISIONS: Obama’s plan invests in a Comprehensive Sanctions Database, expands access to the Healthcare Integrity and Protection Data Bank, among other provisions. The Senate bill also invests in preventing fraud, waste and abuse.
2. Additional grants to states for tort reform: “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.” EXISTING PROVISIONS: The current legislation already authorizes demonstration projects.
3. Increasing Medicaid reimbursement rates: “At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states…I’m open to exploring ways to address this issue in a fiscally responsible manner.” EXISTING PROVISIONS: The House health care bill gradually increased Medicaid reimbursement rates up to Medicare levels, but the Senate legislation did not include this provision.
4. Strengthen high deductible provisions: “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.”
EXISTING PROVISIONS: The current Senate bill allows young Americans to enroll in high deductible coverage and the exchange also offers so-called bronze-level plans that charge higher deductibles and co payments but offer lower premiums. Bronze policies would have to cover the “essential benefits” specified in the legislation and would likely be more comprehensive than policies available in the existing nongroup marketplace. The catastrophic plans for high adults would be required to offer preventive coverage at no cost sharing.
While the whole of the latter is rather expected, I’m surprised that Obama didn’t make stronger concession on tort reform. While in the Senate, Obama co-sponsored “legislation aimed at reducing both medical errors and lawsuits through a program known as Sorry Works, rooted in the idea that injured patients value an apology as much as money.” That legislation would have given physicians who disclosed their errors “certain protections from liability within the context of the program, in order to promote a safe environment for disclosure.“
Rep. Eric Cantor (R-VA) is not satisfied with Obama’s letter:
“If the President simply adds a couple of Republican solutions to a trillion dollar health care package that the American people don’t support, it isn’t bipartisanship – it’s political cover,” Cantor said in reaction to the letter.
,Senate Minority Leader Mitch McConnell (R-KY) is still asking Obama to start over on health reform:
It was with this in mind that we were surprised and disappointed with your latest proposal to simply paper a few of these commonsense proposals over an unsalvageable bill. The American people are asking us for step-by-step reforms that target cost and expand access, not a couple of commonsense ideas layered over a rewrite of one-sixth of the economy, a massive expansion of the federal government’s role in their daily lives, and higher taxes and cuts to Medicare to pay for it. The virtue of the ideas we all agreed upon at the summit is that they would lower costs and expand access without requiring these things. That’s the kind of reform Americans will support.