While Rep. Raul Grijalva ostensibly wrote this letter to Nancy Pelosi, in reality he wrote it to Harry Reid and Barack Obama. In it, he asked for three changes to the “manager’s amendment” (a potential substitute to the current House bill with various changes) and an opportunity to bring an up or down vote on Medicare + 5% rates to the House floor (here’s the language of that amendment). Here are the changes sought:

Americans in every state in the nation must be able to take advantage of the benefits of the bill; thus the bill shall explicitly state that the public option must be available without any triggers or opt-out provisions.

If the Secretary is forced to negotiate provider reimbursement rates in the public plan, a ceiling shall be determined and set for such rates.

The bill shall fully repeal the McCarran Ferguson Act for health and medical malpractice insurance, as oppose to merely amending the Act.

This is clearly a recalibration of the minimum requirements for progressive support on the bill. Grijalva is seeking statutory language that would explicitly reject opt-outs or triggers. That directly comes out of the meeting with the White House and progressive House members where the President focused on opt-outs and triggers. Based on the other provisions, we can assume that the President may have brought them up as well.

#2 is a little weird, because there is already a ceiling on provider reimbursement rates in the House bill’s public option, and in the Senate HELP Committee version of the bill, which is assumed to be the public option that will live in the Senate’s. That ceiling is the average of all reimbursement rates of private plans in the exchanges. So maybe Grijalva is looking for something more stringent. Here’s what he said to Amy Goodman this morning.

Well, the meeting was the Progressive Caucus leadership, Hispanic Caucus leadership, Black Caucus leadership, Asian Pacific Caucus leadership, and basically brought out that now that we’re in this stage of having to deal with this negotiated rates that came out of the House, and something much worse coming out of the Senate, on a public option, that we felt—set some parameters of what we felt very strongly about, that the bill still needed to be strengthened; that there had to be cost controls on the private insurance companies, especially with negotiated rates, because they get to set the rates and we have to chase those rates with taxpayers’ dollar; and no triggers and no opt-outs, that we feel those are detrimental to the public interest and certainly to constituencies that have lacked the ability to access healthcare in this country for so many years.

As for #3, Grijalva has long supported a plan floated by Peter DeFazio (D-OR) that would fully repeal the insurance industry’s anti-trust exemption, and would put the Federal Trade Commission in a regulatory and oversight position over the health insurance industry. The repeal of the exemption in the House bill is partial. Here’s a letter that DeFazio sent to Nancy Pelosi on the subject.

My guess would be that Grijalva heard the President to mean that he wanted to push progressives in the House further toward the Senate bill, and while this letter is addressed to the Speaker, it’s meant to signal to Obama what House progressives will not accept. The architecture of meaningful health reform, to Grijalva, must be preserved.