In a letter to the Congressional leadership, President Obama gave a wrap-up of the health care summit and highlighted several proposals offered by Republicans that he will include in his final proposal for a bill. But he rejected any calls to either start over or scale back the comprehensive measure which has already passed both chambers.
Obama’s letter, available here, characterized the 7-hour session from last Thursday as productive, and stressed that both parties found areas of agreement – insurance market reform, the ability for small businesses and individuals to pool their resources and increase purchasing power (the exchanges, basically), and squeezing out waste, fraud and abuse from health care services. Disagreements cited by the President included the level of oversight of the insurance industry.
But the meat of the letter was a designation of four proposals offered by Republicans at the meeting which President Obama would like to see in a 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.
So what are these pieces? Coburn’s “undercover patient” plan sounds like an interesting job description for someone (“I’m sick for a living”), but I have a hard time believing this will do a whole lot. $50 million more for medical malpractice reform amounts to a rounding error in the bill. Increasing Medicaid doctor reimbursement could be costly, depending on the increase, and seemingly goes against the point of health care reform, to lower the price of basic care. The phrase “fiscally responsible manner” does a lot of work in that paragraph. As for #4, basically adding a high-deductible catastrophic care option in the exchanges that can pair with HSAs, it’s bad policy and would starve the insurance pool of funds, but as I understand it there was already a “young invincibles” policy available in the exchanges.
In addition, the President nodded to a point made at the summit by John McCain, by striking the transitional Medicare Advantage benefit to residents in Florida, among a couple other deals that initially were present to placate individual lawmakers.
So basically, the President offers yet another set of olive branches to Republicans, which they will promptly throw on the ground and kick. These aren’t the most consequential olive branches, in my view, although #3 could get expensive (but as Obama says, lots of Democrats want to increase reimbursement rates, too; it’s more parochial than ideological).
Obama closes the letter with this:
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, even if they lose or change jobs.
My ideas have been informed by discussions with Republicans and Democrats, doctors and nurses, health care experts, and everyday Americans – not just last Thursday, but over the course of a yearlong dialogue. Both parties agree that the health care status quo is unsustainable. And both should agree that it’s just not an option to walk away from the millions of American families and business owners counting on reform.
After decades of trying, we’re closer than we’ve ever been to making health insurance reform a reality. I look forward to working with you to complete what would be a truly historic achievement.
So he clearly rejects any incremental approach, or any call to scrap the bill entirely. We’ll know more tomorrow about his specific plan of action, when he makes a public statement about the way forward.
…Jon Cohn has a bit more.