Opinion: A few more (minor) concessions on healthcare reform by Obama


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The main Democratic theme at last Thursday’s healthcare reform summit was that their proposals weren’t all that far from the GOP’s position on many core issues. President Obama stayed on message Tuesday, issuing a letter to House and Senate leaders identifying four GOP proposals he hoped to incorporate into the bill. (Download a PDF of the letter here.) These weren’t dramatic concessions, though, just small modifications. Specifically, Obama said he was ‘exploring’ these four Republican ideas:

  • Using undercover patients to root out fraud in Medicare and Medicaid (an idea suggested by Republican Sen. Tom Coburn of Oklahoma);
  • Tripling the funding for state experiments in medical malpractice reform;
  • Increasing physician reimbursement rates for Medicaid (as requested by Republican Sen. Charles E. Grassley of Iowa);
  • Clarifying that high-deductible insurance policies will be available through the new insurance exchanges (a response to a plea by Republican Sen. John Barrasso of Wyoming to stop trying to kill health savings accounts).

Obama’s letter also said that his proposal discarded the special treatment for Medicare Advantage subscribers in Florida, as Republican Sen. John McCain of Arizona had called for at the summit.


The letter offered no timetable, but the White House on Wednesday is expected to unveil a revised version of its 11-page blueprint for bridging the differences between the bills passed by the House and Senate. Republicans, who argued at the summit that those bills ought to be discarded in favor of a much more modest effort, aren’t likely to be satisfied with the tweaks. But Obama signaled that he’s ready to move forward anyway by rejecting the GOP’s call for incremental change:

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.

Lines like that one suggest that today’s letter was intended mainly to rebut the GOP’s accusations that their healthcare ideas were being ignored, not to attract Republican votes. Regardless, the main challenge for healthcare reform advocates is retaining the support of wavering Democrats in the House, who’ve made a growing number of concessions to the GOP and moderate Democratic senators.

-- Jon Healey