As Democrats on Capitol Hill prepared a risky effort to muscle sweeping health-care legislation to final passage, President Obama on Tuesday made a last gambit to split Republicans on the issue, proposing to incorporate a handful of GOP ideas into his signature domestic initiative.
On Wednesday, Obama plans to call on Congress to bring the year-long debate to a swift close, and congressional leaders expect him to signal support for a strategy that includes a special budget maneuver known as reconciliation. Under that strategy, the House would adopt the bill the Senate passed on Christmas Eve and approve a separate package of fixes to reflect a compromise worked out between Democrats in the two chambers.
Under reconciliation rules, the fixes could not be filibustered and Senate Democrats could approve them with a simple majority vote -- a move intended to bypass a Republican caucus that remains united in its opposition to the legislation. Republican leaders said Obama's offer to adopt some of the ideas they promoted at last week's health-care summit would do little to improve what they consider a fundamentally flawed measure.
"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," Rep. Eric Cantor (R-Va.), the No. 2 House Republican, said in a statement.
Obama's gesture to include GOP-backed provisions on cutting health costs and preventing fraud appeared to strengthen the resolve of congressional Democrats, however, who were initially queasy about pressing forward after Republicans claimed a crucial 41st Senate seat six weeks ago in a Massachusetts special election. On Tuesday, Democratic leaders seemed increasingly confident that they could revive the bill and deliver it to Obama's desk, perhaps before the Easter recess begins March 29.
"We're anxious to get health care done, which we will get done," Senate Majority Leader Harry M. Reid (D-Nev.) told reporters.
Even some Democrats who had been reluctant to support the original package seemed ready to ignore a growing barrage of criticism from Republicans such as Sen. Orrin G. Hatch (Utah), who characterized reconciliation in a Washington Post opinion piece Tuesday as an attempt to "jam" a bill through Congress "against the will of the American people."
Sen. Mary Landrieu (D-La.), a crucial swing vote who opposed the use of reconciliation in the early stages of last year's health-care debate, said she is comfortable using the procedure to advance a narrower package of changes to the legislation. "The general feeling in our caucus is we've worked very hard, this is a very reasonable, general approach to health-care reform, that the status quo is wholly unacceptable, and that we're hoping to move forward," Landrieu said Tuesday.
Reconciliation is a procedure created in 1974 to help lawmakers advance politically difficult budget legislation, particularly measures that reduce the deficit. It has been used 22 times by both parties since 1980 to promote a variety of policies, including overhauling the welfare system, creating COBRA health benefits for people who lose their jobs, and cutting taxes in two huge packages championed by President George W. Bush in 2001 and 2003.
Administration officials have for days signaled support for the maneuver; White House health-care reform adviser Nancy-Ann DeParle called Sunday for "a simple up-or-down vote" on the legislation. In a letter sent Tuesday to congressional leaders, Obama flatly rejected GOP demands to scrap the existing legislation and start over with more modest measures.
"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," Obama wrote. "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."
As a sign of his willingness to "draw on the best ideas from both parties," Obama wrote that he is open to four proposals Republicans offered at the health-care summit, all aimed at lowering health costs while making coverage more affordable.
Potentially the most significant is the expansion of health savings accounts, which, combined with high-deductible health plans, could create a new coverage model for young people who are less likely to receive comprehensive plans through their employers. Obama also offered to explicitly permit insurance companies to sell high-deductible policies through the new state-run insurance exchanges that would be created under the legislation.
The president also embraced a proposal by Sen. Tom Coburn (Okla.) to root out fraud in Medicare and Medicaid with random undercover investigations of health-care providers. And he suggested an additional $50 million to fund state projects aimed at averting medical malpractice lawsuits, a top Republican priority.
Obama also expressed interest in a move by GOP lawmakers to increase payments to doctors who treat Medicaid patients, provided Congress address the issue "in a fiscally responsible manner." Republicans -- and many Democrats -- have complained that the health legislation would add up to 15 million people to state Medicaid rolls at a time when many current recipients are struggling to find doctors willing to see them.
House Majority Leader Steny H. Hoyer (D-Md.) said House and Senate leaders had not yet decided precisely how to move forward, but said discussions were ongoing. "We need an agreement between the House and the Senate about where we're going," Hoyer told reporters as he left Reid's office late Tuesday.
Lawmakers and budget experts monitoring the talks said the most likely path would begin with a House vote to approve the Senate bill, despite House Democrats' deep-seated reservations about that legislation, quickly followed by approval of a reconciliation package. That package is likely to be crafted in the Rules Committee by House leaders in consultation with Senate Democrats and the White House, budget experts said. In addition to the health-care fixes, it could include a major Obama initiative aimed at overhauling the federal student loan program, Democrats said.
The Senate could then take up the House reconciliation bill, moving it rapidly to the floor, where Coburn and other Republicans are vowing to try to rip it apart by challenging the relevance of its provisions -- under Senate rules, reconciliation can be used to advance only measures that directly affect the budget -- and by offering dozens of amendments.
Though a reconciliation bill cannot be filibustered, Senate Republicans can offer an unlimited number of amendments once debate has closed. Senate Democrats, eager to avoid changes to the bill that would require another round of votes in the House, were exploring ways to cut short the amendment period.
Such a move, said G. William Hoagland, who spent years as a senior budget adviser to Senate Republican leaders, "would be unprecedented and would certainly poison the water even worse than it already is."