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Obama Seeks Health Policy Bridge; Republicans Skeptical

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Republicans and Democrats today showed fleeting signs of willingness to talk about specific ideas for changing the U.S. health finance system.

President Obama brought lawmakers to Blair House, the vice presidential residence, for a summit meant to find out what, if any, overlap there really is between the Democratic positions and the Republican positions on health care and health insurance.

“I’d like to make sure this is a discussion and not just us trading talking points,” Obama said.

During the early hours of the summit, Democrats continued to talk about their constituents’ health coverage horror stories and their worries about their own pre-existing conditions, and Republicans continued to complain about the Democrats hammering out health bills in sessions that excluded Republicans.

Lawmakers also talked briefly about areas of possible policy position overlap.

Participants seemed open to the idea that they might agree, in principle, on ideas such as:

- Ensuring that people with preexisting conditions can still buy health insurance.

- Reducing “defensive medicine” by protecting doctors from frivolous malpractice lawsuits.

- Reducing fraud and waste in Medicaid and Medicare.

At one point, Rep. Robert Andrews, D-N.J., looked at a Republican and conceded that the Democrats’ proposed health insurance purchasing exchange system for individuals and small groups appears to resemble the Republicans’ proposed association health plan system, which would give small businesses the ability to form multistate health insurance purchasing groups.

“The idea of exchanges is a Republican idea,” Obama said at another point.

Sen. Lamar Alexander, R-Tenn., who presented the Republicans’ opening statement, said Republicans’ share Obama’s interest in improving the U.S. health care system.

“We want you to succeed,” Alexander said. “If you succeed, our country succeeds.”

But the proposal the Obama administration released earlier this week is too similar to the Senate health bill, which is unpopular with the American people, Alexander said.

The Obama administration proposal would dump tens of millions of people into Medicaid, or a Medicaid-like program, and Medicaid is not known for offering the kind of coverage that most people would want, Alexander said.

The Obama administration proposal also is too complicated and too expensive, Alexander said.

The Democrats should start with relatively small, focused steps, such as reforming the medical malpractice system, Alexander said.

Sen. Jon Kyl, R-Ariz., told Obama that he may not be able bridge the gap between Republicans and Democrats.

“We do not agree about the fundamental question about who should mostly be in charge,” Kyl said, arguing that Democratic health proposals would shift too much authority to Washington.

Kyl said he also opposes the Democrats’ efforts to increase taxes to pay for the proposals; increase the threshold for deducting catastrophic medical expenses to 10% of income, from 7%; and impose new benefits mandates.

Obama said he has listened to Republicans talk about health care, read their proposals, and liked many of the points Alexander had made.

“A bunch of these things are things we’d like to do and in fact are in the legislative proposals,” Obama said.

But Obama said he disagrees with some of the Republicans’ arguments, such as criticism of efforts to set minimum policy standards for the policies sold through the exchange system.

The Republicans have not been rushing to have the government offer high-deductible health plans or limited-benefit health plans to members of Congress, Obama noted.

Ordinary Americans deserve the same kind of comprehensive coverage that lawmakers have, he said.

Obama warned that practical considerations might make some ideas that sound good difficult to implement.

The Democrats, for example, are open to the idea of helping individuals and small groups buy health insurance across state lines, to give buyers in small markets access to bigger, more competitive markets, but a poorly designed system for allowing cross-state purchases could lead to the healthiest individuals flocking to some states and saddling insurers in other states with older, sicker pools of insureds, Obama said.

Also at the summit:

- U.S. Health and Human Services Secretary Kathleen Sebelius, a former Kansas insurance commissioner and a former president of the National Association of Insurance Commissioners, Kansas City, Mo., talked about issues such as cherry picking.

“It’s a lot cheaper to insure people who promise never to get sick,” but that is not really insurance, Sebelius said.

- Senate Majority Leader Harry Reid, D-Nev., expressed irritation about Republican assertions that the Democrats are planning to use the budget reconciliation process, which requires only 51 votes to get a measure through the Senate, rather than 60, to pass a health bill.

The Republicans are responsible for most of the talk about use of reconciliation, Reid said.

Even if the Democrats did end up using reconciliation, both Republican-led and Democratic-led congresses have used reconciliation to pass many major pieces of legislation over the years, Reid said.