President Barack Obama embraced a handful of Republican health care ideas Tuesday to lure votes of Democrats wary of a more partisan approach as he prepared to spell out his final package for a sharply divided House and Senate, where its fate is unsure.
In a bit of political sleight of hand, Obama said he might include four GOP-sponsored ideas in his plan, even though virtually no one in Congress or the White House thinks it will procure a single Republican vote.
The move is aimed instead at wavering Democrats, especially in the House. Some of them might find it easier to vote for the health care package if they can tell constituents it had bipartisan elements that Republicans should have supported. Yet there is no guarantee that Democratic leaders will incorporate Obama's suggestions in revised legislation.
Senate Republican leader Mitch McConnell warned that Democrats will enact their health care plan at their own political peril, vowing to make it an issue in every congressional race this fall.
In remarks at the White House on Wednesday, the president will describe the final elements of his proposal and then ask Congress to enact it, aides said. Obama was expected to reiterate why changing the system is so important and again explain what his plans would mean to families and businesses. The aides also expected Obama to talk about the Republican ideas he wants woven into the Democrats' plans.
He is expected to leave no doubt that, barring an unexpected change in Republican tactics, he wants Congress to pass the legislation using budget reconciliation rules, which prohibit Senate filibusters. Obama is unlikely to use those exact words, as Democratic leaders are emphasizing they want to pass a bill with simple majority votes in the House and Senate.
"He'll urge Congress to move swiftly toward votes on this legislation," said a White House official who described Obama's remarks on condition of anonymity to avoid upstaging the president.
It takes 60 votes to halt a filibuster, and Democrats can count on only 59 in the 100-member Senate.
In a letter to congressional leaders Tuesday, Obama said he would consider four ideas floated by Republican lawmakers: sending investigators disguised as patients to uncover fraud and waste in Medicare and Medicaid; expanding pilot programs to bring more predictability to medical malpractice lawsuits; increasing payments to Medicaid providers; and expanding the use of health savings accounts.
"I said throughout this process that I'd continue to draw on the best ideas from both parties, and I'm open to these proposals in that spirit," Obama wrote.
In a nod to his 2008 presidential rival, he said he had eliminated a special deal for Medicare Advantage beneficiaries in Florida and other states that drew criticism from Sen. John McCain, R-Ariz.
But Obama again rejected Republican appeals to restart the health care debate or dramatically scale back his proposals.
"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," his letter said.
House Speaker Nancy Pelosi said the letter "brings us just another step closer to passing the bill." She said she hopes to incorporate some of the GOP ideas.
Republicans, meanwhile, made it clear the president's overtures will not win their hearts or votes.
Sen. Tom Coburn, an Oklahoma Republican who proposed some of the notions Obama is weighing, said that "merely incorporating these ideas into the deeply flawed House and Senate bills will not bring us any closer to real reform."
In a letter to Obama, Coburn noted that opinion polls show extensive opposition to the Democratic plan. "An all-or-nothing reconciliation strategy will give the American people nothing," Coburn wrote.
White House chief of staff Rahm Emanuel, after meeting with top Democrats in the Capitol, told reporters: "Reconciliation is a vehicle that's been used many times. This is a normal procedure."
The Democratic package would extend health coverage to 30 million uninsured Americans over 10 years, with a first-time mandate for nearly everyone to buy insurance. It would provide subsidies to help low-income people buy insurance, and it would impose several new requirements on insurers and employers.
It will be less expensive than the health care bill the House narrowly passed in November, and will contain no government-run insurance program to compete with private insurers.
Those changes might appeal to some of the three dozen Democratic House moderates who opposed the November version of the bill. The revised bill may die if none of those Democrats vote for it, because some Democrats appear likely to switch from yes to no because of a dispute over abortion funding restrictions.
Obama signaled a willingness to take a small step farther into the contentious issue of limiting lawsuits that allege medical malpractice. Plaintiffs' lawyers, a key fundraising source for Democrats, staunchly oppose such limits. But Republicans and many doctors have demanded them for years.
Obama's letter said he was open to appropriating an extra $50 million for pilot programs that experiment with specialized health courts rather than jury trials. A judge steeped in medical matters would hear evidence and render verdicts for patients alleging injuries from wrongful acts.
A plaintiff lawyers' group, the Center for Justice & Democracy, said it strongly opposes such health courts, calling them "anti-patient."
It was unclear Tuesday when the House and Senate might vote on the revised health care proposals. Some Democrats hope to do so before Obama leaves for a trip to Asia on March 20.
Data from a Democratic pollster has been circulating on Capitol Hill showing that opposition to the health care plan drops substantially when people learn more details about how it might help them. This is especially true of independent voters, who fear the plan involves too much government intervention until they learn more about it, the poll states.