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Tuesday, February 23, 2010

how to save health

President Obama made his best effort to save health care reform Monday by leaving the Senate-passed bill largely intact while removing provisions that were viewed as the most egregious and offensive products of back room deals with special interests.

The “Cornhusker kickback” for Sen. Ben Nelson, Nebraska Democrat, is gone in the proposal posted online Monday morning. In its place, the White House is proposing to give all states full federal financing for Medicaid expansion from 2014 through 2017, and significant assistance beyond that.

The special treatment for organized labor – they were exempted from taxes on expensive health care plans until 2018 – was extended to all Americans. And the amount at which family plans can be taxed would be raised under Obama’s plan from $23,000 to $27,500.

The changes, said White House communications director Dan Pfeiffer, “will help take away a little of the concern people had about this seeming to be something that was hatched behind closed doors.”

Despite all the talk of a potential public option in the president’s plan, such a provision was not included. And abortion language in the Senate bill, which was not stringent enough for many pro-life legislators and advocates in forbidding the use of federal funds for abortion, was left unchanged.

The White House said their changes added $75 billion to the price tag, giving it a total cost of $950 billion. They said the bill will be deficit neutral, but the Congressional Budget Office said later Monday that the president’s proposal lacked “sufficient detail” for them to provide independent verification of that claim.

“CBO cannot provide a cost estimate for the proposal without additional detail, and, even if such detail were provided, analyzing the proposal would be a time-consuming process that could not be completed this week,” CBO Director Douglas Elmendorf wrote on the agency’s blog.

The proposal also includes new powers for the federal government – through the department of Health and Human Services – to regulate the health insurance industry’s prices.

It is the first time Obama has offered his own legislative proposal in the more than year long health care debate (read the president’s plan here). But the president continues to mull the possibility of using reconciliation to push a bill through the Senate if Republicans go to what Pfeiffer called “the extraordinary step of filibustering health reform.”

At the same time, the White House dared Republicans to come to a televised showdown on Thursday with their own proposal.

“This is the opening bid for the health meeting,” Pfeiffer said. “It is our hope the Republicans will come together around their plan and post that online prior to the meeting so that the American people have a chance to look at it, analyze it and be truly informed.”

Republicans said they have already proposed alternative plans, though it was clear that there is no one plan that all Republicans are standing behind.

“House Republicans’ health care alternative – the full text of the legislation – has been available at for months, which the President knows, since he discussed it with us in Baltimore a few weeks ago,” said Kevin Smith, spokesman for House Minority Leader John Boehner, Ohio Republican.

John Hart, a spokesman for Sen. Tom Coburn, pointed to legislation the Oklahoma Republican and Rep. Paul Ryan, Wisconsin Republican, proposed in 2009.

“We posted our plan in May of last year,” Hart said. “We released our detailed plan months before any Democrat plan was released.”

On the Senate side, Senate Minority Leader Mitch McConnell’s office continued to stand behind a message of more incremental reforms instead of a comprehensive piece of legislation.

“Republicans have had hundreds of town halls and meetings across the country and what we’ve heard is that Americans don’t want another 2,700-page bill that raises taxes and slashes Medicare for our seniors,” said McConnell spokesman Don Stewart. “As we have over the past year, Republicans will continue to offer the types of ideas and step-by-step approach that Americans are calling for.”

Obama, however, remains determined to try for a comprehensive bill.

“Starting from scratch doesn’t make sense,” Pfeiffer said. “However we are coming to this meeting with an open mind to add ideas, and it is our hope that Republicans will do the same.”

Pfeiffer added that the White House was “more than happy” to post a Republican counterproposal on the administration’s website.

Though Republicans have said will attend the session Thursday, a spokesman for House Minority Whip Eric Cantor, Virginia Republican, left no doubt about where they stand.

“The Obama plan costs a trillion dollars, puts government in control of personal health decisions, and allows the government to set prices in the private market,” said Cantor spokesman Brad Dayspring. “That mirrors the Pelosi/Reid plans that have already been soundly rejected by the bipartisan majority of Americans.”

Nancy-Ann DeParle, head of the White House office of health reform, outlined the changes to Medicaid assistance for state governments.

“We’re treating all states equitably and adding an additional year of full federal financing,” she said. “That will be four years, starting 2014, of full federal financing for the states for any expansion of Medicaid that is in this bill.”

“Then in the out years, 2018, 2019, there will be time 95 percent federal financing, and beyond that 90 percent. We think it gives states plenty of time to adjust to these new responsibilities and gives them additional financing, pretty much forever, to cover the expanded population.