President Obama said Tuesday that he is considering adding four Republican ideas to his health overhaul plan, a bipartisan overture that Republicans said still does not get at the root of their objections with the bill.
The move comes a day ahead of Mr. Obama's expected announcement on how to move the plan through Congress, which many lawmakers expect will include the use of reconciliation - a complicated procedural tool to circumvent a Republican filibuster in the Senate.
In a letter to congressional leaders, Mr. Obama said he's interested in several Republican suggestions, including: allowing private "health savings accounts" into the insurance exchanges; addressing disparities among the states in Medicaid reimbursements to doctors; authorizing another $50 million in medical malpractice grants to the states; and using undercover investigators to ferret out waste in the Medicare and Medicaid programs.
"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," he wrote.
Mr. Obama's letter merely said he is exploring the policy ideas, which Republicans outlined in the White House's bipartisan health care summit last week.
But minority lawmakers said Tuesday that added provisions wouldn't change the bill's underlying new taxes and cuts to Medicare funding.
"Unless you're going to attack the cost of health care, which those bills obviously don't - they increase the cost of health care and they spend more money when we should be spending less - you haven't solved the underlying problem," said Sen. Tom Coburn, the Oklahoma Republican who proposed the medical malpractice grants and the anti-fraud measures.
The other proposals came from GOP Sens. Charles E. Grassley of Iowa, Richard M. Burr of North Carolina and John Barrasso of Wyoming.
Mr. Obama also said he would remove from the final health overhaul plan extra Medicare Advantage funding for Florida and extra Medicaid funding for Nebraska - two provisions targeted by Republicans, including his 2008 presidential rival, Sen. John McCain of Arizona, as "sweetheart" deals designed to buy the support of wavering lawmakers.
Instead, Mr. Obama said his proposal would gradually reduce Medicare Advantage payments across the country and provide more federal funding to the states to help them with their Medicaid bills, which would grow under the Democrats' plan.
Republicans said they were expecting to see more tangible progress out of one of the key agreements at the summit - that both parties want to reduce health costs.
"It was with this in mind that we were surprised and disappointed with your latest proposal to simply paper a few of these common-sense proposals over an unsalvageable bill," Minority Leader Mitch McConnell of Kentucky said in a letter in response to Mr. Obama's announcement.
Congressional Republicans repeated their call to start the process on health care all over again, an idea Mr. Obama has rejected as a waste of a year of work on his key agenda item.
Mr. Obama is expected to release more details on a procedural way forward on Wednesday. He could endorse reconciliation, which would allow the Senate to pass repairs to their underlying health reform bill, which passed in December, without needing the 60-vote majority needed to quash minority filibusters.
Under the Democrats' game plan, the House would pass the Senate's health bill without changes. A second bill then would be crafted that "fixes" what the president wants changed in the Senate's plan. The House would pass that bill and then send it to the Senate, which would pass it under the reconciliation procedure.
Democrats say that since Republicans are ready to do whatever it takes to block the bill - and now that they have 41 votes in the Senate - reconciliation is the only way to ensure the health plan gets a fair "simple majority" vote. Republicans call it a procedural trick to get an unpopular health plan through Congress.
House Speaker Nancy Pelosi said Tuesday that she still has hope for a bipartisan bill, but "if not, we'll have to go to a simple majority."
Each provision in the "fix" bill would have to be ruled by the Senate parliamentarian as being budget-related to qualify for the reconciliation process. While reconciliation eliminates the chance for a filibuster, Republicans would get a chance to offer as many amendments as they would like, further delaying a final vote.
Senate Budget Committee Chairman Kent Conrad, North Dakota Democrat, who would be a key player in passing a bill, has warned that passing the "fix" bill using the procedural measure is possible, but it would be difficult.
Perhaps the most significant wrinkle is that the House would have to pass the Senate's bill first and the repairs second. But there are many House Democrats who don't want to vote on the Senate's bill without assurances that the repairs will pass as well.
c Kara Rowland contributed to this report.