The health care industry’s pledge to the White House on Monday to reduce spending increases by $2 trillion was the first step as both sides began to jockey for the upper hand in the congressional battle over expanding health care coverage.
President Obama noted that some of the players who fought the last proposed health care overhaul in 1993 were at the White House on Monday, but the groups say they have not signed on to his health care agenda and are hoping voluntary cuts now will stave off onerous government mandates.
“The president asked for the individuals in the room to work with him,” said Health and Human Services Secretary Kathleen Sebelius. “And I think that he has every expectation that in addition to beginning to tackle the cost side of this puzzle, that he wants their involvement, help and support on the legislative side of the puzzle.”
The $2 trillion in savings would come from cutting the expected 6.2 percent increase in health care spending by 1.5 percentage points each year over the next decade.
Mr. Obama framed the pledge as a strong show of support for his plan and a “watershed moment” from an industry that had ferociously fought previous health care reform efforts.
But representatives said the industry won’t blindly endorse a reform bill.
“Each trade organization will approach [a reform bill] own their own,” said Karen Ignagni, president and chief executive officer of the America’s Health Insurance Plans and signer of the pledge. “On the Democratic and Republican side they are looking for help in the area of cost containment. What you are hearing from all of us is that we want to help.”
The trade organizations that signed on to the letter committing to the cost-cutting didn’t provide details on where the savings would be generated and they have few ways of requiring their members to comply with their plan.
“Each sector of the health care community is self-identifying ways they can meet the goals outlined by the president,” said Service Employees International Union health care Chairman Dennis Rivera, who also signed the letter.
Mr. Obama has made expanding health care coverage one of his three top priorities for this year, along with combating greenhouse gas emissions and working on education. But he’s intent on avoiding the mistakes that doomed President Clinton’s attempt at health care reform, and one key goal is to get groups that opposed the 1993 effort to buy in early.
Asked whether the industry groups might have gained an upper hand to maneuver in the debate, White House press secretary Robert Gibbs expressed doubts: “I think we’re more cagey than that might seem.”
Mr. Obama has announced broad goals but left the details to Congress.
Senate Finance Committee Chairman Max Baucus, Montana Democrat, has said he expects to mark up such legislation in June.
“Lowering health care costs is one of the most important goals of health care reform,” Mr. Baucus said. “I’m very pleased that the ideas proposed by these industry groups meet my goals of increasing focus on value, efficiency and prevention in the health care system.”
Still unresolved is whether a health care reform package should include a government-run plan that would compete with private insurers, an option supported by Mr. Obama. Mr. Baucus initially had said that any reform package should include the so-called public option, though he has backed off in recent weeks.
Over protest from the far left, neither Mr. Baucus nor Mr. Obama is proposing a complete government takeover of the health insurance system.
Health care groups that advocate reform said the they were encouraged by but cautious about the pledge.
“It’s a good thing that these groups are engaged and constructive and focusing on the cost issues,” said Mark Goldberg, executive vice president of the National Coalition on Health Care, a nonpartisan group advocating reform. “It’s not automatic that their pledges to work to reduce the rate of increases in cost will translate to support legislation.”
Some consumer groups were doubtful about the savings, which the industry didn’t define.
“If the savings described today truly occur, this may be one of the most significant developments in promoting meaningful health care reform,” said Ron Pollack, executive director of the liberal-leaning consumer health organization Families USA.
Other groups that signed the letter include the Pharmaceutical Research and Manufacturers of America, Advanced Medical Technology Association, American Hospital Association and the American Medical Association.
Many congressional Republicans, who have been largely left out of the health care reform debate, said they failed to see many positives in the industry groups’ pledge, and accused the plan of lacking meaningful substance.
“Today’s announcement promises savings with no concrete plan to achieve them and no enforcement mechanism if they don’t,” said House Minority Leader John A. Boehner, Ohio Republican. “The administration has yet to answer the fundamental question of how to pay for its massive multitrillion health care plan.”
Sen. John Cornyn, Texas Republican, called the industry collaboration “another special interest working group” that ignores the consumer.
“The patient has been left out of the administration’s backroom deal with special interests,” he said. “No one knows how the alleged ‘savings’ will be measured or enforced.”
Sen. Charles E. Grassley of Iowa, the top Republican on the Senate Finance Committee - which is taking the lead in Congress in drafting health care reform legislation - said it’s impossible to know whether the plan would deliver the level of savings the industry leaders project until it’s reviewed by the nonpartisan Congressional Budget Office.
“Then we’ll know if the suggestions really achieve that kind of savings, and it’ll be big news,” Mr. Grassley said. “For health care budgeting purposes, CBO’s word is the only one that counts.”
But White House officials have said that the CBO’s primary role is to analyze legislation, not the impact of private initiatives on national health care spending.
John Hart, a spokesman for Sen. Tom Coburn, Oklahoma Republican and one of several doctors in the Senate, said Monday’s deal appears to take credit for efforts already under way, such as reducing obesity. Mr. Hart also said spending on health care will grow as a percentage of the economy even with the changes.
Mr. Coburn is working on his own health care overhaul bill with Sen. Richard M. Burr, North Carolina Republican.
A group of House Republicans lead by Rep. Roy Blunt of Missouri also is developing an alternative plan to the Democrats’ health care reform strategy.
• Stephen Dinan contributed to this report.