Republicans may be no-shows at health-plan summit

WASHINGTON — Leading House Republicans raised the prospect Monday night that they may decline to participate in President Obama's proposed health-care summit if the White House chooses not to scrap the existing bills and start over.

In a letter to White House chief of staff Rahm Emanuel, House Minority Leader John Boehner, of Ohio, and Minority Whip Eric Cantor, of Virginia, expressed frustration about reports that Obama intends to put the Democratic bills on the table for discussion at the summit, scheduled for Feb. 25.

"If the starting point for this meeting is the job-killing bills the American people have already soundly rejected," Boehner and Cantor wrote, "Republicans would rightly be reluctant to participate."

Obama on Sunday proposed a nationally televised, half-day summit, but the two GOP leaders shared their suspicion that the president is not serious about opening bipartisan negotiations on health-care legislation.

" 'Bipartisanship' is not writing proposals of your own behind closed doors, then unveiling them and demanding Republican support," Boehner and Cantor wrote. "Bipartisan ends require bipartisan means."

White House press secretary Robert Gibbs responded by saying Obama has sought Republican input since early last year, and that the president remains interested. But he appeared to give little ground on the idea that Obama might abandon the months of work that produced Democratic bills that passed the House and the Senate late last year.

If Republicans take Obama up on his invitation, they will carry a fairly well-developed set of ideas intended to make insurance more widely available and affordable, by emphasizing tax incentives and state innovations, with no new federal mandates and a modest expansion of the federal safety net.

Republicans rely more on the market and less on government. They would not require employers to provide insurance. They oppose the Democrats' call for a big expansion of Medicaid, which Republicans say would burden states with huge long-term liabilities.

While the Congressional Budget Office has not analyzed all the GOP proposals, it is clear they would not provide coverage to anything like the number of people — more than 30 million — who would gain insurance under Democratic proposals.

As one way to encourage competition and drive down costs, congressional Republicans want to make it easier for insurance companies to sell their policies across state lines, an idea included, in a limited form, in the Democratic bills.

Republicans would:

• Offer federal money as a reward to states that achieve specified reductions in premiums or in the number of people without insurance.

• Provide federal money to states to establish and expand high-risk pools, for people with chronic illnesses who cannot find private insurance at an affordable price. But they would not cap premiums, so some people still could find insurance too expensive.

• Contend that changes in state medical-malpractice laws could lower costs and slow growth of premiums. However, some of these proposals — such as federal limits on damages for pain and suffering and punitive damages — are potentially in conflict with the Republicans' emphasis on federalism and state autonomy.

Sen. Lamar Alexander of Tennessee, the Senate's No. 3 Republican, said he and his colleagues were skeptical of "grand legislative policy schemes" and favored "a step-by-step approach" focused on lowering costs for families and businesses.

The Republican health-care agenda can be inferred from bills they have offered in the past few years and from their criticism of Obama's proposals and of the Democratic bills.

Likewise, Republicans want to expand the use of health savings accounts, to cover routine expenses for people who enroll in high-deductible health plans. Democrats denounce such accounts as a tax shelter for higher-income people.

Many Republicans want to expand the role of private insurance companies in Medicare. Insurers already manage Medicare's prescription-drug benefit, and Republicans see that as a model.

Republicans agree on the need to slow the explosive growth of Medicare but say the savings should be used to shore up Medicare.

Like Democrats, Republicans are divided on some questions, including the taxation of employer-provided health benefits.

Some Republicans, including Sen. Tom Coburn of Oklahoma and Rep. Paul Ryan of Wisconsin, would replace the tax-free treatment of health benefits with a refundable tax credit for the purchase of insurance.

Other Republicans say eliminating the current tax break for employer-provided insurance would amount to a tax increase and should be opposed.

Some Republicans, such as Coburn and Ryan, would encourage but not require states to set up health-insurance exchanges, or marketplaces, where consumers could buy coverage.

The exchanges would require insurers to offer coverage to all applicants, regardless of age or medical history. Insurers in the exchange would have to offer at least the same benefits available to members of Congress.

While Republicans generally oppose any new entitlement or tax increase, they do have areas of potential agreement with Democrats. They agree, for example, on the need to emphasize wellness and preventive-health programs; to provide more transparency for price and quality data on doctors and hospitals; and to speed approval of lower-cost generic versions of high-cost biotechnology medicines.

Many Republicans also would join Democrats in requiring insurers to let dependent children stay on their parents' policies through age 25 or 26.

Democrats and Republicans share another goal: making it easier for small businesses to buy insurance. The House and Senate bills would offer tax credits for two years to businesses with 25 or fewer employees to help them buy coverage.

Republicans would help small businesses band together and buy insurance through trade associations and professional societies. But Democratic lawmakers, like consumer advocates and many state officials, oppose Republican suggestions that such small-business health plans should be exempt from state regulation, including requirements for the coverage of specific services.