WASHINGTON (AP) — President Barack Obama said Tuesday he was open to four new Republican proposals on health care legislation, in a gesture of bipartisanship meant to jump-start his stalled drive to overhaul the system.

Obama detailed the ideas, all of which were raised at a bipartisan health care summit last week, in a letter to congressional leaders. In a nod to his 2008 presidential rival, Obama also called for eliminating a special deal for Medicare Advantage beneficiaries in Florida and other states that drew criticism at the summit from Sen. John McCain, R-Ariz.

The proposals Obama listed are: sending investigators disguised as patients to uncover fraud and waste; expanding medical malpractice reform pilot programs; 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," wrote Obama, who will make remarks Wednesday at the White House on a path forward for his legislation.

He rejected the GOP's preferred approach of scrapping the existing sweeping overhaul bills and starting afresh with step-by-step changes.

"I also believe that 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," Obama wrote.

Obama's announcement is not likely to win any votes from Republicans. Nor is there any guarantee that Democratic leaders will agree to incorporate the administration's suggestions in revised legislation. But it could give wavering Democrats political cover by showing the White House has been willing to compromise in the wake of last week's summit.

At its core the Democrats' legislation would extend coverage to 30 million uninsured Americans over 10 years with a first-time mandate for nearly everyone to buy insurance and a host of new requirements on insurers and employers. However, the package soon to reach the House will be less expensive than the one that passed in November and will contain no government-run insurance program to compete with private insurers, making it more appealing to some moderates.

Obama said he was open to these four GOP ideas:

—Conducting undercover investigations of Medicare and Medicaid providers to search for waste, fraud and abuse, an idea put forth by Sen. Tom Coburn, R-Okla., at least week's summit.

— Experimenting with specialized health courts as an alternative to jury trials in medical malpractice cases to cut down on defensive medicine. That idea has been promoted both by Democrats and Republicans, including Coburn and Sen. Mike Enzi, R-Wyo., who attended the summit.

The approach calls for an expert judge — not a jury — to hear the evidence and make a final determination in cases where a patient has suffered harm. Trial lawyers are strongly opposed to the concept.

Months ago, Obama budgeted $23 million for states to experiment with alternatives to malpractice litigation, but at the time he stopped short of endorsing health courts. The president now says he wants to more than double the budget for state experiments to $50 million.

—Obama also agreed that health savings accounts would be offered in new markets his plan sets up for individuals and small business to purchase coverage. Sen. John Barrasso, R-Wyo., brought up the idea at the summit.

The president said he's open to the tax-sheltered accounts, which go hand-in-hand with high-deductible health insurance policies. Premiums on those policies are lower than for regular health insurance, and people who have them use the health savings accounts to pay their out-of-pockets costs.

—Obama also suggested increasing reimbursements to Medicaid providers, a concern raised by Sen. Charles Grassley, R-Iowa.

Obama's letter was in keeping with the spirit of the summit. As expected, Republican leaders continued to assail the president's health care agenda, with Senate Minority Leader Mitch McConnell of Kentucky arguing that "Americans don't want the one-party bill Democrats in Washington are planning to force on them, or any variation of it — and they certainly don't want Democrats to push it through with even more backroom deals."

Democrats said that furthered their argument that Republicans have been unreasonably opposed to almost any compromise, justifying the White House decision to push for passage with no GOP help at all.

A small number of House Democrats who opposed the legislation on the first go-round may be Obama's most important constituency when he unveils his revised proposal.

At least nine of the 39 Democrats who voted "nay" when the House passed sweeping overhaul legislation 220-215 in November are now undecided or withholding judgment until they see Obama's final product, according to an Associated Press survey.

"Do I think there's a possibility of some people changing? Yes, I do," House Majority Leader Steny Hoyer, D-Md., said Tuesday. "I think that's because it'll be a different bill than either the House or the Senate bill; it will hopefully take some strengths of both."

Some lawmakers will almost certainly have to change from "nay" to "aye" in order for House Speaker Nancy Pelosi, D-Calif., to round up the votes necessary to pass the Senate's version of the legislation, along with a package of changes that Obama proposes. The changes — designed to make the Senate bill more palatable to House Democrats by rolling back a tax on high-value insurance plans, among other things — would get through the Senate under controversial rules allowing for a simple majority vote.

That's the only option for Democrats because they no longer control a filibuster-proof 60 votes in the Senate, and Republicans are unanimously opposed.

With four vacancies in the House, Pelosi will need 216 votes.


Copyright 2010 The Associated Press.