A year after he nearly became President Barack Obama's commerce secretary, the three-term New Hampshire Republican is reaching out to the White House with a plan to overhaul health care that has some key features in common with the Democratic bills passed by the House and Senate. For instance, it would require everyone over age 18 to get coverage.
But the plan is almost secondary to the approach Gregg is pushing: Start from scratch and work through the goals Republicans and Democrats agree on one by one rather than using the Democratic bills as a starting point or pitting them against a Republican-crafted alternative.
"There are a whole series of things that would improve the health care delivery system that both sides can agree on," he said this week. "When the president said he was looking for ideas, I sent him some. I think all those ideas could be agreed on in a bipartisan way."
It's unclear how seriously the Obama administration is taking Gregg, who famously accepted then turned down the commerce secretary nomination. The senator said he has spoken with White House staff, but as of Wednesday, he was still not on the invitation list for the televised health care forum Obama will moderate next week.
The first invitations went to congressional leaders and the top members of the relevant committees, but Gregg could attend the Feb. 25 summit as one of the four picks of Senate Republican leader Mitch McConnell of Kentucky.
"The opportunity is there," Gregg said. "I don't know if it's going to end up being theater. I don't know if it's going to end up being a substantive effort to accomplish something."
If the administration opts for a fresh start -- a big "if," as Obama has said he doesn't want to begin anew -- Gregg is well-positioned to play a key role. He is a former chairman of the Senate Health, Education, Labor and Pensions Committee and remains the ranking Republican on the Budget Committee.
"I think he brings some credibility as a fiscal conservative," said Wayne Lesperance, associate political science professor at New England College in Henniker, N.H. "And he seems, unlike a lot of his colleagues in the Republican Party, to have a sense of what the issues are with this debate."
Gregg, 63, who was elected to the Senate in 1992, announced a year ago that he would not seek re-election this year.
"The conventional wisdom is that an outgoing senator just sort of fades away, but clearly Judd Gregg does not want to go gentle into that good night," Lesperance said.
By inserting himself into the health care debate, Gregg is adding to his well-established legacy as a fiscal hawk, Lesperance said. But Gregg said that was not his motivation.
"I am not thinking of a legacy, rather of the need to get our fiscal house in order," he said. That includes reforming health care in a way that reduces costs and making sure that Medicare doesn't create an excessive burden for the next generation, he said.
Gregg's plan exists not in formal legislation but as a set of proposals grouped under the acronym CPR, for Coverage, Prevention and Reform.
It parallels some of the key ideas in the Democratic plans, but it is more aggressive in trying to control costs and less ambitious in extending the federal government's role as an insurance regulator.
Similar to that the Democrats, Gregg's plan would require everyone over 18 to carry at least basic coverage. And he would provide federal subsidies for households making up to three times the federal poverty level, or about $66,000 for a family of four.
The plan would be financed by taxing employer-sponsored coverage above certain limits. That's a nonstarter for many Democrats, but economists say adopting such a policy would begin to push down health care spending, allowing for expanded coverage without busting the budget.
Gregg would also encourage employers to offer discounted premiums for workers who take steps to live healthy lives, and his plan shifts payments for hospitals and doctors to reward quality care rather than sheer volume of procedures and visits.
Though he would like to apply a projected $500 billion in 10-year Medicare savings to a Medicare solvency fund, Gregg said he would be willing to split the difference with Democrats, using $250 billion to shore up Medicare and using the rest to fund expanded health coverage.
Speaking to a business group this week, Gregg was asked whether he thought passing health care overhaul was impossible and whether he believed -- as Sen. Evan Bayh, D-Ind., expressed in announcing his retirement on Monday -- that Congress has become impossibly partisan. Gregg answered no to both.
"There is still significant collegiality in the Senate," he said. "I deal with my colleagues on the other side of the aisle on big issues all the time."