Clinton Allies Rein In Health Bill Ambitions

WASHINGTON —  In a stunning retreat, Senate champions of President Clinton’s ambitious health reform agenda regrouped Thursday and began pushing privately for a modest proposal that they--and the White House--could call a small but vital first step toward comprehensive reform.

“We’ve got to deal with the reality of trying to get the very most we can,” said John D. (Jay) Rockefeller IV (D-W.Va.), a new convert to the go-slow approach.

Added Sen. Tom Daschle (D-S.D.), another die-hard Clinton ally: “We ought to go as far as we can and recognize that there was always the expectation all along that we’d be right back here next year to do more.”

The shift came as the Senate decided to postpone consideration of health care reform until it returns in September from a shortened summer recess.

The unexpected concession by Clinton’s allies substantially raises the likelihood that Congress will adopt insurance market reforms but forego until next year any attempt at broader change. The insurance reforms, which enjoy widespread support, would enable consumers to buy or retain affordable coverage even if they have existing illnesses or when they change jobs.

Despite Clinton’s vows to veto legislation that did not make significant progress toward covering all Americans, the sentiment for compromise--and taking what can be achieved--seemed infectious Thursday on Capitol Hill.

Another convert to incremental reform was Sen. Harris Wofford (D-Pa.), whose upset victory in 1991 galvanized the reform movement because he had made health care reform the centerpiece of his campaign.

“We must concentrate now on what this Congress can do this year,” Wofford said. He said that a “strong dose of practical realism is necessary” after two weeks of desultory Senate debate that he called “a classic case of Washington gridlock.”

During the two-week recess, Senate Majority Leader George J. Mitchell (D-Me.), whose own health reform proposal is all but dead, intends to continue negotiations with Sen. John H. Chafee (R-R.I.), co-leader of a bipartisan “mainstream coalition” of about 20 senators who have advanced their own proposal as an alternative to Mitchell’s.

There are numerous unresolved issues between Mitchell and the “mainstream” group, and whether compromises can be forged is far from certain.

In the meantime, Sens. Rockefeller, Wofford and Tom Harkin (D-Iowa) are preparing a counterproposal to the “mainstream” alternative that would make insurance more accessible to small businesses, individuals and especially women and children--a far cry from their long-held goal of universal coverage.

“We have many miles to travel,” Wofford conceded.

The Rockefeller-Wofford-Harkin proposal may represent a last-ditch effort to salvage what’s left of a movement that set out nearly three years ago to overhaul what is one-seventh of the U.S. economy.

“A lot of people here are pretty discouraged,” said one top Senate aide. “But nobody’s willing to throw in the towel yet.”

The House has already gone home, unable to form a consensus around any plan. And on Tuesday, Speaker Thomas S. Foley (D-Wash.) conceded that comprehensive reform is unlikely and said he would settle for insurance reforms and put off more ambitious efforts until next year.

The President, asked if he thinks the recess would leave Congress with too little time to enact health care reform before it adjourns in early October, replied: “I wouldn’t say that, no. I don’t think you can say that and I don’t think the recess will kill it.”

Clinton also told a news conference that he retains hope for health care legislation so long as senators are negotiating.

“I think the less I say the better right now as long as Sen. Mitchell and Sen. Chafee and Sen. (John B.) Breaux (D-La.) and others are doing their best to continue this dialogue,” the President said. “I think we just have to let this thing develop a little bit.”

Mitchell’s plan aims to cover 95% of Americans by the year 2000, relying on voluntary measures and insurance reforms and subsidies to the needy. The legislation stipulates that in states where the 95% coverage level is not achieved by 2002, large businesses would be required to provide insurance and pay at least 50% of worker premiums.

Mitchell’s plan has been criticized for its reliance on such an employer mandate and on government to oversee a redesigned health care system.

The “mainstream” plan relies on insurance reforms but eliminates any provisions for an employer mandate. It aims to trim $400 billion from future growth of Medicare and Medicaid over 10 years to generate funds to help poor people buy insurance. It seeks to cover about 92% of the population by 2000.

But critics say that the “mainstream” plan would lead to excessive litigation, that it lacks sufficient cost containment measures and that its structure for subsidies could cause employers to drop coverage for their workers.

The Rockefeller-Wofford-Harkin proposal, according to Senate staffers, would allow small businesses, individuals, women and children access to the Federal Employees Health Benefits Plan, which now offers 9 million subscribers a large choice of health plans at relatively low cost.

It also would cut the rate of growth in Medicare and use savings to provide the elderly with coverage for outpatient prescription drugs and long-term home care.

Also Thursday, independent analysts warned that congressional inaction would hasten deterioration of the current system, renewing medical inflation and driving up the number of uninsured Americans.

Speaking at a Capitol Hill seminar organized by the nonpartisan Alliance for Health Reform, William Custer, director of research for the independent Employee Benefit Research Institute, noted that if current trends hold true, there will be about 48 million persons without insurance by the year 2000, up from 39 million now.