Budget battle fuels doubt on Clinton health plan

June 20, 1993|By John Fairhall | John Fairhall,Washington Bureau

WASHINGTON -- President Clinton's struggles with Congress over his economic program are fueling doubts about his ability to win approval of an even tougher task looming on his agenda: health care reform.

Worried reform advocates say his ambitious and costly plan for overhauling the health system will demand leadership and communication skills akin to President Ronald Reagan's to rally public support for yet more taxes. But the president -- whose approval rating is at a historic low of 36 percent -- has little of the political capital he needs to control the health care debate.

While Senate Democrats on the Finance Committee agreed last week on a greatly altered version of the president's $500 billion deficit reduction package, they demonstrated little loyalty to Mr. Clinton.

House Ways and Means Committee Chairman Dan Rostenkowski, an Illinois Democrat, believes "that the lesson of the ongoing [budget] and tax debate is not encouraging," says an aide. "If people in Congress, for whatever reason, are unwilling to accept presidential leadership . . . that's going to make it really tough."

Yet the White House remains publicly optimistic and committed to what officials call "fundamental" reform. Mr. Clinton predicted Thursday that once the "debate really begins in earnest, you will see the prospects of passage intensify, not diminish" because of Americans' demand for change.

A threat of delay

Many reform advocates worry that the president's far-reaching plan -- postponed until Congress finishes work on his economic program -- will be scaled back under pressure from Congress and special interests. For the public, that might mean a lengthy delay in the administration's goal of guaranteeing all Americans comprehensive health coverage before the 1996 elections.

Other key but controversial features of the president's plan are also at risk: cost controls on insurers, hospitals and doctors, a national health care budget and establishment of powerful insurance purchasing organizations in every state.

Lawmakers are cautioning the president that they're in no mood for a new round of tax increases, although the health reform bill might be as high as $90 billion and require either a big payroll tax or a costly mandate requiring all companies to insure workers.

Mr. Clinton's hopes of partly financing reform with savings from Medicare and Medicaid disappeared when the House cut $58 billion from the programs for the elderly and poor and the Senate Finance Committee chopped another $19 billion. That only increases the pressure for major tax increases.

"I hope that one of the messages they've received from those of us on Capitol Hill is you don't want a big tax increase," says Rep. Benjamin L. Cardin, a Maryland Democrat and administration ally on the Ways and Means panel. "I want to see cost controls first before you put in more federal funds."

Recipe for gridlock

The complexity of Mr. Clinton's plan will require action by as many as 14 congressional committees and subcommittees -- a recipe for gridlock. Besides the main features, the plan includes provisions for dealing with such issues as the Department of Veterans Affairs health system and medical malpractice.

What worries reform advocates -- but heartens opponents -- is that the challenges to the president's economic program have thrown into question his skills at building support. Mr. Clinton barely won House approval for his deficit plan after allowing special interest groups to whip up public opposition, and he then surrendered to Senate opponents of his broad energy tax. He's left health reform advocates wondering how resolute he'll be.

"As controversial as tax increases are, health care is even more so because it's so personal," says Linda Lipsen, legislative director of Consumers Union. "It affects everybody, and everybody has an opinion about it."

"We're looking at the budget fight to see: Is he going to be beleaguered after this? Is he going to be strong? A strong president can communicate" an ambitious health reform plan, Ms. Lipsen says.

But if he's weak, "no one's going to trust the messenger."

White House officials and reform advocates hope the president will rebound with passage of a deficit plan and an effective strategy for communicating the health reform issue to the public. Supporters are urging Mr. Clinton to begin speaking out on health issues next month to build public support and counter advertising campaigns by interest groups.

"The prospects for health reform do ride to a large extent on Bill Clinton, and he's got at some point to make this cause his own," says John C. Rother, lobbyist for the American Association of Retired Persons. "And when that happens, I hope he'll have a successful deficit reduction package behind him and that he'll have restored to some extent relationships with conservatives and Republicans so that this can be done on a bipartisan basis."

Mr. Clinton needs to boost his standing in the polls to give him bargaining power with Congress.

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