Clinton's health care plan already being challenged ON POLITICS



TULSA, Okla. -- Republicans attending the annual conference of the National Governors' Association are sending unmistakable signals that they intend to resist key elements of President Clinton's health care reform program. Moreover, they are convinced they hold the political high ground.

And the fact that they are probably right about the politics of the issue speaks volumes about both the president and the electorate now.

Such prominent governors as Pete Wilson of California and Carroll Campbell of South Carolina, the new NGA chairman, are saying they would oppose any plan mandating universal coverage that would oblige small business to provide health insurance. And they and many of their Republican colleagues seem equally adamant in their opposition to higher payroll taxes to provide broader coverage.

Although the details of the Clinton proposal remain a month away, it is already clear that he intends a comprehensive program that will mandate coverage and that some new taxes will be required if that goal is to be reached.

The Republicans are casting their opposition in terms of their preference for what they call "flexibility" at the state level -- meaning the freedom to set their own standards rather than have them established in Washington. "That's going to be the defining difference," Campbell says.

The Republicans argue that many states already are demonstrating they can confront the health care problem with innovative approaches that, for example, allow small businesses to form larger pools of health insurance buyers that can negotiate better rates. But, as Wilson puts it, the crucial factor is that businesses be allowed to join on a voluntary basis. It would be a "disaster," the California Republican says, "to force upon employers costs small businesses could not afford."

The Republican resistance on health care reform -- or at least the Clinton version of it -- rests on some political premises that are difficult to challenge.

The first is that the voters share their hostility to government solutions dictated from Washington. There is abundant evidence in the opinion polls to support that expectation.

Another is that the voters will be equally resistant to any form of higher taxes. The reaction of the electorate to the minimal tax increase in the budget plan suggests they are right on that one, as well.

The Republicans also are convinced that the vast majority of Americans who are concerned about the health care system but have insurance coverage of their own will be reluctant to approve changes that they think might either reduce their benefits or force them to pay for those who are not already covered. "I'm hopeful that we won't get right back into the tax issue," said Gov. William Weld of Massachusetts. "I'm not in favor of imposing a payroll tax or other tax."

Although they don't say it in so many words, it is also clear that Republicans are emboldened in their reluctance by the widespread consensus in the political community that President Clinton doesn't have the political clout right now to impose his ideas on the electorate or the Congress, let alone the states.

It is possible, of course, that the Republicans may be underestimating the popular concern about the flaws in the health care system and the demand for changes that would make the system less expensive and more user friendly. Opinion polls have shown consistently that health care ranks second only to the economy as the issue of the highest priority with the electorate.

But the debate over the Clinton budget plan demonstrated that the facts are often less important than perceptions. The plan imposes only a minimal burden on the middle class, but the administration allowed the Republicans to depict the budget as a truly draconian measure. The question now is whether the president or his opposition succeeds in defining terms of debate over health care.

At the moment, Clinton has the initiative in setting the agenda on health care. He will decide what is to be included in the program and have the initial opportunity to shape perceptions of his proposals when he presents them to Congress.

But it is already clear that Republican governors are not prepared to swallow the whole thing quietly.

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