Health plan debuts tonight before divided Congress Clinton's proposal viewed as gamble

September 22, 1993|By Karen Hosler and John Fairhall | Karen Hosler and John Fairhall,Washington Bureau

WASHINGTON -- President Clinton will unveil his ambitious plan to overhaul the nation's health care system tonight before a Congress that seems eager to act on the issue but deeply divided over how far to go.

Rep. Vic Fazio of California, a Democratic leader, echoed the uncertainty of many in both political parties who consider Mr. Clinton's top-to-bottom reform plan an enormous political gamble.

"There is a general assumption that we are going to do something, but a lot of the optimism about the president's program I think is unwarranted," said Mr. Fazio, vice chairman of the House Democratic Caucus.

Amid growing public concern about the cost and quality of health care, members of Congress have been predicting for months that some reform measure would be approved before next year's elections.

Changes thought to have a good chance of becoming law include guaranteeing that people don't lose their medical insurance when they contract serious diseases or move from one job to another.

But no one knows how much further Congress would be prepared to go. In particular, it is uncertain whether Congress is ready to pass a plan that would guarantee health insurance to all Americans, as Mr. Clinton wants.

"The big thing we have to decide soon is how much we are going to try to do right away," said Republican Sen. John H. Chafee, who offered a GOP alternative to Mr. Clinton's plan last week.

"The president's bill is very, very costly," the Rhode Island senator said. "We would like to see the savings in place first before we expand the benefits."

Mr. Clinton begins his effort to reshape one-seventh of the nation's economy with the cooperation of some Republicans, whose continued backing is essential if his plan is to have any chance of success.

"We have Republicans wanting to play a constructive role," said Sen. Edward M. Kennedy, a Massachusetts Democrat who is a longtime champion of national health insurance. "I think the stars are in the right place."

The tentative timetable for consideration of the health care reform proposal calls for public hearings the rest of this year, committee action next spring and final floor votes next summer or fall.

Crafting a 'gumbo'

Although the Clinton administration has signaled its willingness to compromise on many details, aides say the president is

committed to the basic concept of extending health coverage to all Americans, including the more than 30 million who have no health insurance today, and providing the assurance that health benefits won't be threatened by the change or loss of a job.

To achieve those goals, Mr. Clinton has crafted what Sen. John B. Breaux, a Louisiana Democrat, calls a "gumbo": a blend of sweeping new government powers to regulate the delivery of medical services and incentives designed to cut costs by encouraging greater competition.

This compromise approach is already under attack from various quarters, including at least 85 liberal House Democrats who favor a single, national insurance plan run by the government and conservatives of both parties who want far less federal intervention in private business than Mr. Clinton has proposed.

With more than a dozen committees or subcommittees in both houses expected to take up portions of Mr. Clinton's plan, it must clear an unusually large number of hurdles. Major battles are expected over:

* Requiring employers to insure their workers. Mr. Clinton wants to force employers to give their workers health insurance and pay up to 80 percent of the premiums. Critics say that would cause many small businesses to go under and cost the country up to a million jobs.

* Cutting health programs for the poor and elderly. Mr. Clinton would cut the growth of Medicare and Medicaid spending to provide $238 billion in federal money to help pay for the reform plan. Sen. Daniel P. Moynihan, a New York Democrat who is chairman of the powerful Senate Finance Committee, calls these expected savings "fantasy."

* Cost controls. A proposed national "budget" for health spending would be enforced through limits on insurance premium increases. Mr. Clinton says this is critical to slowing down increases in health care spending, but conservatives predict it would lead to rationing care.

* Taxes. The president is expected to ask for $105 billion in new "sin" taxes, most of which apparently would fall on tobacco products. The administration is consulting Congress on whether split such a tax between tobacco products and alcohol, which would force Mr. Clinton to take on two influential industries, rather than one.

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