Clinton seeks health compromise with businesses

September 25, 1993|By Karen Hosler | Karen Hosler,Washington Bureau

WASHINGTON -- As Clinton administration officials scramble to win support for the president's health care proposal, they are already seeking a compromise on one of its thorniest provisions: that employers must pay 80 percent of workers' insurance premiums.

First lady Hillary Rodham Clinton said in a television interview Thursday that the administration is "going to be exploring" several possible compromises, including a proposal that would require large firms to buy insurance for their workers but allow small businesses to opt out of the program. Workers at small firms would buy their own insurance but get help from the federal government.

But critics and supporters of the employer requirement say the more likely compromise, which could take months of bargaining in Congress to achieve, could include a reduced benefit package, a smaller employer contribution, a delay in Mr. Clinton's timetable for guaranteeing health coverage for all Americans or some combination of these elements.

Seeking savings

"I sense a compromise is possible if the program is cost-effective," said Jerry Jasinowski, president of the National Association of Manufacturers, which represents 12,500 mostly large companies that hope the Clinton proposal will reduce their current health care costs. "I think the business community will be willing to cooperate if it is convinced real savings will result."

Because Mr. Clinton is relying on employers to finance a large part of universal coverage for all Americans, the deal on whether and how much they pay is critical to the final shape of the legislation, lawmakers say.

Mrs. Clinton has been discussing compromises on this issue and other controversial sections of the health care proposal in an attempt to quickly resolve whatever differences she can before the legislation is formally drafted and sent to Capitol Hill for consideration.

"I think it's very significant that no bills have been put out yet by the administration," said Sen. John B. Breaux, a Louisiana Democrat who was invited to meeting at the White House with Mrs. Clinton on Thursday. "That's an indication of how flexible they are."

Senator Breaux is considering offering an alternative to the Clinton proposal that would rely largely on market competition to bring down health care costs without imposing any mandatory requirements on the purchase of insurance.

Making a deal

The White House and many Democratic leaders in Congress have been more encouraged by a Republican proposal offered by Sen. John Chafee of Rhode Island and 22 of his moderate GOP colleagues that would put the burden on all individuals to buy health insurance.

Low-income people who could not afford the premiums would get help from the government through vouchers.

Though it differs from the Clinton approach, the Chafee bill accepts the principle that the government should require health insurance coverage.

"We are so pleased that the Republicans are talking in those terms with us," Mrs. Clinton said.

Sen. Nancy L. Kassebaum, a Kansas Republican who helped write the Chafee plan, suggested one possible compromise might be scaling back the employer share of health premiums to 50 percent or delaying implementation of the program until it is clear what savings will result. Mr. Clinton has proposed that all Americans will be covered by health insurance by 1997.

Mr. Jasinowski said his members would like to see "some real reality" applied to Mr. Clinton's proposed basic benefits package, which he suggested should be pared back to remove such expensive items as a prescription drug program, coverage for mental health treatment and long-term care.

Rep. Henry A. Waxman, a California Democrat who chairs the House Energy subcommittee on health, is likely to resist any reduction on the Clinton benefits package. He said he believes that over the next few months of public hearings, most business people will come to understand that the Clinton plan as offered would be cheaper for them than the current system.

He argues that employers are suffering now from escalating health insurance costs and from picking up the tab for uninsured workers whose medical expenses are passed on in the form of higher hospital and doctor bills.

But that lesson might take more time to sink in, particularly for small firms that don't provide insurance for their workers because they say it's too expensive.

Costs uncertain

"If this would actually control costs, the small-business community would be for it, but we don't know that yet," said Terry Hill, a spokesman for the National Federation of Independent Businesses. His organization of 615,000 firms with fewer than 50 employees, including 7,500 in Maryland, is so far vigorously opposed to requiring employers to pay for health insurance benefits.

"We're willing to listen, though," Mr. Hill said. "We are not going to knock the president's legs out from under him."

Rep. Fred Grandy, an Iowa Republican who has been active on the health care reform issue, said he believes a compromise on requiring employers to pay for health insurance may lie in increasing the subsidies Mr. Clinton has proposed to help out small, low-wage businesses.

Mr. Hill said his group is concerned about more than subsidies, however. "Subsidies are only temporary; mandates last forever," explained.

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