Clinton revising health plan Changes aimed at easing concern in Congress

October 26, 1993|By John Fairhall and Karen Hosler | John Fairhall and Karen Hosler,Washington Bureau

WASHINGTON -- Facing a tough fight over the health care reform legislation he'll present tomorrow, President Clinton is making last-minute changes to ease congressional concerns about costs, regulation and other issues.

To save money, Mr. Clinton is considering phasing in some benefits over a longer period of time and limiting future federal subsidies for low-income people. To address fears that he would impose government controls on the health care system, he is cutting back the proposed state regulation of competition.

Administration officials and outside groups consulting with the White House on health reform say Mr. Clinton is mulling other changes in the outline of the plan he submitted to Congress last month. The president and first lady Hillary Rodham Clinton will go to Capitol Hill tomorrow for a ceremonial presentation to Congress of a 1,600-page bill that details exactly how their proposed health care system would work.

The president has scaled back parts of the plan to mollify critics who think the changes are too radical in scope, affecting one-seventh of the economy and fundamentally changing the way health care is delivered and financed.

Alternative reform plans are proliferating on Capitol Hill and lawmakers say it's likely some legislation will pass, but not the bill the president will present. The other proposals are generally less costly, less complex and, in most cases, far less likely to achieve the president's goal of universal health coverage for all Americans by 1997.

"I think there is a good chance a comprehensive health care bill is going to pass, but a lot of us feel we've just got to move very cautiously on this thing," said Sen. John H. Chafee, a Rhode Island Republican trying to forge a legislative compromise. "The potential costs are so explosive, we've got to make sure we're achieving some savings first."

Finding common ground

Finding common ground won't be easy. Lawmakers who like some changes don't like others Mr. Clinton is contemplating.

If Mr. Clinton's bill is to prevail, he will have to do a better job persuading people that they would benefit personally. Wary and confused, Americans aren't yet sure whether they'd fare best under his approach, the Republican proposals or the status quo, according to a poll released last week by Harvard University and the Kaiser Family Foundation.

The Clinton plan would guarantee a comprehensive package of benefits to all Americans, including the 37 million who are uninsured. Employers would pay at least 80 percent of workers' premiums, with workers paying the rest. The money would go to regional "health alliances," organizations that would represent consumers in negotiations with health plan providers.

Consumers would be offered a choice of health plans, including one from a health maintenance organization and a more expensive alternative that would allow patients a broader choice of doctors. Poor people now served by the Medicaid program would join this new system; most elderly would remain in Medicare for the time being.

Mr. Clinton's draft plan included a long-term care benefit that would be phased in over five years, beginning in 1996. But to save money, the White House is considering lengthening that to seven years, said John Rother, legislative director of the American Association of Retired Persons, which is still assessing its position on the plan. In another effort to lower costs, a draft plan provision for government-subsidized coverage of early retirees, people 55 to 64 years of age, "may have been bumped back a year," he said.

Despite the changes, the scope of the plan remains ambitious -- a radical reshaping of one-seventh of the nation's economy. Robert J. Blendon, a Harvard professor who helped design the Harvard-Kaiser poll, said Mr. Clinton must win over a large majority of the public, or face a further scaling back of his plan.

"There are 800 lobbying organizations on health care and the general message of the lobbying organizations is go slow," he said. "What Clinton needs is so much public support that Congress can look at these 800 lobbyists and say, 'I can't do something small, I've got all these people here.' "

But so far the president has not mounted the "enormous effort, on a sustained basis," which Mr. Blendon believes is required to get such popular backing. But even if he does make the effort, it may be difficult to build support.

One health care expert who informally advised the White House task force on health care reform said the Clinton plan doesn't inspire enthusiasm because it gives a little to a lot of people but not a lot to anybody.

"This plan doesn't have a lot of major groups that are dying to support it," he said. "I can't find anybody who is passionate."

'News mostly bad'

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