Health plan changes are likely

January 27, 1994|By John Fairhall and Karen Hosler | John Fairhall and Karen Hosler,Washington Bureau

WASHINGTON -- Despite President Clinton's vow to veto any health reform legislation that doesn't cover all Americans, Congress is likely to modify his plan in favor of a compromise that would fall short of his ambitious goal of "health security" for everyone.

The president's veto threat -- a highlight of his State of the Union address Tuesday night -- cheered supporters of his reform plan but probably came too late to change the attitudes of lawmakers. Many are increasingly convinced that the nation's health care system does not require the kind of costly, radical reform advocated by Mr. Clinton.

Mr. Clinton met with House Democratic leaders yesterday to devise strategy for the fight over his bill, whose prospects have deteriorated in the past few months. Lawmakers returning from a lengthy holiday recess say their constituents are highly skeptical of the Clinton plan.

Underscoring the mood on Capitol Hill, House Speaker Thomas S. Foley told reporters that the veto threat doesn't preclude Congress from passing legislation that would phase in universal coverage. He didn't set a date or mention Mr. Clinton's 1998 deadline for universal coverage -- a goal many in Congress call impossible.

Senate Republican leader Bob Dole said in an interview with ABC yesterday that Mr. Clinton would have to "drop a lot of these big things," including the requirement that employers pay most of their workers' insurance premiums.

Administration officials said they were willing to accept compromises on every aspect of the plan but the goal of universal coverage and a generous package of health care benefits.

"This plan's going to be massaged a lot in the Congress," Treasury Secretary Lloyd Bentsen told a manufacturers' group. "We want to hear your second opinions. And together let's come up with something that's sensible that we can enact this year."

The waning enthusiasm in Congress for Mr. Clinton's plan reflects the feedback lawmakers have been getting from their constituents. Like many members who held health reform meetings during the congressional recess, Sen. Barbara A. Mikulski found lukewarm support for the president's plan, whether in "the drive-ins, the delis or the boardrooms."

"Everybody's concerned about the cost and complexity," the Maryland Democrat said, adding that she believes Congress will "take the best" of the Clinton plan and the alternative proposals and fashion a new plan this year. The compromise probably would cut the number of uninsured Americans, now 38 million, but will fall short of achieving universal coverage, many lawmakers and lobbyists predict.

Public enthusiasm for the Clinton plan has slipped considerably since the president unveiled it in a speech to the nation Sept. 22. While the president worked to pass the North American Free Trade Agreement, critics mounted a public relations campaign that has eroded support among the majority of Americans who have health insurance.

The Health Insurance Association of America, an insurance industry trade group, spent millions on television ads attacking the Clinton plan. The American Medical Association, representing doctors, is running newspaper ads warning patients that health reform threatens their relationships with physicians.

Some recent polls show that less than half the public favors the Clinton plan and that crime is overtaking health care as the public's No. 1 concern.

Momentum a challenge

"Momentum has been lost, and the president's challenge is to regain the momentum," said Drew Altman, president of the Kaiser Family Foundation, a health philanthropy interested in reform.

The next two months will be critical for the president's plan because of House committee deadlines to act on a reform bill. Clinton supporters say his speech to the nation Tuesday was an effective beginning of a campaign to win over the public.

"I think he advanced the cause tremendously," said Ron Pollack, executive director of Families USA, an advocacy group working closely with the administration.

Mr. Clinton's 1,342-page reform bill would overhaul the financing and delivery of health care, making employers responsible for 80 percent of workers' premiums and workers responsible for 20 percent. The federal government would subsidize small businesses and low-income workers, spending $390 billion over five years. Funds for this would be raised from an increased cigarette tax and savings extracted from the Medicare and Medicaid health programs.

Most Americans would receive coverage through powerful regional bureaucracies called "health alliances," which would collect premiums from employers and negotiate coverage with competing private health plans. All health plans would be required to provide a federally determined set of benefits, including coverage of hospital and doctor visits, prescription drugs and preventive care services. Medicare, the health program for the elderly, would remain separate and be enhanced by the addition of a prescription drug benefit.

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