Clinton offers health care deal, but governors, GOP don't buy

February 01, 1994|By John Fairhall | John Fairhall,Washington Bureau of The Sun

WASHINGTON -- Making a new bid for support for his health care reform plan, President Clinton offered yesterday to compromise on two key provisions, but he failed to placate many critics.

The president told a meeting of the nation's governors that he was willing to compromise on proposals to limit health care spending and to require employers and employees to buy insurance through regional bureaucracies called "alliances."

But the governors approved a health reform policy that doesn't achieve the president's goal of guaranteed coverage for all Americans.

The chief problem for many of the governors and for many in Congress is the president's proposal to finance universal coverage by requiring employers to pay 80 percent of their workers' premiums.

Critics fear this would burden employers and ultimately lead to less employment and fewer businesses.

Maryland Gov. William Donald Schaefer, a Democrat who endorsed President George Bush in the 1992 election, said of Mr. Clinton: "I don't think he fully understands the impact on small business."

Although Mr. Clinton didn't specify what compromises he'd accept on other features of his plan, his willingness to consider changes could rob critics of some of their ammunition. Senate Minority Leader Bob Dole of Kansas, the most prominent congressional opponent of the president's plan, has attacked the alliances and health care spending limits as harmful governmental intrusions.

"What I and my colleagues refuse to accept," Mr. Dole said yesterday, "is the destruction of the best health care delivery system in the world . . . in the guise of making health care available to all." Mr. Dole spoke to the American Hospital Association, which Mr. Clinton will address today.

Republican lawmakers have embraced a number of different bills, but most now agree on similar goals that they say would make it easier for Americans to buy and retain private health insurance. Mr. Dole said Republicans could support creation of insurance purchasing organizations -- a voluntary form of Mr. Clinton's alliances -- and insurance reforms that would permit people with health problems to buy coverage and keep it without fear of termination. Administration officials say, however, that the GOP bills would not result in universal coverage or make insurance affordable for people with serious health problems.

In his State of the Union address last week, the president said he would veto any bill that didn't provide universal coverage.

The debate over health reform has intensified now that Congress is back after a lengthy recess and health reform is at the top of its agenda.

Families USA, an advocacy group supporting the administration, condemned yesterday the alternative reform approaches espoused by Sen. John Chafee, a Rhode Island Republican, and by Rep. Jim Cooper, a Tennessee Democrat who has teamed up with Sen. John B. Breaux, a Louisiana Democrat.

But the White House received bad news from a new study, published in the journal Health Affairs, which said health care costs will continue to rise 5 percent a year even if reform legislation can eliminate waste in the system. Financing of the president's plan may fall short if health care costs rise 5 percent or more a year, according to the administration's own projections.

Just how hard it will be to achieve consensus on reform was apparent at yesterday's meeting of the National Governors' Association, which took place after the governors had met with Mr. Clinton at the White House. The governors, hoping to influence the debate in Congress, struggled to agree on reform goals and ultimately approved a bipartisan statement that fell far short of what the White House wants.

The governors did not endorse the president's goal of guaranteed universal coverage, or his proposals that employers pay workers' premiums and that people buy insurance through alliances. Despite the statement, some governors said they remained committed to the president's goal of universal coverage.

But the governors' statement, pounded out behind closed doors, does go well beyond some of the minimal reform approaches embraced by some Republicans. It calls for government subsidies for low-income families, voluntary insurance purchasing groups in each state and a requirement that employers make available -- but not necessarily pay for -- health insurance.

To fund the subsidies, the governors proposed that the government tax individuals on the value of health benefits they buy in excess of a "core benefits package" that all employers would be required to offer. The core package would be "comparable to those that are now provided by the most efficient and cost-effective health maintenance organizations," the statement said.

Much of the statement dealt with ways the federal government can help the states, including Maryland, which have been busy enacting reforms within their own borders.

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