AFL-CIO support draws health care battle lines



BAL HARBOUR, Fla. -- The decision by the AFL-CIO to run a full-scale campaign supporting President Clinton on health care reform is a mixed blessing for the White House.

One the one hand, there is no question Big Labor can be a significant ally in pressuring senators and congressmen teetering on the edge on the issue. The unions lost last fall in their effort to block the North American Free Trade Agreement, but it shouldn't be forgotten that more than half the Democrats in the House voted with them.

But the active role planned by the unions -- they are talking of spending $10 million or more on health care -- also serves to draw the ideological lines on the issue in sharper terms than otherwise might be the case. Or, put another way, it probably will be easier for conservatives to depict the Clinton plan as another old-fashioned liberal nostrum when the AFL-CIO is highly visible supporting it.

Announcing the labor decision, AFL-CIO President Lane Kirkland made no secret of the fact that the union leaders would have preferred a single-payer or government-run plan but had recognized "our only real hope" lay in supporting the Clinton program because it also includes the basic requirements for universal and comprehensive coverage.

The bipartisan alternative being offered by Democratic Rep. Jim Cooper of Tennessee and other conservatives and moderates, said Kirkland, is not a plan at all but "something to do instead of health care reform."

The union leaders, meeting with administration officials and Democratic congressional leaders here this week, made it plain that the bottom line for them is the controversial employer mandate -- meaning the requirement in the Clinton plan that everyone is covered by health insurance with employers paying 80 percent of the cost and a system of subsidies to make that goal feasible. Both Vice President Al Gore and White House adviser George Stephanopoulos were pressed for -- and delivered -- commitments that Clinton would not abandon that feature of the program that is essential to reaching universal coverage.

Now organized labor, both through the federation itself and affiliated unions, can establish itself as a countervailing force in both public advertising campaigns and lobbying on Capitol Hill.

But the problem may be that the unions are likely to be most effective in reaching senators and congressmen in industrial states who are already most likely to support the Clinton plan if they cannot have the alternative of single-payer. In some other parts of the country, especially the South and the Far West, union support often can be considered as much a stigma as a blessing these days.

As the health care debate evolves in Washington and elsewhere, it is becoming increasingly obvious that the employer mandate requirement is likely to be the sticking point for partisans on both sides of the argument. It is the focus of complaints from business groups such as the National Federation of Independent Businesses and the U.S. Chamber of Commerce that represent many smaller employers who claim they could not absorb the added costs.

The White House has sent some confusing signals in the past few weeks that might be interpreted as meaning the mandate could be compromised. But the only alternative route to universal coverage would be a tax increase, and that course is politically impossible. The only room for compromise appears to lie in reducing the 80 percent requirement to, let's say, 50 percent and in phasing in the universality of coverage over a longer period of time to make the cost burden more manageable.

Neither the White House nor the union leaders have ruled out such a deal if it becomes the price for putting together a winning coalition for passage when the bargaining grows serious sometime during the summer and early fall. But any such concession now would be seen as a sign of weakness.

What is clear now is that the AFL-CIO commitment draws a line in the sand even more emphatically than has been the case up to now. The message is that universal coverage means just that.

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