Health Care Reform Begins Its Journey

March 26, 1994|By Karen Hosler | Karen Hosler,Washington Bureau of The Sun

WASHINGTON -- Slowly, the legislative iceberg that represents President Clinton's drive for health care reform has begun to move through Congress.

As predicted, it is already melting into a much less ambitious program.

Details of the bill likely to pass next fall are far from clear, but its general shape is beginning to emerge. Compared with the original Clinton proposal, the final product will offer a less generous benefits package, place a lighter burden on employers, rely less on new bureaucracies, impose weaker cost controls and take longer to go into effect.

The first steps were taken by the House Ways and Means Committee's subcommittee on health, which scaled back Mr. Clinton's bill considerably in the version approved by a one-vote margin this week. The chairman of the Ways and Means Committee, Rep. Dan Rostenkowski, an Illinois Democrat, predicts that the full committee will produce an even more conservative version.

Leaders of the House Energy and Commerce Committee haven't yet secured the votes to pass any version of health reform legislation, despite a compromise plan to eliminate nearly all the cost to small businesses.

In the Senate Finance Committee, which will begin next month to craft its version of health care reform, there is strong sentiment to drag out full implementation of health care reform well into the next century.

"The prospect was always that we would move to the right of the president's plan," said Rep. Robert T. Matsui of California, a senior Democrat on the Ways and Means Committee. "But that's OK, as long as we stick to the goal of making sure that every American is covered."

"Universal coverage," Mr. Clinton's one nonnegotiable demand, remains the standard sought by the Democratic leadership and by many Republicans.

But in the months ahead, the debate will rage over just what universal coverage means and how to pay for it.

Those two questions, Mr. Rostenkowski says, are inextricably linked.

"Politically, of course, we'd like to immediately provide everything to everybody," the Ways and Means chairman said in speech Wednesday to the American College of Obstetricians and Gynecologists. "But that isn't a real possibility."

As the legislative process grinds on, there will be bargaining and compromising that will shrink the scope of what Mr. Clinton can achieve.

"Financing -- it all comes down to financing," said Thomas Scully, a top budget official in the Bush administration who specialized in health issues. "They'll be fighting that out to the very end."

Here is a glimpse of where key elements of the bill stand:

* Health care industry reforms: There is broad agreement on the need to end the insurance abuses to which Mr. Clinton referred in his news conference Thursday night: "No more dropping coverage or cutting benefits, no more lifetime limits, no more raising rates just because someone in your family has been sick or some are older than others."

Lawmakers are also united in a desire to make sure that workers won't lose coverage when they change jobs, that they will be able to choose their own doctors and that the paperwork process be streamlined.

These provisions, as well as limits on awards in medical malpractice cases, are included in nearly every version of health care legislation.

Such changes alone -- many of which were unthinkable just a couple of years ago -- could dramatically expand availability of insurance coverage, according to Sheila Burke, chief of staff to Senate Republican leader Bob Dole of Kansas and a former nurse who is considered a health care expert.

* Purchasing alliances: There has been broad rejection of Mr. Clinton's proposal to require all Americans to join regional alliances that would negotiate on their behalf for health insurance. But the alliances are likely to survive in a voluntary form because they provide a means for individuals and small businesses to pool resources to bargain for the lowest-cost insurance.

* Subsidized coverage for low-income people: This is a feature of all but the most limited Republican proposals and is likely to be approved. Because of its cost, though, the timing will probably be delayed past the 1998 deadline proposed by Mr. Clinton.

The goal is to provide a basic package of benefits to people now dependent on the limited services of Medicaid or who make too much money to qualify for Medicaid but cannot afford private insurance. The Ways and Means health subcommittee voted to create a new government-run program for them.

This costly part of the program inspires much of the debate about financing. Some money is expected to come from savings the existing Medicaid and Medicare programs. But new taxes would also be required. Proposals include Mr.

Clinton's call for a 75 cents-a-pack increase in the cigarette tax, which was raised to $1.25 by the Ways and Means subcommittee.

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