President may be forced to compromise on his goal of health care for everyone

June 14, 1994|By Karen Hosler and John Fairhall | Karen Hosler and John Fairhall,Washington Bureau of The Sun

WASHINGTON -- President Clinton may have to yield soon on what he has called the one nonnegotiable element of his health care reform proposal -- guaranteed private insurance for all Americans -- or risk getting no bill at all this year.

As the practical deadline for bringing the legislation to the House and Senate floors fast approaches, the president is being advised by Democratic and Republican legislators that he must settle for a compromise far short of what he's seeking or pass no bill and put the issue before voters in the fall congressional elections.

These lawmakers say the compromise will likely have to go beyond just slowing the timetable for achieving "universal coverage," which Mr. Clinton has already agreed to.

The president may have to drop altogether the idea of guaranteed coverage, at least for the foreseeable future.

Members of the Senate Finance Committee, which is crucial to the process but is hopelessly stalled, have been talking about trimming back the legislation so that it would assure basic health insurance for about 90 percent of Americans instead of 100 percent.

Nearly 85 percent of Americans now have some health insurance.

A recent private study, which is said to have greatly intrigued Mr. Clinton, concluded that nearly all Americans who want health insurance can get it with more limited reforms than those Mr. Clinton has in mind.

Neither the cost controls nor the requirement that employers help pay insurance premiums for their workers under the Clinton bill would be necessary, according to the Lewin-VHI Report, a study by a northern Virginia medical statistics research organization.

This option is expected to be raised at a White House meeting today between Mr. Clinton and the bipartisan leadership of the Senate Finance Committee.

But it's not clear whether Mr. Clinton is convinced that he needs to bend so far, or that it might not be better to stand and fight.

Many of his advisers argue that covering 9 out of 10 Americans isn't good enough.

"I'm not going to get into the numbers game," Vice President Al Gore said yesterday when reporters pressed him on whether the White House would accept less-than-100-percent coverage of Americans.

But he observed that none of the alternatives to Mr. Clinton's bill proposed so far would reach even 90 percent coverage.

"All of the plans that do not have universal coverage will leave millions and millions of Americans without health insurance and . . . we will not accept that," Mr. Gore said. "Universal coverage is universal coverage."

Universal coverage, however, is impossible to reach without some means to pay for it.

Mr. Clinton's proposal to require employers to shoulder most of the burden for financing health care premiums is highly controversial.

Yet an alternative Republican plan to require individuals to buy their own insurance may be even more unpopular. A third plan -- to raise taxes -- is considered the worst of the lot.

All three congressional committees grappling with the financing issue have stumbled on it so far.

The House Energy and Commerce Committee is deadlocked on the employer requirement and might not produce a bill.

The House Ways and Means Committee is scheduled to begin work tomorrow on its version of the Clinton bill. But the acting chairman, Rep. Sam Gibbons, a Florida Democrat, does not have all his votes locked up.

Sen. Daniel Patrick Moynihan, D-N.Y., the Senate Finance Committee chairman, also unveiled a draft bill similar to Mr. Clinton's last week but has attracted the support of only five of the committee's 11 Democrats and none of 10 Republicans.

Mr. Moynihan, who was under great pressure from the White House to try to get a bill through solely with Democratic votes, offered the Clinton-style proposal as a way to demonstrate that he needs bipartisan support to get a bill through.

Sen. Bob Dole of Kansas, the Senate minority leader, declared Saturday that he was ready to filibuster the health care reform bill if it includes some form of financing requirement for employers.

But Sen. Bob Packwood of Oregon, who is the ranking Republican on the Finance Committee and will be going with Mr. Moynihan to the White House today, said that such a filibuster won't be necessary.

Mr. Packwood predicted that the Democrats will not find a majority for any kind of employer requirement -- even one phased in over many years.

"The fact is that 85 percent of Americans have health insurance, and they don't care about universal coverage," he said.

"Those who don't have health in surance want it, but they aren't passionate about it. But those who are passionate are the small-business people, who don't want to have to pay for it. For them, the issue is as emotional as gun control or abortion."

Still, the Democratic loyalists have not given up.

Sen. George J. Mitchell of Maine, the majority leader, is sounding out moderate Republicans on the Finance Committee this week to determine what it might take to get a bipartisan bill passed.

He met yesterday with Sen. David Durenberger of Minnesota and also plans sessions with Sen. John H. Chafee of Rhode Island and Sen. John C. Danforth of Missouri.

The Clinton administration also seems increasingly enamored of a compromise plan floated by Sen. John B. Breaux, a moderate Louisiana Democrat who holds a swing vote on the Finance Committee.

Mr. Breaux suggests that employers be given time to voluntarily provide health care for workers who do not have it. If they fail to do so, however, a mandate for employer action would be phased in over time.

"I don't want to sit here and endorse the plan in its entirety," Treasury Secretary Lloyd M. Bentsen told reporters yesterday. "[But] phasing it in certainly has some appeal. I think the administration could live with that."

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