WASHINGTON -- Democratic leaders plan to send to the full House next month a health care reform bill that includes President Clinton's controversial proposal that employers be required to buy health insurance for their workers -- but puts off its effective date for five years.
The delay, which would set a date at least two years later than the 1998 target proposed by Mr. Clinton and endorsed by two House committees, is intended to secure the votes of wary Democrats whose support is needed to pass the measure, according to House Majority Leader Richard A. Gephardt.
"The phase-in is real important," Mr. Gephardt, a Missouri Democrat, said yesterday. But, he added, "I believe we can pass that bill."
Including such an "employer mandate" in a bill guarantees a fierce fight in which Democratic leaders will have to gain the minimum 218 votes to pass the bill. Preliminary counts indicate they are at least 50 votes short.
Some Democrats and all House Republicans want to eliminate the employer requirement. Others favor postponing a decision for a few years. A dispute over the employer requirement forced a third House committee -- Energy and Commerce -- to give up trying to write a bill.
"I don't think a mandate will survive -- not now or in five years," said Rep. Jim Cooper, a Tennessee Democrat who sponsored a rival proposal that relies largely on greater competition in the insurance market to expand coverage.
House leaders don't want to weaken the employer requirement further before the legislation heads to a conference with the Senate,where opposition to any burden on employers runs high. House negotiators want room to bargain with the Senate while preserving the financing method most lawmakers believe is critical to achieving Mr. Clinton's goal of guaranteed health insurance for all Americans.
Mr. Gephardt said yesterday that he favors giving employers a "very generous phase-in" period before the mandate included in both bills would take effect.
Asked for a timetable, the majority leader said he thought that "five years is reasonable." That target is consistent with a House leadership's goal of putting Mr. Clinton's program in place before the end of the century.
The difficulty of achieving that goal was underscored yesterday by opening debate in the Senate Finance Committee. The chairman, Democratic Sen. Daniel Patrick Moynihan of New York, proposed his own version of the bill, which would require employers to finance health insurance within five years if lower costs and reforms in the insurance market fail to raise the level of coverage on their own.
But that so-called "triggered" approach is not expected to win a majority when the committee meets to vote today.
Even Sen. John B. Breaux, a Louisiana Democrat who first offered the plan to Mr. Moynihan, says he will vote against it.
Mr. Breaux is part of a bipartisan group of six Finance Committee members who developed a plan to set up a commission to recommend what steps Congress should take if fewer than 95 percent of Americans have health insurance by 2002. Even that plan, which includes tax increases to subsidize the poor, goes too far for Senate Minority Leader Bob Dole of Kansas.
Mr. Dole offered his own package yesterday of modest subsidies and insurance-law changes that he says has the support of "40 or 41" Republicans. Forty-one is enough to block a stronger bill with a filibuster, but it appears Mr. Dole can count on no more than 39 Republican votes.
"You can talk until you're blue in the face -- the issue of mandated universal coverage is dead," said Sen. Bob Packwood of Oregon, the senior Republican on the Finance Committee.
In the most controversial section of his bill, Mr. Clinton proposed that the bulk of health insurance be financed by requiring employers to pay 80 percent of the cost of premiums for their workers by 1998.
The employer requirement was endorsed both by the House Ways and Means Committee, which is expected to complete work on its version of a bill today, and in a bill passed by the House Education and Labor Committee.
As majority leader, Mr. Gephardt is charged with trying to stitch those two committee bills into a measure that can win support in the full House, where the membership is more conservative than the Education and Ways and Means committees.
The Ways and Means Committee version is likely to prevail on the issue of cost controls. Mr. Clinton proposed limits on insurance premiums that were passed by the Education and Labor Committee but inspired warnings of health care rationing from the insurance industry.
Ways and Means opted for a nine-member commission to review health costs annually and recommend controls to take effect by 2001.
Another feature of all bills in the House is the cigarette tax increase, which is popular as a financing device for health insurance with almost everyone but the tobacco industry. The Ways and Means Committee approved an increase of 45 cents a pack, phased in over five years.
Mr. Clinton proposed a 75-cent-a-pack increase. Mr. Moynihan's proposal before the Finance Committee would raise the tax to $2 a pack. The federal tax on cigarettes is now 24 cents a pack.