Still a Chance for Health Reform

July 10, 1994

There is a bumpy road ahead for health care reform -- and precious little time before congressional elections overtake all else on the national agenda. But the flurry of proposals that emerged from committees before Congress adjourned for its July 4 recess kept alive the chances that health care legislation can be enacted this year.

That's important, because mid-term shifts in party power may well strengthen the hand of Republican opponents enough to scuttle prospects for significant reform during this presidential term.

On purely political grounds, President Clinton and his Democratic Party sorely need a health care victory as Exhibit A in their case to retain the White House. And in terms of the national interest, it may well be now or never for far-reaching reforms that can assure health coverage to all Americans at a reasonable price.

The plans now pending in the House and Senate present a patchwork of proposals. Of the two major plans, the House Ways and Means Committee, traditionally the incubator for milestone social legislation, produced the bill closest to the administration's own proposals, promising health insurance to all Americans and requiring employers to shoulder the bulk of the cost. By contrast, the Senate Finance Committee's bill fails to require coverage for everyone, relying instead on insurance reforms to make coverage more widely available.

Even so, it was more important to the administration for key committees to report a bill -- any bill -- than the specifics of each proposal. With that accomplished, House and Senate majority leaders can use those bills to craft proposals for consideration on the floor. That work is under way as Congress goes back into session tomorrow.

The big debates -- universal coverage, employer mandates, cost containment measures, the shape and cost of minimum benefits packages, timetables for instituting reforms -- will generate much rhetoric. But, initially at least, both House and Senate bills will almost surely contain President Clinton's linchpin demand of universal coverage, a point that many observers consider the key upon which other important elements of reform will rise or fall.

If the pattern of deliberations in the Ways and Means Committee are any indication, the greatest strength of universal coverage is that without it other key goals of health care reform become virtually impossible to attain -- cost containment representing a prime example. But it takes time for the parties to these debates to trace the connections between the various elements of such complex and far-reaching proposals. That is why at this point the ticking clock is the greatest obstacle to health care reform.

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