Senate opens debate today on Mitchell health proposal

August 09, 1994|By Karen Hosler and John Fairhall | Karen Hosler and John Fairhall,Washington Bureau of The Sun

WASHINGTON -- After nearly a year of national confusion and anxiety over health care reform, the Senate begins a debate today that may determine whether the centerpiece of Bill Clinton's presidency survives.

The next few days and weeks will test whether President Clinton's gamble to undertake the most ambitious social welfare crusade in at least three decades pays off or succumbs to the enormous political pressures that have stymied such efforts in the past -- possibly taking Mr. Clinton's chances for a second term down with it.

Those pressures -- from an array of well-financed special interests -- have already prompted Senate Majority Leader George J. Mitchell of Maine to dramatically scale down the Senate version of Mr. Clinton's proposal so that it falls far short of the president's original goals.

The bill Mr. Mitchell will bring up for full Senate consideration today doesn't match the president's promise of health care for all Americans. Nor does it slow down the runaway health care spending that consumes one-seventh of the national economy and threatens to take more.

But the delicately crafted Mitchell plan makes what Mr. Clinton has called an acceptable start toward dismantling an inefficient system that rewards unnecessary testing and treatment, while leaving millions of working people without health care that could save money and lives.

Greater competition among doctors and health plans would be encouraged through insurance reforms. Subsidies would expand access to primary and preventive care for vulnerable groups, such as children and pregnant women. The elderly would get prescription-drug coverage through Medicare and federal support for home- and community-based long-term care.

"It's certainly not all we hoped for, but it's better than the status quo," said John Rother, chief lobbyist for the American Association of Retired Persons, which is among the advocates of Clinton-style health reform.

Given the highly charged atmosphere in which the Senate will debate the plan, Mr. Mitchell's great challenge will be to get even this watered-down version of Mr. Clinton's original plan passed.

Months of pounding from business and insurance-industry lobbyists have made the public so wary of further government intrusion in their lives that a majority of Americans told pollsters // for Newsweek recently that they believed congressional action on health care reform should be put off until next year.

Attacks on the Mitchell plan from Republicans, who believe they have a chance to take control of at least one house of Congress this fall if Mr. Clinton falters on health care, are certain to give the debate a biting edge. The Mitchell bill is expected to be bombarded with GOP amendments, and some Republicans are threatening to filibuster.

"Am I willing to use every power I have as a member of the U.S. Senate to stop a government takeover of health care in America?" Sen. Phil Gramm of Texas, a likely contender for the 1996 Republican presidential nomination, said yesterday. "The answer is yes, and I'm going to do it proudly."

House Democrats are keeping a watchful eye on the process before opening debate next week on their proposal. Party leaders are hoping for clues that the Senate would be willing to accept at least Mr. Mitchell's modest version of the Clinton proposal to require businesses to pay 80 percent of the cost of their workers' health insurance. Mr. Mitchell dropped the requirement to 50 percent, delayed it until 2002 and exempted companies with 25 or fewer employees.

If the Senate amends the Mitchell bill to further lighten the burden on employers, House leaders may not be able to pass their more sweeping version of the health care bill, which is similar to the original Clinton plan. The House bill is scheduled to come up for a final vote on Aug. 19.

While Republicans and conservative Democrats are shooting at the Mitchell bill from the right, the measure is coming up for criticism from virtually every other quarter as well. Many complain that the Mitchell proposal offers few immediate benefits to the middle class.

Americans who are provided by their employers with good insurance plans are unlikely to receive new benefits or lower premiums. Some employees could lose ground if their employers tailor benefits to match a less-generous benefits package approved by Congress.

And people who lack adequate health insurance today won't necessarily get it from the Senate proposal. Mr. Mitchell set a benchmark of 95 percent coverage as the test for determining whether the program has succeeded within five years in expanding coverage beyond today's 85 percent level. If the benchmark is reached, no further action would be required. But if the benchmark is not reached, the 50 percent "employer mandate" would take effect in 2002.

Further, the health insurance price controls in the Clinton plan have been replaced with a tax on high-cost insurance plans as the only cost-control feature.

"While this bill is touted as reform, it will not control skyrocketing health care costs, will not provide universal coverage and will not improve our health care system," said Ira Arlook of Citizen Action.

AFL-CIO officials, who were initially the strongest supporters of health care reform, are also up in arms. They denounce the Mitchell bill as "timid" and charge that it "would not solve the root causes of the current health care crisis."

Insurers, meanwhile, oppose a provision to require most employers to permit workers to buy insurance through state purchasing cooperatives. That means that companies that now offer their workers insurance through privately negotiated plans would lose the ability to bargain directly for those benefits.

Also likely to be unhappy are smokers and gun owners. Mr. Mitchell would increase the federal tobacco tax by 45 cents a pack and impose a 50 percent excise tax on ammunition.

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