WASHINGTON -- Facing a tough fight over the health care reform legislation he'll present tomorrow, President Clinton is making last-minute changes to ease congressional concerns about costs, regulation and other issues.
To save money, Mr. Clinton is considering phasing in some benefits over a longer period of time and limiting future federal subsidies for low-income people. To address fears that he would impose government controls on the health care system, he is cutting back the proposed state regulation of competition.
Administration officials and outside groups consulting with the White House on health reform say Mr. Clinton is mulling other changes in the outline of the plan he submitted to Congress last month. The president and first lady Hillary Rodham Clinton will go to Capitol Hill tomorrow for a ceremonial presentation to Congress of a 1,600-page bill that details exactly how their proposed health care system would work.
The president has scaled back parts of the plan to mollify critics who think the changes are too radical in scope, affecting one-seventh of the economy and fundamentally changing the way health care is delivered and financed.
Alternative reform plans are proliferating on Capitol Hill and lawmakers say it's likely some legislation will pass, but not the bill the president will present. The other proposals are generally less costly, less complex and, in most cases, far less likely to achieve the president's goal of universal health coverage for all Americans by 1997.
"I think there is a good chance a comprehensive health care bill is going to pass, but a lot of us feel we've just got to move very cautiously on this thing," said Sen. John H. Chafee, a Rhode Island Republican trying to forge a legislative compromise. "The potential costs are so explosive, we've got to make sure we're achieving some savings first."
Finding common ground
Finding common ground won't be easy. Lawmakers who like some changes don't like others Mr. Clinton is contemplating.
If Mr. Clinton's bill is to prevail, he will have to do a better job persuading people that they would benefit personally. Wary and confused, Americans aren't yet sure whether they'd fare best under his approach, the Republican proposals or the status quo, according to a poll released last week by Harvard University and the Kaiser Family Foundation.
The Clinton plan would guarantee a comprehensive package of benefits to all Americans, including the 37 million who are uninsured. Employers would pay at least 80 percent of workers' premiums, with workers paying the rest. The money would go to regional "health alliances," organizations that would represent consumers in negotiations with health plan providers.
Consumers would be offered a choice of health plans, including one from a health maintenance organization and a more expensive alternative that would allow patients a broader choice of doctors. Poor people now served by the Medicaid program would join this new system; most elderly would remain in Medicare for the time being.
Mr. Clinton's draft plan included a long-term care benefit that would be phased in over five years, beginning in 1996. But to save money, the White House is considering lengthening that to seven years, said John Rother, legislative director of the American Association of Retired Persons, which is still assessing its position on the plan. In another effort to lower costs, a draft plan provision for government-subsidized coverage of early retirees, people 55 to 64 years of age, "may have been bumped back a year," he said.
Despite the changes, the scope of the plan remains ambitious -- a radical reshaping of one-seventh of the nation's economy. Robert J. Blendon, a Harvard professor who helped design the Harvard-Kaiser poll, said Mr. Clinton must win over a large majority of the public, or face a further scaling back of his plan.
"There are 800 lobbying organizations on health care and the general message of the lobbying organizations is go slow," he said. "What Clinton needs is so much public support that Congress can look at these 800 lobbyists and say, 'I can't do something small, I've got all these people here.' "
But so far the president has not mounted the "enormous effort, on a sustained basis," which Mr. Blendon believes is required to get such popular backing. But even if he does make the effort, it may be difficult to build support.
One health care expert who informally advised the White House task force on health care reform said the Clinton plan doesn't inspire enthusiasm because it gives a little to a lot of people but not a lot to anybody.
"This plan doesn't have a lot of major groups that are dying to support it," he said. "I can't find anybody who is passionate."
'News mostly bad'
Although Mr. Clinton scored a public relations victory Sept. 22 with his speech to the nation on the need for reform, the news since then has been mostly bad for him. Insurers and the Republican National Committee launched television advertising attacks, lawmakers griped about White House delays in delivering the reform legislation, a manufacturers' group that was courted by the administration criticized the plan, and the president was diverted by foreign policy problems and the debate over the North American Free Trade Agreement.
One bright spot -- Mrs. Clinton's well-received congressional testimony in the days following the speech -- dimmed quickly when the administration later sent surrogates to Capitol Hill to talk about the plan. Lawmakers snapped at Health and Human Services Secretary Donna E. Shalala when she couldn't answer questions about the funding of the plan, which is emerging as the most controversial issue.
Mr. Clinton says he could pay for universal coverage with only one comparatively small tax increase, a 75-cent boost in the federal cigarette tax. But many economists believe the plan would require massive infusions of tax funds in the future.
Arnold Bennett, media relations director of Families USA, a small advocacy group working closely with the administration on health reform, says the administration's presumed allies on reform, such as the American Association of Retired Persons and the AFL-CIO, need to do more.
"If anyone deserves criticism, it is those . . . who want reform. We're not doing enough," Mr. Bennett said.
Despite the problems in the days ahead, Mr. Clinton is widely seen as already having won the key reform battle: making it a national priority.
"It seems to me that since taking office, Clinton has defined health reform as an issue you can't afford to be against politically," said an aide to Rep. Dan Rostenkowksi, the Illinois Democrat who chairs the Ways and Means Committee. "And I think that's pretty significant."
Thomas A. Scully, a top Bush Administration official who worked on health issues, objects to the substance of the White House plan but calls it "brilliant" politically."
"They bought off a lot of the traditional Democratic constituency," such as senior citizens, who would receive drug and long-term coverage, he said.
As long as the White House is willing to compromise, it will come out a winner, said Mr. Scully, now a lobbyist with Patton, Boggs & Blow, which represents some clients opposed to the Clinton plan.
"I believe something is going to pass. And the president is going to get credit."
QUESTION AND ANSWERS
QUESTIONS: I plan to retire at age 55 and won't have any company insurance coverage. How would the Clinton plan affect me? P. S., Fork.
ANSWER: The government would pay 80 percent of the cost of early retirees' health care; retirees would pay 20 percent. You'd receive the same guaranteed benefits package all Americans would be entitled to. If you were working at a firm that provided health care to retirees in the 55-to-64 age group, the firm could continue paying for that coverage. It also could supplement the benefits you'd receive under the government-guaranteed plan. For example, it could provide dental coverage, which would not be available in the government plan.
QUESTION: How would this health care plan affect the vTC watermen of the state of Maryland -- like my dad -- who are considered self-employed, but, as we all know, do not make enough money to pay the $4,000 a year for family health coverage? And they obviously don't have an employer to pay 80 percent for them. T. S., Baltimore.
ANSWER: Your dad will have to purchase health insurance for himself and his dependents. For a typical family, the full cost of insurance is expected to run about $4,200. But if his income is low, as you say, most of his cost will be subsidized. Small businesses may pay as little as 3.5 percent of their income as a premium for the standard benefits package.
If you have questions about health care reform, we'd like to hear them. Call Sundial, The Baltimore Sun's telephone information service, at (410) 783-1800 (268-7736 in Anne Arundel County). After you hear the greeting, punch in the four-digit code 4425 on your touch-tone phone.