WASHINGTON -- Personally delivering his massive health care reform bill to Congress yesterday, President Clinton warned lawmakers already predicting changes in the legislation that he will not compromise on guaranteeing health care to all Americans.
First Lady Hillary Rodham Clinton shared the limelight with the president in a ceremony that marked their second launching of his plan, which he first unveiled in a nationally televised speech last month. The president will begin to sell his legislation outside Washington in an appearance at the Johns Hopkins University in Baltimore today.
Drawing a line on how far he will go to win approval for health reform, Mr. Clinton said for the first time he "will not support or sign a bill" that doesn't guarantee a "comprehensive package of health care benefits that are always there and that can never be taken away."
That drew applause from the approximately 70 Republicans and Democrats attending the ceremony inside a hall at the Capitol housing statues of famous Americans. But many of the same lawmakers made it clear that Congress will be the final arbiter of health care reform -- and the result may not look like the president's 1,336-page bill.
"We have some honest differences," said Senate Minority Leader Bob Dole, who believes the legislation relies too heavily on regulation. "Turning over one-seventh of our economy to the United States government is an idea that has many Americans, Republicans and Democrats, very concerned."
But Clinton supporters disputed critics of his plan who believe it is too ambitious. "The major players have rejected incrementalism," said Sen. Edward M. Kennedy, a Massachusetts Democrat, asserting that key lawmakers are in favor of comprehensive reform.
Lawmakers and administration officials expressed confidence that some legislation would be enacted before congressional elections next year. Congressional hearings on reform, which began after Mr. Clinton spoke to the nation about health care reform Sept. 22, resume today.
Critics of the Clinton plan attack the credibility of its financing, the requirement that all employers pay for health care and the imposition of limits on insurance premiums if market competition failed to hold down prices. Small business groups predict the plan would cost millions of jobs, and the American Medical Association warns that it could lead to rationing of health care.
The public release of the long-awaited legislation triggered a stampede to government bookstores, where the 2-inch-thick copies were selling for $45. Lobbyists and officials of the hundreds of groups who would be affected by the bill were eager to dissect it.
Even the most supportive groups have some qualms about various parts and will join the battle to amend the legislation.
Most of the major elements of the Clinton plan had been publicized before yesterday, although the plan was changed in several ways in recent days as the administration sought to allay fears about creating a new entitlement program whose costs could spiral out of control.
Cost estimates rise
But the administration released new estimates -- higher than previously reported -- for the costs of health care in the new system envisioned by the president.
The average premium for a two-parent family would be $4,360 a year, according to administration officials. That's up from the previous estimate of $4,200 and reflects new forecasts of inflation.
The premium for a single person would be $1,932, $132 more than had been projected. The premium for a single-parent family of any size would be $3,893, and for a childless couple, $3,865.
These numbers reflect what premiums would be if the plan were put into effect in 1994. But the deadline for universal coverage set by Mr. Clinton is Jan. 1, 1998, at which time the premiums would be higher, accounting for rising medical costs. Administration officials provided no estimates for 1998.
Mr. Clinton's plan provides that employers pay at least 80 percent of the premiums for their workers, who would pay the remainder. Premiums for the unemployed, low-income workers, small businesses with no more than 75 employees and early retirees -- 55 to 64 years of age -- would be government subsidized.
No one would have to pay more than 3.9 percent of their income for health coverage, and administration officials predicted the average would be closer to 2 percent.
The administration plan outlines a comprehensive package of benefits all Americans would receive. One change, noted by officials yesterday, would add comprehensive dental coverage for adults in the year 2001. The plan's basic benefits include dental care for children and emergency dental care for adults.
Most Americans would receive coverage through regional health alliances, large purchasing organizations that negotiate with health plans on behalf of consumers. Although the Clinton plan is geared toward increasing managed care arrangements like health maintenance organizations, consumers would be guaranteed a more expensive fee-for-service option permitting broad freedom to choose doctors.
Participants in HMOs also would have the option, for an extra fee, to see doctors outside the organization.
Uncle Sam's share
Lawmakers generally have praised the benefits package, even while wondering how the government could afford its share of financing -- $331 billion in the first five years of the plan. Mr. Clinton sought to balance his promise of good benefits with a provision in his legislation that would limit the government's responsibility for funding the new health care system.
If the amount budgeted by the government for subsidies was in danger of being exceeded, the president and Congress would have to find other sources of revenue or cut back coverage.
That provision alarms Rep. Henry A. Waxman, chairman of the House Energy and Commerce subcommittee on health. "I think it undermines the administration promise of universal coverage -- insurance that will always be there -- because it won't be there if they run out of money," the California Democrat said.
"I don't like the uncertainty," said Rep. Benjamin L. Cardin, a Maryland Democrat on a House Ways and Means health subcommittee.
The administration moved quickly to dampen the criticism, dispatching deputy Treasury Secretary Roger Altman to talk to reporters at the White House late yesterday. Referring to the subsidy limits, he said, "I think it's far-fetched to think the ceilings would be breached."