Flexibility breaks out on health care reform

WASHINGTON — WASHINGTON -- At the close of the winter meeting of the nation's governors here, Republican Gov. Carroll Campbell of South Carolina, the group's chairman, was asked whether in the conversations they had with President Clinton on health-care reform, the president had ever reiterated his State of the Union veto threat to Congress.

"He didn't wave the pen," Campbell replied with a wry grin, referring to Clinton's theatrical gesture in warning Congress what he would do to any health-care bill sent to him that did not "guarantee every American private health insurance that can never be taken away."


Since that time, much of the debate over health-care reform has centered on that proposition, more often referred to as a presidential insistence on "universal coverage." It continued 0' through the governors' conference, but there was a sense among many of the governors of both parties that Clinton is not going to be as rigid on what that constitutes as the veto threat first implied.

On a range of other issues regarding health care, he clearly demonstrated a conciliatory attitude. He told the governors that perhaps the health alliances his package has proposed to RTC purchase private insurance for participating businesses could be put on a voluntary basis. And he indicated he was not wedded to his specific proposals for controls on insurance premiums.


The president's apparent flexibility on these points, together with a number of issues on which the governors themselves hammered out bipartisan agreement with the Clinton plan, seemed to narrow the central dispute to the question of what would constitute universal coverage and who would pay for it.

The Republicans had already agreed to such major aspects of the Clinton package as portability -- keeping coverage if you move from one job to another -- and coverage for illnesses suffered before applying for insurance. Republican Gov. Tommy Thompson of Wisconsin, one of the architects of the governors' resolution, said later it went 85 percent of the way toward meeting the Clinton plan.

The centerpiece of Clinton's approach to universal coverage is that all employers would be required to pay at least 80 percent of the cost of private health insurance for their employees. The administration has argued that there are only two ways that the insurance can be paid for: with higher taxes, which it rejects for obvious political reasons, and with this so-called employer mandate.

The Republican governors counter that they favor, as in a bill proposed by Republican Sen. John Chafee of Rhode Island, universal "access" -- making the insurance available to employees, who would be required to buy it themselves (with whatever assistance employers might care to provide). In the governors' discussions with administration officials in the last few days, Campbell said, the phrase universal "availability" has been introduced, suggesting to some of the Republicans at least that the president is signaling a willingness to find a way past the seeming impasse.

One possibility raised by Democratic Gov. Howard Dean of Vermont, a strong Clinton backer, might be to change the formula to something like the employer's and the employee's each paying 50 percent of the cost. He says the Republican governors accepted the principle that the insurance would be bought through employers. Campbell, however, points to the resolution that says: "While governors do not agree on whether employers should be required to pay for any portion of the premium, governors agree that coverage should be available."

"There's already been a softening," said Republican Gov. John Engler of Michigan regarding Clinton's position on universal coverage. "He wants to compromise and he's giving himself more and more wiggle room."

At the same time Senate Minority Leader Bob Dole, who had been digging in his heels, saying there was no health-care crisis but only a problem, has backed off by saying it's time to get away from semantics and work something out. That distinctly was the mood among the governors as they left town believing they had helped create a conciliatory climate to which Clinton appeared to be responding.