Panel headed by Clinton critic may be best hope for health care reform bill


WASHINGTON -- When Congress finally begins work this week on President Clinton's plan to overhaul the nation's health care system, the lawmaker in the driver's seat will be one of the administration's most relentless critics: Rep. Fortney H. "Pete" Stark.

Yet the California Democrat who chairs the House Ways and Means health subcommittee may give the president's plan more favorable treatment than it will get from any other congressional panel with such an important role in its fate.

Mr. Stark's subcommittee is expected to scrap the president's controversial and untested government-run purchasing alliances, through which Mr. Clinton would require nearly everyone to obtain health insurance.

The subcommittee also plans to reverse Mr. Clinton's overall approach to health care reform by dealing first with the one-third of Americans who now lack health insurance coverage before interfering as much as the president would with the mostly private insurance that serves the remaining two-thirds of the nation.

"The Clinton bill is wonderful, brilliant; I'm a co-sponsor of it," said Rep. Benjamin L. Cardin, a Baltimore Democrat who serves on the health subcommittee. "But it needs to be made more credible."

Employer contribution

Even so, the Stark panel is expected to endorse the most controversial elements of Mr. Clinton's proposal: a requirement that employers pay a portion of their employees' health care costs in order to achieve universal coverage, and cost controls through caps on fees or insurance premiums.

Neither of two other major committees with jurisdiction over health reform -- House Energy and Commerce or Senate Finance -- shows any sign of being able to match this feat.

In fact, the health subcommittee of Energy and Commerce, which had originally been scheduled to kick off legislative work on the president's proposal last week, is deadlocked and may not be able to agree on a bill.

This week marks the beginning of a legislative process so complicated, contorted and complex that it is unlike anything Congress has attempted in recent memory.

Dozens of committees and subcommittees in the House and Senate will get at least a small piece of the 1,400-page bill, which is aimed at nothing less than an overhaul of an industry that represents one-seventh of the national economy.

As if that weren't enough to make the job difficult, the refusal of most Republicans to participate has made it highly partisan. Worse yet, the Democrats are sharply divided into at least three camps that the White House and legislative leaders must somehow draw together.

Though almost everyone still expects some kind of health reform legislation to pass this year, many lawmakers have been reluctant to move toward a compromise because they haven't known exactly what's on the table.

So, the Stark subcommittee's product, due to be completed by the Easter recess, will be touted by the administration as a critical first victory for Mr. Clinton.

'The ball in play'

"Stark wants to achieve the president's ends though not necessary by the same means, but he's putting the ball in play," observed Martin Corry, a lobbyist for the American Association of Retired Persons, which is generally sympathetic to Mr. Clinton's proposal. "We may not see the high-water mark until we get to the Rose Garden."

Whatever legislation Congress enacts that meets Mr. Clinton's minimum demand of guaranteed health insurance for all Americans will be feted in the Rose Garden as a presidential triumph.

"We're pleased the congressional committees are finally beginning to act," said Lorrie McHugh, a White House spokeswoman for the health care reform effort. "We know this is going to be a long process with a lot of twists and turns."

By getting the process rolling, Mr. Stark may unleash a political dynamic that will break the stalemate that has prevented the development of any consensus on the health care issue.

Mr. Stark is an unlikely champion for the White House: He has been openly, often nastily critical of Mr. Clinton's bill almost since it was introduced. He is a strong-willed maverick more concerned about following his own principles than building consensus.

But the California Democrat is possessed of a subcommittee on which six of the seven Democrats are either backers of the Clinton plan or supporters of the more liberal Canadian-style, single-payer alternative, including its chief sponsor, Rep. Jim McDermott of Washington.

Mr. Clinton, who met with many lawmakers from the single-payer group at the White House last week, has promised them their plan will be put to a vote on the House floor if they cooperate in the development of his proposal.

With this working majority, Mr. Stark is expected to be able to shape a health care reform plan that blends elements of the Clinton and McDermott plans for dealing with the uninsured but seeks a minimum of disruption for Americans who feel they are adequately served by the current system.

The other major House subcommittee that will deal with the Clinton plan still lacks a majority in support of any proposal.

Rep. Henry A. Waxman, a California Democrat who heads the Energy and Commerce subcommittee on health, doesn't have the votes to get his version of the Clinton program through.

He needs the support of all but two of his panel's 15 Democrats. But at least three of the Democrats, including Rep. Jim Cooper of Tennessee, sponsor of the leading rival proposal, appear to be out of reach. A fourth is firmly undecided.

"We have a lot of work to do," acknowledged Rep. Ron Wyden of Oregon, a Waxman backer.

Unimpressive numbers

The numbers aren't much better on the full Energy and Commerce Committee, despite chairman John D. Dingell's passionate desire and career-long determination to help enact national health care insurance legislation.

At an informal gathering of 11 Clinton supporters on his committee earlier this month, Mr. Dingell grudgingly agreed that the Ways and Means subcommittee should go first.

Even the full Ways and Means Committee is likely to produce a more conservative product than its Stark subcommittee, according to its chairman, Rep. Dan Rostenkowski, a Democrat from Illinois.

The Clinton bill is expected to be all but rubber-stamped by two of the most liberal committees in Congress: the House Education and Labor Committee, headed by William D. Ford of Michigan, and the Senate Labor and Human Resources Committee, chaired by Sen. Edward M. Kennedy of Massachusetts.

But neither panel has jurisdiction over the key financial matters at the heart of most of the controversy.

"If Stark's as good as they get, the Clinton bill is really in trouble," observed Nicholas E. Calio, a lobbyist for the Health Insurance Association of America, which opposes the measure as offered. "But I think that's probably right."

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