WASHINGTON -- President Clinton's proposal to require employers to buy health insurance for their workers -- the keystone of his plan to guarantee health care for all Americans -- won a narrow endorsement yesterday from a House subcommittee.
The 6-5 mostly party-line vote by the Ways and Means Committee's health subcommittee to approve the most controversial feature of Mr. Clinton's plan to overhaul the health care system comes at the beginning of an expected seventh-month battle. The legislation could be radically altered many times before it is final.
"We probably won't reach a final consensus until October," said Rep. Benjamin L. Cardin, a Baltimore Democrat who serves on the panel and supported the employer mandate.
Even so, yesterday's subcommittee vote was an important psychological victory for the president. Forcing businesses to pay at least 80 percent of the cost of a basic health package for their workers is considered critical to Mr. Clinton's goal of guaranteed care for all Americans. Many people without coverage are low-income workers whose employers do not provide it.
The employer-mandate provision was embraced by the subcommittee chairman, Rep. Pete Stark, a California Democrat who has rejected many other Clinton proposals in drafting the health care reform package being considered by his panel.
But the mandate has been under attack for months from small businesses and other potent political forces, and it is not at all clear whether it will be survive in whatever legislation emerges from Congress in the fall.
Congressional Republicans so far are solidly against it, as are many moderate and conservative Democratic lawmakers who prefer to encourage employers to offer health insurance through tax incentives and through lowering costs.
"This is the mother of all entitlements, cradle-to-grave health insurance paid for by business if you can get it," said Rep. Bill Thomas of California, the ranking Republican on the Stark subcommittee.
Rep. Fred Grandy of Iowa, one of three other Republicans on the subcommittee, argued that Mr. Clinton's "one-size-fits-all" approach would cost jobs at some companies and put others out of business.
"This provision establishes the fault line that runs through this committee and probably through the whole Congress," Mr. Grandy said. "The question is whether we believe in making health coverage voluntary or whether we believe in mandates."
The Republicans were joined in their opposition to the employer requirement by Rep. Michael A. Andrews, a Texas Democrat who is a co-sponsor, with Mr. Grandy, of an alternative reform proposal. That proposal relies on greater competition between health care plans to make insurance more affordable.
But Rep. John Lewis, a Georgia Democrat, called the effort to eliminate employer mandates "a dagger in the heart of the deal" that would kill the chance for meaningful reform.
Rep. Jim McDermott, a Washington Democrat and one-time practicing physician, said there "are only two ways" to achieve universal coverage: by making employers pay or by including everyone in a government-run program financed by taxpayers.
Mr. McDermott favors the second choice, but President Clinton determined that it would be even more difficult to get that kind of plan through Congress.
Yesterday was only the opening round in what may be two weeks of wrangling by the subcommittee before the full Ways and Means Committee begins work on the health care reform plan next month.
Mr. Stark must hold together his six-vote bloc to get a bill passed. Because all the Democrats have their own -- sometimes conflicting -- ideas about what the bill must contain, his work is uphill from here.
Mr. McDermott is seeking a more generous package of benefits than Mr. Stark has proposed, and Rep. Sander Levin, a Michigan Democrat, is determined to avoid a payroll tax on employers. Mr. Cardin said he also feels strongly about restoring some
subsidies for small businesses that Mr. Stark dropped from the Clinton proposal.