WASHINGTON -- President Clinton scored his biggest victory so far in his quest to overhaul the nation's health care system yesterday when the influential House Ways and Means Committee approved the basic elements of his program.
The bill, which would require employers to pay most of the cost of their workers' health insurance, faces an uncertain fate in the full House. Many lawmakers there fiercely oppose such an "employer mandate." Still, an endorsement of the core of Mr. Clinton's program by the committee that has shaped the major social legislation of this century was a critical milestone.
"This could well be a historic day," said the acting committee chairman, Rep. Sam M. Gibbons, before the panel voted 20 to 18 to approve legislation that Mr. Gibbons said would guarantee all Americans health care "from birth to death."
"Many historic things have happened in this room," the Florida Democrat added, referring to the Social Security legislation of the 1930s and the Medicare program passed in the 1960s. "This could be another."
Mr. Clinton, watching on television as his sweeping proposal to overhaul one-seventh of the nation's economy reached a high-water mark in an arduous process, called the committee action "a giant stride forward."
The Ways and Means bill will be combined with another version (( of Mr. Clinton's proposal, passed earlier by the Education and Labor Committee, and will be sent to the House floor later this month.
As the Congress adjourned yesterday for its eight-day July Fourth recess, the fate of health care reform legislation was still much in doubt.
The Senate Finance Committee, a Ways and Means counterpart whose members are less inclined to respect party discipline, voted 14 to 6 to defeat a watered-down version of Mr.Clinton's proposal to require employers to provide health insurance.
In its place, the senators voted 12 to 8 to adopt a bipartisan alternative that does not assure the president's chief goal of guaranteed insurance coverage for all Americans. Instead, a commission would recommend steps Congress should take if voluntary measures fail to expand insurance coverage to 95 percent of Americans by 2002.
But even that was considered progress by Democratic leaders who had spent weeks trying to break a stalemate in the Finance Committee, which may complete work on the bill today.
"The most important thing is that we move the process forward,said Senate Majority Leader George J. Mitchell of Maine, who voted for the bipartisan compromise, although he said he does not agree "with every aspect."
Mr. Clinton, preparing for a fiercely partisan showdown on the Senate floor, yesterday attacked an alternative health care proposal unveiled Wednesday by Senate Republican leader Bob Dole.
"It does a little bit for the poor, it leaves all the powerful vesteinterest groups with everything they've got, and it walks away from the middle class and small business," Mr. Clinton said. "It is politics as usual."
zTC The Dole plan, for which the minority leader has lined up 39 of the 44 Republican senators, relies on subsidies for the poor and tax breaks for many workers to expand coverage, coupled with changes in insurance laws.
House Republicans on the Ways and Means Committee offered a similar proposal during a highly acrimonious finish to the committee's monthlong consideration of the health care bill.
Rep. Bill Thomas, a California Republican, predicted that if a health care bill is finally enacted this year, it will be the more modest Republican approach.
No Republicans supported the Ways and Means bill, but they sought to embarrass the Democrats by stressing how far it had strayed from Mr. Clinton's original proposal. Many of the provisions in the Clinton plan that inspired the most objections -- including limits on health insurance premiums and a requirement that everyone participate in regional health-purchasing alliances -- have been dropped or weakened in the committee proposal.
But Rep. Benjamin L. Cardin, a Baltimore Democrat, noted that Mr. Clinton's basic principles are included in the committee product. The bill includes Mr. Clinton's proposal that employers pay 80 percent of the cost of premiums for their workers -- the primary device for achieving Mr. Clinton's goal of guaranteed health care for all Americans.
"I believe we have taken the president's bill and we have improved upon it," Mr. Cardin said. "We are here today because of his leadership."
House Majority Leader Richard A. Gephardt of Missouri, who will package the legislation for the floor, said he hopes to overcome wariness about the employer requirement by delaying its implementation until the end of the century.
As Mr. Gibbons described the Ways and Means Committee measure, it will provide "health care for all Americans from birth to death, including prenatal care. Over a five-year period, it will do no harm to the budget deficit, and over a 10-year period, it will produce a substantial deficit reduction."
Other key provisions of the bill:
* Expansion of the Medicare program to cover an additional 60 million Americans: the poor now on Medicaid, the jobless and low-wage workers in businesses with fewer than 100 employees.
* Subsidies to help small businesses defray the cost of buying insurance for their workers.
* A 45-cents-a-pack increase in the cigarette tax, to be phased in over five years.