Health reform accord may be delayed


WASHINGTON -- The forces of delay appear to be overtaking Congress as Democratic leaders struggle to find a consensus for health care reform legislation this year.

President Clinton and other advocates of a swift and sweeping overhaul of one-seventh of the nation's economy have a month or less to turn the tide before the urge to postpone the tough decisions may be too powerful to overcome.

"Congress meets every year," Sen. Max Baucus, a Montana Democrat who co-sponsored the president's original bill, observed yesterday. "I think we need to do something solid this year, but then come back later and build on it."

Over the next five weeks, Democratic lawmakers will be asked by their leaders to pass a version of the health care bill through each house of Congress so a final combined product can be enacted in the fall.

But many Democrats returned to Washington yesterday from a week-long July 4th recess confused, concerned and apprehensive about how far voters want them to go in restructuring the health care system.

"People are scared that we're going to mandate another government program that we don't have enough money to pay for," said Sen. Jim Exon, a Nebraska Democrat. He noted that his colleagues are equally afraid of raising money for health care through taxes or by requiring employers to pay.

The confusion is multiplied by the number of health care proposals that have been approved by separate congressional committees or offered as alternatives.

"People are quite puzzled -- we're going to have to have some kind of clarity," said Rep. Ron Wyden, an Oregon Democrat who is urging Mr. Clinton to give another speech on health care before a joint session of Congress. Senate Republican Leader Bob Dole of Kansas, who is working determinedly to deny Mr. Clinton a victory on health care legislation, seized the moment to complain that the Democrats were trying to rush through sweeping legislation without adequate debate.

Mr. Dole noted that Senate Majority Leader George J. Mitchell of Maine plans to bring the health care legislation up for debate by the end of July, with the intention of completing action before the August recess begins two weeks or so later.

"This is the most important issue we've dealt with as long as I can remember," Mr. Dole said. "We ought to take the time to get it right. . . . Most Americans think we ought to put it off until next year."

That timing certainly suits Mr. Dole, a potential challenger to Mr. Clinton in 1996. The Democrats fear they will lose at least two Senate seats in the midterm elections this fall, which would give BTC the Republicans even greater advantage in the debate over health care next year.

Republican recalcitrance adds mightily to the challenge faced by Mr. Mitchell and Rep. Richard A. Gephardt of Missouri, the House majority leader, as they try to guide Mr. Clinton's health care reform drive through its final stages. The two leaders are already called upon to achieve what no one else has accomplished so far: to fashion a version of the legislation that can pass at least one house.

Mr. Gephardt needs to find 218 votes from a pool of 256 Democrats, of whom 35 to 40 have expressed concerns about requiring employers to buy health insurance for their workers. Others object to abortion coverage and a proposed increase in the tobacco tax.

"The screamers" representing small businesses have had the greatest impact on lawmakers in their districts, said Rep. Benjamin L. Cardin, a Baltimore Democrat who is active in the health care debate. Small businesses will be further accommodated in the bill Mr. Gephardt brings to the floor, Mr. Cardin said.

The House leader said two weeks ago that he favored "a generous phase-in" to delay the employer requirement until about the year 2000. Mr. Cardin predicted that there would also be more generous subsidies for small businesses.

Mr. Mitchell's task is more difficult because he has only 56 Democratic senators to work with; it takes 60 senators to block a filibuster. Senator Dole, who has 39 Republican co-sponsors for his alternate proposal of modest health insurance market changes, announced yesterday that he has approached 14 Democratic senators as well.

Mr. Mitchell, who is meeting privately with each of colleagues in hopes of fashioning a bill that can gain at least the 51 needed to pass, hinted yesterday that he may include some form of employer requirement.

Several senators predicted yesterday, though, that the strongest version of an employer requirement that could pass the Senate floor would be not only delayed, but uncertain.

For example, Mr. Exon suggested that a majority of the Senate might agree to create a commission that would recommend steps to Congress if health insurance is not available to all Americans within the next few years.

The White House has signaled its willingness to delay some elements of the health care reform as long as Congress makes a clear commitment to assuring that everyone is eventually covered. But that's further than the Senate seems willing to go.

The president and his wife, Hillary Rodham Clinton, are expected to resume stumping for their cause shortly. They may even take another bus trip, in hopes of recreating the fabulously successful tactic from their 1992 presidential election campaign.

Sen. Thomas A. Daschle, a South Dakota Democrat, predicted yesterday that those efforts would help make clear the public's desire that all Americans have health insurance paid for in part by their employers.

"Good luck," said Mr. Dole of the Democrats' efforts.

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