WASHINGTON -- Stung by complaints from liberal Democrats and some party leaders, President Clinton said yesterday that he had not meant to signal a major policy retreat on health care reform when he said Tuesday that he would accept less than his primary goal of guaranteed coverage for all Americans.
"My goal is universal coverage," Mr. Clinton told reporters before a meeting yesterday with congressional leaders. "It is the only goal that works for ordinary Americans. I have always said, from the time I presented the bill, that I was flexible on how to get universal coverage and would be willing to compromise on that."
The president told the nation's governors at their conference Tuesday that he recognizes that achieving his goal of 100 percent coverage isn't technically possible because a few people always slip through the cracks of government programs, such as Social Security.
As a more realistic goal, Mr. Clinton said, he could accept a bill that expands health insurance coverage from today's level of about 85 percent of Americans to "somewhere in the ballpark of 95 percent or upwards."
In Washington, those comments set off alarms among the fiercest and most loyal advocates of Mr. Clinton's proposal to overhaul one-seventh of the nation's economy, who immediately demanded a clarification.
Ninety-five percent coverage "is not acceptable to this senator, and I do not think it is acceptable to the American public," declared Sen. Paul Simon, an Illinois Democrat. If a bill is passed that provides only 95 percent coverage, he said, he will offer an amendment that would provide a lottery to limit senators to only 95percent coverage as well. So five senators would have to go without.
"The president ought to be in there standing up for universal coverage," Mr. Simon said. "Anything less is a compromise he should not make."
Mr. Clinton said yesterday that he had not meant to suggest that 95 percent is acceptable to him as a final result, and that he had seized on that figure only because it was included in a health care bill produced by a Senate committee. Under that bill, a failure to achieve at least 95 percent coverage by 2002 would trigger recommendations to Congress on how to make up the difference.
But at this delicate point in the negotiations on Capitol Hill, when the success or failure of alternative proposals depends on such nuances as whether they achieve 91 percent or 95 percent or 98 percent coverage, the president's comments were taken as a signal of greater flexibility than he has shown before.
The signal was greeted Tuesday as good news by moderates who don't want to vote for a bill that requires the tough decisions necessary to provide health care for all Americans.
The majority leaders in the House and Senate are working to combine versions of bills approved by four House and Senate committees into legislation to take to their full chambers as soon as possible.
Democratic leaders trying to marshal their forces to pass the most sweeping possible bill -- including some version of the controversial proposal that employers be forced to buy insurance for their workers, as the surest way to achieve universal coverage -- were dismayed by Mr. Clinton's comments.
Sen. Edward M. Kennedy of Massachusetts, author of one of the most expansive health care proposals, stormed into a meeting with Senate Majority Leader George J. Mitchell of Maine on Tuesday, spewing epithets at the president.
At a meeting with House whips yesterday, House Speaker Thomas S. Foley referred disparagingly to Mr. Clinton's "dance of the veils."
Sen. Paul Wellstone, a liberal Democrat from Minnesota, joined Mr. Simon yesterday in his proposal for a Senate lottery that would determine which five senators must drop their government health coverage if only 95 percent of Americans are to be covered.
The frantic White House efforts at damage control, which began with a television appearance yesterday morning by Vice President Al Gore, only added to the confusion.
"Nothing has changed when it comes to the commitment to ensure that all Americans have health care coverage that can never be taken away," Mr. Gore said.
Rep. Earl Pomeroy, a moderate Democrat from North Dakota who had been encouraged by Mr. Clinton's comments Tuesday, said after the backtracking yesterday, "I don't know what to make of it now."
The only clear result was that Mr. Clinton had managed to take the difficult process of searching for a consensus on health care legislation and made it even more challenging.
"It's pretty hard to pull the rug out from under yourself," Rep. Jim McDermott, another Washington Democrat, observed wryly. "Just try it sometime."
For months, the assumption on Capitol Hill has been that Mr. Clinton would accept essentially what he said he would yesterday -- the strongest bill the lawmakers can produce that at least sets the nation on the path toward guaranteed health insurance for all.
Some Democratic leaders, notably Rep. John D. Dingell of Michigan, have argued for a tougher stand -- that Mr. Clinton reject any halfway measure, blame Republicans and take the issue to voters in the fall.
But the prevailing Democratic view is that passage of health reform will become more difficult next year when Republicans -- who oppose all but the most modest reforms --are expected to pick up seats in both the House and Senate.
Presidential politics, which are already having an impact on the debate this year, could bring Congress to a virtual standstill in the 18 months or so before Mr. Clinton's 1996 re-election bid.
Although Democratic leaders realize that they will have to compromise with moderates to get some measure passed, they would rather not yield much before even the floor debate begins.
For example, House Majority Leader Richard A. Gephardt is determined to include in his bill an employer "mandate" that would automatically take effect in the year 2000.
House approval of such a measure would likely strengthen Mr. Clinton's hand in dealing with the more troublesome Senate. But Mr. Clinton's signal Tuesday that he is willing to accept a measure without the employer requirement threatens the Missouri Democrat's effort.
"It's like throwing a firecracker into a corral of horses," Mr. McDermott said.
"The horses will jump over and break through fences to get out ofthere, and now Dick has to go about rounding them up again."
Mr. Clinton emphasized yesterday that while he is willing to consider alternatives to the employer requirement, he remains doubtful that any other approach will work.
"I'm sorry that after all my skills and efforts at communicating, the point I really made yesterday somehow didn't get through," the president told reporters.
"We have to do something that works. That's going to be my bottom line. Let's don't do something that won't work."
As part of the damage-control effort yesterday, the White House arranged for three special-interest groups that have been among its strongest allies to reaffirm their faith in Mr. Clinton's commitment to universal coverage.
"I think he was just thinking out loud," said AFL-CIO President Lane Kirkland, who appeared at a joint news conference with representatives of the American Medical Association and the American Association of Retired Persons. "I think what the president had to say was over-interpreted."
WHAT CLINTON HAS SAID
"If you send me legislation that does not guarantee every American private health insurance that can never be taken away, you will force me to . . . veto the legislation."
-- State of the Union Address, Jan. 25
"You've got to cover everybody. . . . I can't compromise on that."
-- Town Hall meeting, Charlotte, N.C., April 5
"There is no compelling evidence that we can both have quality )) and cost control and stop cost-shifting in the absence of covering everyone."
-- Speech to the Business Roundtable, June 21
"I'm not changing my position [on universal coverage]. I don't want to get into a Jesuitical debate on what constitutes that."
-- Interview with Business Week magazine, July 11 edition
"It's impossible to have 100 percent coverage of anything. . . . So we know we're not going to get right at 100 percent, but we know that you've got to get somewhere in the ballpark of 95 percent or upwards."
-- Remarks to the National Governors' Association, July 19
"There's never been a suggestion that we would have a law which would set that [95 percent coverage] as a goal."
-- Remarks to news media, July 20