WASHINGTON -- President Clinton and Democratic leaders vowed yesterday to press for congressional approval this summer of the fundamental elements of Mr. Clinton's health care reform program while trying to assure a wary public that it will be a new, improved version.
After a tumultuous week of mixed and confused signals, the White House and Clinton lieutenants on Capitol Hill were eager to make clear that they remain dedicated to the goal of expanding health coverage to all Americans, even as they negotiate changes to make the measure more palatable to nervous lawmakers.
With debate scheduled to begin in both the House and Senate early next month, the Democratic leaders hope to distance their proposals from the original 1,300-page Clinton bill, which has been the subject of such unrelenting attacks from lobbyists that polls show it is opposed even by people who agree with its central features.
"We listened to the American people -- all of us did," Mr. Clinton said yesterday in describing with approval what he called the "dramatic changes" Congress has already made in his bill and further adjustments contemplated.
These include decisions by the four congressional committees that have approved versions of the bill to drop a proposed regulation that would have required everyone to buy their insurance through regional alliances, and to delay or drop price controls and premiums caps on insurance that some feared would lead to rationing of health care.
Even so, Mr. Clinton noted that at a meeting with Democratic congressional leaders Thursday night they all agreed: "Our goals are the same. We reaffirmed them: universal coverage, quality and choice, and emphasis on preventive and primary care, and discipline in constraining costs, not only for the government so that we don't increase the deficit, but also for people in their private insurance plans. And we will have a bill in the Senate and a bill in the House that will achieve those objectives."
Employers must pay
House Speaker Thomas S. Foley of Washington reiterated yesterday his intention to send to the House next month a bill that will include the most controversial element of Mr. Clinton's plan: a requirement that employers buy health insurance for their workers. But he noted there will be "some slight possible delay in the phasing-in."
The tentative target date is 2000 -- two years later than Mr. Clinton proposed.
Senate Majority Leader George J. Mitchell of Maine is putting together a somewhat different proposal that probably will not include an automatic requirement on employers but will try first to expand health care to all Americans through voluntary means.
Mr. Mitchell's plan would likely "trigger" in the employer requirement if universal coverage isn't achieved by a certain date.
About 85 percent of Americans now have health insurance coverage either through their employers or through government programs for the poor. Many of those left out are working at low-wage jobs that don't provide health care.
The definition of universal coverage has been subject of much debate this week after Mr. Clinton suggested Tuesday that he could accept 95 percent as a realistic target, prompting charges that he was backtracking on his most fundamental principle that everybody must be guaranteed coverage. Some moderate senators took that as a signal that Mr. Clinton would accept a compromise calling for 95 percent by 2002.
Insurance for all
But Mr. Mitchell said yesterday that he remains committed to "health insurance for all Americans and that means not only providing health insurance to those who do not now have it, but also providing security to those who now have it but fear losing it."
Mr. Mitchell and House Majority Leader Richard A. Gephardt of Missouri are engaged in the difficult task of melding competing health care proposals approved by the various committees into legislation that can pass in the Senate and House before the mid-August recess.
The House plan is expected to closely follow the bill approved by the House Ways and Means Committee, including a basic package of health benefits that employers must offer, an expansion of the Medicare program to cover the unemployed, self-employed and part-timers, and a variety of tax increases, including at least 45 cents a pack more on cigarettes.
Probably the trickiest issue yet to be resolved in the House is whether abortion services should be included in the basic benefits package. Leaders are seeking a compromise that would include it for everyone except poor women whose benefits are federally subsidized.
In the Senate, Mr. Mitchell is creating his bill largely out of whole cloth because of the difficulty in finding a proposal backed by a majority, with few or no Republicans. Bipartisan groups of moderates are working in both the House and Senate to produce alternative proposals with no employer requirements. They would be offered as substitutes.
Whatever versions of the bill survive in the House and Senate will be combined by a joint conference committee into a final product that Congress will be asked to enact before it adjourns for the year in October.
Throughout this process, which formally began in September, the president has been walking a narrow line between supporters of his proposal who want him to remain unyielding and critics who want him to compromise.
Each time the president appeared to lean too far in one direction, a public outcry has pulled him back. That happened twice just this week.
Now that the legislative process is nearing a conclusion, advocates of reform hope that the public will become more fully engaged in the debate and recognize that the original Clinton bill has been improved.
"It's important to get the American people to understand we are producing a different bill, that a lot of the things they may be concerned about aren't issues anymore," said Rep. Benjamin L. Cardin, a Baltimore Democrat.