Modest effort favored for health care


WASHINGTON -- In a development that could alter the balance of the health care debate, the Congressional Budget Office has tentatively determined that a modest approach to revamping the current health care system would be significantly less expensive and more workable than initially believed, according to congressional sources.

If that is the conclusion in the CBO's final report, it could add fuel to a movement among moderate Republicans and conservative Democrats toward more conservative reforms that would fall short of President Clinton's goal of universal coverage. The report could be released as early as today.

The more modest measure would contain no mandate that employers pay for any part of their workers' health benefits and would contain no government-imposed price controls on insurance premiums -- giving it strong appeal among lawmakers who see those elements of Mr. Clinton's plan as too drastic.

The measure, which is the only health care alternative to have significant support among members of both parties, is one of several that Senate Majority Leader George J. Mitchell, D-Maine, must consider as he prepares legislation to take to the Senate floor this week or next. Mr. Mitchell has insisted, however, that he will not back away from universal coverage.

Sen. Joseph Lieberman, D-Conn., said, "He's trying to see how many votes he can get for mandates," a proposal that engenders strong opposition in both houses of Congress.

Mr. Clinton and his allies in Congress have warned that an incremental approach, such as that approved earlier this month by the Senate Finance Committee, would be unworkable because it would lack the necessary funding, particularly to provide subsidies to help poor and moderate-income people buy insurance.

Because the bill lacked the controversial employer mandate, the subsidies were its chief means of assuring coverage to those who could not otherwise afford it.

The bill's backers feared the budget office would find that the measure would fall short by as much as $100 billion over five years. Instead the CBO has tentatively determined that the gap is far more bridgeable -- well under $20 billion, according to sources familiar with the early draft.

"It just shows that our figures are good. It says that the figures show it can work. I just hope they're right," said Sen. John H. Chafee, R-R.I., the chief GOP architect of the legislation:

However, the sources told the Los Angeles Times, the Finance Committee bill also would fall several percentage points short of its target of expanding coverage to 95 percent of the population. It would get to about 92 percent, up from the current level of about 85 percent but well short of the universal-coverage goal.

Mr. Clinton's allies, taken off guard when reports of the CBO draft swept Capitol Hill, strove to put the best face on them. "In many respects, it's good news that we can do so much for so little," said Sen. Thomas A. Daschle, D-S.D. However, he added, "93 percent is not 100 percent."

In the House, Majority Leader Richard A. Gephardt, D-Mo., met with other members of the Democratic leadership to brief them on the bill that he is putting together to take to the House floor.

It will be based on legislation approved earlier by the House Ways and Means Committee, a measure that achieves universal coverage through a combination of an employer mandate and a vast expansion of the Medicare program. However, he said, "a lot of issues" remain.

Mr. Gephardt said he expects to make a draft of his measure public by Friday.

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