WASHINGTON -- House Democratic leaders are circulating a draft proposal for health care reform that includes all of President Clinton's major goals, including a requirement that employers pay 80 percent of the cost of their workers' health insurance.
Nevertheless, House Speaker Thomas S. Foley of Washington tacitly endorsed yesterday a compromise plan being floated by Senate Majority Leader George J. Mitchell of Maine that would reduce the burden on employers to 50 percent and require workers to pay the rest.
"I think the percentage of employer-employee contribution is one of those things that can be discussed," Mr. Foley told reporters. "Nothing there is written in stone."
The legislative maneuvering, conducted almost entirely in back-room negotiations, came as congressional leaders are rushing to put the final touches on legislation to be debated on the House and Senate floors next month.
The House bill, being readied for floor debate beginning two weeks from today, closely follows the version of Mr. Clinton's bill that was adopted in June by the House Ways and Means Committee.
It is still subject to change on several crucial points, including the timing. The draft calls for the health care reform to take effect by 1998, but House Majority Leader Richard A. Gephardt of Missouri has said that he favors delaying the program until 2000.
In the House, the wording of the Democratic leadership bill is particularly important because it is most likely to be the measure that wins approval in that body.
Mr. Gephardt has told associates he wants to structure the debate so that no amendments can be offered. Instead, he will probably allow two or three substitute proposals to be offered in order to give members some options.
One such alternative will be the so-called "single-payer" plan, which would set up an entirely government-run health care program financed by taxes. Another will be a Republican approach of modest changes in the insurance laws.
While requiring all employers to buy health insurance, the House leaders' plan would give small companies the option of enrolling theirworkers in an expanded Medicare program or buying the same insurance now available to federal employees.
Small businesses, which have expressed vociferous opposition to Mr. Clinton's bill, would be granted tax credits to reduce the cost of health insurance premiums.
Jobless workers, part-timers and low-income people would also get insurance through the expanded Medicare program financed government subsidies. A family of four making as much as $38,400 would be eligible for assistance.
As with the Clinton bill, the House plan would create a minimum package of basic benefits -- including deductibles and co-payments -- that all employers would have to offer. This package, emphasizing preventive services and including prescription-drug coverage, would set the standard to which all private insurance plans would be compared.
In the House proposal, the benefits packages includes "pregnancy-related and family planning services," which would cover abortion as a basic benefit.
Mr. Gephardt is seeking a compromise on the abortion issue, however, to pick up votes from anti-abortion Democrats. One option might be to allow individuals or employers to choose health plans that don't include abortion services.
The House proposal, outlined in a seven-page summary distributed to lawmakers yesterday, would also create a new long-term-care program that would be established to provide home and community-based care.
Meanwhile, a group of Senate moderates who make up a bloc of swing votes rejected an effort by Senator Mitchell, a Maine Democrat, to compromise by reducing the burden on employers to buy health insurance for their workers. The moderates called the plan too modest a concession.
"Any form of a mandate is not going to fly with our group," said Sen. John H. Chafee, a Rhode Island Republican who is leading the self-dubbed Mainstream Coalition. "But at least they're coming our way."
Mr. Foley's almost casual endorsement of the 50 percent worker requirement seemed to put both Democratic congressional leaders in the awkward position of yielding on a costly financing issue in the health care debate without necessarily advancing their cause.
Yet it wasn't clear yesterday whether the change would pick up any new votes.
Under the terms of his tentative compromise, Mr. Mitchell would also delay implementation of the mandate on employers until at least 2001. The mandate would only take effect then if the level of insurance coverage has not expanded to include at least 95 percent of Americans and Congress has failed to address the problem otherwise.
But even that watered-down approach was viewed as too burdensome on employers by most of a bipartisan group of a dozen or so senators whose votes can mean success or failure for reform legislation this year.
The struggle for votes in the Senate is particularly difficult because Mr. Mitchell is starting from a base of just 42, mostly Democratic liberals. He hopes to put together a simple majority of 51 votes for a bill.
LTC Not all of the Mainstream Coalition rejected the majority leader's proposal out of hand.
But Sen. Bob Kerrey, a Nebraska Democrat warned Mr. Mitchell in a floor speech yesterday that he needs to broaden his approach beyond the minimum needed to pass the bill.
"A 51-vote strategy just won't work," Mr. Kerrey said. "The only way the American people will support reform is if it has the support of a majority of both parties in Congress."
There was more bad news for Mr. Mitchell yesterday from the Congressional Budget Office, which will not be able to finish its cost estimates of various reform proposals in time for him to take the legislation to the Senate floor next week as he had hoped.
It is politically unthinkable for the Democrats to try to pass a bill without knowing for sure how much it's going to cost.
L Other provisions of the House draft leadership bill include:
* An annual limit of out-of-pocket health spending of $5,500 for individuals, $11,000 per family.
* Broad leeway for states to establish their own health reform programs so long as they guarantee all citizens will be covered.
* A stand-by cost control mechanism using a commission to monitor health spending and recommend steps to Congress if the spending exceeds targets.
* A 45-cents-a-pack increase in the cigarette tax and a 2 percent tax on health insurance premiums.