WASHINGTON -- A coalition of centrist senators whose votes are crucial to the enactment of health care reform this year unveiled a proposal yesterday that sharply scales back President Clinton's original plan and reverses his priorities.
This plan drew immediate attacks from both Senate Democratic liberals and Republican conservatives. But it is unique among all the offerings so far in that it is backed by a large group of lawmakers in the center of both parties.
"This is a bill that can pass this year," said Sen. John Chafee, a Rhode Island Republican who leads the centrist group of nearly two dozen senators.
This latest, and perhaps most important entry in the crowded field of competing health care proposals falls far short of meeting Mr. Clinton's goal of guaranteed health insurance for all Americans. It promises to expand coverage to 93 percent of Americans at most by 1999, compared with 85 percent who have health insurance today. Senate Majority Leader George J. Mitchell's more ambitious plan aims for 95 percent coverage by 2000.
Instead of Mr. Clinton's package of new benefits -- including a prescription drug program for the elderly -- the plan offered yesterday by the so-called "mainstream" group seeks to reduce federal spending by $100 billion over 10 years, in part by cutting spending on the Medicare program for the elderly.
The plan also would not require employers to pay for their workers' insurance premiums -- an issue central to the health care debate. Instead, it would seek to expand health insurance coverage through subsidies to the poor, paid for through Medicaid and Medicare savings and a 45-cent increase in cigarette taxes.
The centrist group also rejects Mr. Clinton's proposal to limit the premiums insurance companies can charge. Instead, it puts the burden of curbing medical inflation at the other end of the system: Employers would lose their tax deductions for providing workers with health care plans more generous than a basic national package, and workers would have to pay taxes on some extra benefits as though they were income.
Mr. Mitchell greeted the new proposal yesterday with relief and resignation, if not enthusiasm. His own bill, a version of the
Clinton plan, is stalled, lacking perhaps a dozen or more votes needed to pass.
"This is a step toward getting final action on the bill," Mr. Mitchell said after the Chafee plan was presented to him at a meeting with the mainstream group. "It is a good, positive step."
Mr. Clinton, who has had to continually adjust his expectations downward during the yearlong debate, also characterized the mainstream effort to join forces with Mr. Mitchell as a hopeful sign in an otherwise discouraging process.
This new opening "made me believe that there is still a chance that people will work together and resolve this," the president said at a news conference yesterday.
Some lawmakers found it encouraging that Senate Republican leader Bob Dole of Kansas did not reject the mainstream plan immediately, although he is backing a much more modest proposal.
Mr. Dole called the mainstream plan a "real effort . . . but it is pretty late in the game." He suggested that the Senate take a two-week recess, which Mr. Mitchell called a delaying tactic designed to kill any health reform legislation this year.
"Bob Dole did not say anything wildly negative, so that was an encouraging sign," said Christopher S. Bond of Missouri, one of about 10 Republicans who took part in the centrists' negotiations.
"I think this is the best hope we have of getting health care reform this year," Mr. Bond added.
But conservative Republican Sen. Phil Gramm of Texas said: "There is no way this group is mainstream in America. I intend to fight the Chafee bill the same way as the Clinton bill."
Mr. Mitchell, who had been marking time until he received the centrists' offer, promised to analyze it over the weekend and respond to the group formally next week. He is considered certain to accept at least parts of the proposal.
The centrist bill eliminates the most controversial element of Mr. Clinton's plan, the requirement that employers buy health insurance for their workers. Mr. Mitchell had already reduced and delayed the employer requirement in his version of the Clinton bill.
But the centrist plan retains the goal of "universal coverage" and calls for a commission to recommend steps Congress should take if that goal is not reached by 2002.
Like many of the less ambitious alternatives, the centrist plan hopes to expand insurance coverage through market reforms and increased competition. But all employers would be required to offer their workers a choice of three health plans, including one in which they could see any doctor they choose.
Low-income people would get help in buying health insurance through federal subsidies, which would be available to those with incomes up to 200 percent of the poverty level by 2004. More generous subsidies would be available to pregnant women and children.
Most benefits in the plan would not be even as generous as what Mr. Mitchell proposed. For example, a long-term-care program would be limited to those with incomes below 150 percent of poverty.
"This is not a Neiman-Marcus plan," said Sen. Joseph Lieberman, a Connecticut Democrat who belongs to the centrist group. "It is a Price Club plan. You get what you need, at a price you can afford."
Some liberal senators were outraged by the centrist offer.
"The Chafee proposal is not a step toward meaningful health care reform," said Sen. Paul Wellstone, a Minnesota Democrat. "It is a lurch backward on our promise to provide affordable health care to everyone that's as good as members of Congress have."
But one of the centrists, Sen. William Cohen of Maine, explained that the group had discovered that it simply could not afford to provide a generous plan without imposing huge burdens on employers and taxpayers.
"It's time that we leveled with the American people," he said. "If we are going to give this particular benefit, it's going to cost this amount. We cannot afford any longer to say we are going to give you something for nothing."