WASHINGTON -- President Clinton's dream of guaranteed, cradle-to-grave health insurance for all Americans appeared to be dead last night, as Senate moderates unveiled a deficit-conscious plan that would expand coverage gradually and cautiously.
"It's not a Neiman-Marcus plan, but a Price Club plan," said Sen. Joe Lieberman, a Connecticut Democrat and one of the so-called "mainstream" group of some 20 Republicans and Democrats that produced the new measure.
The compromise -- or something close to it -- is widely seen as the last, best chance to pass any bill this year.
The plan sets a goal of insuring 95 percent of the population by 2001. If the goal is not met, Congress would have to vote the following year on recommendations for closing the gap. Supporters suggested the best the plan could do is reach 92 percent or 93 percent coverage by 1999.
"This is a bipartisan bill. This is a bill that can pass this year," said Sen. John Chafee, a Rhode Island Republican and a leader of the group.
Even so, it could be torn apart in the partisan brawl that has overpowered the health care debate. Liberals will say it does not go far enough; conservatives will call it government-run medicine.
Mr. Chafee said the proposal also aims to reduce the federal deficit by $100 billion over 10 years. Other plans have been a wash, or added slightly to government red ink.
To control health costs, the plan would limit employers' ability to deduct premiums for workers' health insurance as a cost of doing business. Employers could deduct no more than 110 percent of the average cost of health insurance in their area. The limit is strongly opposed by labor unions, who have negotiated generous benefits for their members.
Some liberals called the plan a betrayal. "It will not live up to any of the commitments we have made to the people we represent," said Sen. Paul Wellstone, a Minnesota Democrat.
But Senate Majority Leader George J. Mitchell of Maine praised the effort and indicated that he would like to negotiate.
Mr. Mitchell said he would check with other Democrats before responding to the mainstream senators next week.
"My hope is that we can get a compromise that will be a good program for the country and will pass the Senate," Mr. Mitchell told reporters after being briefed on the plan.
Republican Minority Leader Bob Dole of Kansas did not reject the plan, but he said that the Senate should go home. "The American people have bought into the idea that maybe we shouldn't do health reform this year," said Mr. Dole. "They don't understand it."
But mainstream member Sen. Bob Kerrey, a Nebraska Democrat, said: "There's no way we can close our eyes, click our heels and say there is no place like home, and be transported with Senator Dole to Kansas."
Conservative Republicans vowed to kill the deal even before they had seen it. "I want to say to those in the mainstream group, I will fight them as hard as I have fought Bill Clinton," said Sen. Phil Gramm, a Texas Republican. "I think we will defeat their effort."
Sen. Dan Coats, an Indiana Republican, said the compromise was like the latest incarnation of a horror-movie monster. "We may have to put one more stake through its heart," he said. "We will drive it through."
At a news conference, Mr. Clinton urged the Senate to keep working to reach a compromise. "If we don't move now, there's a chance that it won't happen at all," said the president. He pointedly declined to criticize the work of the moderates, even though he vowed earlier in the year to veto any bill that does not not guarantee insurance for every American.
The plan omits or scales back many of the new benefits proposed by Mr. Clinton and congressional Democratic leaders. For example:
* Outpatient prescription drug coverage for elderly Medicare beneficiaries is missing from the mainstream plan. Mr. Clinton and the congressional Democrats would have provided it.
* Subsidies for home and community-based long-term care would be available only to poor and near-poor people. Mr. Clinton's plan would have provided assistance without regard to income.
* Government subsidies to help lower-middle class people buy health insurance would be reduced from the levels proposed by Mr. Clinton, although seven in 10 uninsured Americans are in families with incomes above the poverty line. The poor would receive full subsidies, while people up to twice the poverty level would receive a partial subsidy.
Cost estimates on the plan were not finished, and its authors said some details could change.
The mainstream plan would reform insurance practices to limit denial of coverage because of pre-existing health problems, allow insured workers to keep their coverage when they switch jobs, and narrow the gap between what insurers charge older people and younger ones.
Employers would be required to offer, but not pay for coverage. All Americans would have a choice of three plans, including one that allowed free choice of doctor. Individuals and small businesses could buy lower cost coverage through insurance-purchasing co-ops. Insurers would have to offer a standard benefits package.
The mainstream plan would be financed by reductions in the rate of growth in Medicare and Medicaid, a cigarette tax increase of at least 45 cents per pack, and an increase in the premium that high-income Medicare beneficiaries pay for coverage of doctor visits.