The administration's effort to push through an enormously complex healthcare reform plan this year could be further complicated by political pressure to advance its welfare reform plan before, or at the same time, as the healthcare plan.
In a practical sense, what the Clinton administration and healthcare reform advocates fear most is that an aggressive push on welfare reform would delay or derail healthcare reform, because the same congressional committees would have jurisdiction over both policies.
"The time (those committees) are spending on welfare reform is time they're not spending on healthcare reform," said Bruce Vladeck, head of HCFA, in a recent interview with MODERN HEALTHCARE.
Sen. Daniel Patrick Moynihan (D-N.Y.), chairman of the Senate Finance Committee, recently heightened the public policy battle when he said in a Jan. 9 interview on NBC's "Meet the Press" that there was no healthcare crisis and suggested that welfare reform should take precedence. The remarks dealt a particularly heavy blow to the administration because Mr. Moynihan controls a committee that will have a major role in shaping any health reform initiative.
Administration officials have refuted the contention that there's no healthcare crisis and have kept to the strategy of giving priority to healthcare reform.
"We are going to do (welfare reform), but we are going to do healthcare first," said Roger Altman, deputy secretary of the Treasury, in a Jan. 13 interview on CNN's "Moneyline."
At the same time, officials have sought to dispel the perception that the welfare plan has been put on the back burner by advancing the argument that healthcare reform is an essential component of welfare reform.
At a hearing on welfare reform last week, convened by the Senate Finance subcommittee on Social Security and family policy, David Ellwood, assistant secretary for planning and evaluation at HHS, said "an element of welfare reform has to be healthcare reform." He argued that people who leave welfare rolls to go to work often lose health coverage, creating a disincentive to get a job. Inequities in health coverage between the working uninsured and welfare recipients must be resolved by abandoning the current "welfare-based health system," he said.
Under the administration's welfare initiative, which hasn't yet been introduced legislatively, recipients who are able to work would be required to do so after two years.