President Clinton reignited his campaign for healthcare reform last week in the State of the Union speech, threatening to veto any bill that didn't "guarantee every American private health insurance that can never be taken away."
After weeks of political distractions and personal crises that have diverted his attention-including the North American Free Trade Agreement, turmoil over the appointment of a defense secretary, the gathering Whitewater scandal and the death of his mother-Mr. Clinton came out swinging on healthcare reform.
He challenged charges made primarily by Republicans that there's no healthcare crisis and offered assurances that his plan would provide the security of healthcare coverage now lacking in the current system.
With the veto threat, Mr. Clinton also drew a line in the sand that some health experts said needed to be drawn, but which others charged could further polarize the debate and lessen the chances of producing beneficial reforms.
"What's he going to tell the Mr. Andersons of the world when he vetoes the bill?" asked Michael Bromberg, executive director of the Federation of American Health Systems. He was referring to Mr. Clinton's anecdote about Richard Anderson, who was laid off from an $8-an-hour job and went bankrupt from medical bills incurred to treat his gravely ill wife.
Mr. Bromberg, who opposes key elements of the president's plan, said he believes the administration should be willing to accept a less comprehensive, more politically feasible route to reform, such as insurance reforms. But the veto threat for anything short of universal coverage "increased the odds of nothing happening, which is very dangerous," he said.
But William Cox, vice president for government services for the Catholic Health Association, said Mr. Clinton "did what he needed to do."
Calling universal coverage the "real linchpin of reform" that influences everything else, Mr. Cox said the president had made his position on that "extremely clear to Congress."
As soon as the president had thrown down the gauntlet on universal coverage, however, White House officials rushed to give clues about what might be subject to compromise.
At a briefing with reporters the morning after the speech, Ira Magaziner, senior White House healthcare policy adviser, said the administration would consider lowering the threshold on the size of businesses that could opt out of regional insurance purchasing groups, known as health alliances, and become self-insured. Under the president's plan, only those with 5,000 or more employees could do so. However, a threshold of 100 workers, as suggested by some industry representatives, would be "far too low," would result in higher alliance premiums and would perpetuate risk-based competition among health plans, he said.
In other areas, Mr. Magaziner said:
|The timetable for phasing in universal coverage might be stretched beyond the 1998 deadline now in the administration's plan. But he indicated that the 2005 deadline in a bill offered by moderate Senate Republicans would be unacceptable, saying that would be "a long time to ask people to wait."
|Cost sharing between workers and employers could be altered from the current split requiring businesses to pay at least 80% of employees' premiums.
|Congress would have a lot of leeway to shift financing sources. Lawmakers might reduce the size of the $124 billion in five-year Medicare spending curbs to subsidize the plan. They could do that by lowering the $58 billion set aside for deficit reduction or raising the tobacco tax, Mr. Magaziner said.
He flatly ruled out the possibility that Mr. Clinton would sign an incremental bill, such as insurance reforms. The plan must assure universal, affordable, private insurance coverage, and only the president's proposal meets those criteria, he added.
A single-payer plan wouldn't be private, and, in the administration's view, all other proposals would fail to achieve universal coverage.