President Clinton restated his commitment to healthcare reform that would guarantee coverage for all Americans and appealed to hospital executives for help in a speech last week at the American Hospital Association's annual legislative conference in Washington.
Mr. Clinton told an audience of nearly 3,000 hospital executives that they could play a crucial role in making the case for universal coverage to members of Congress, who will decide the fate of Mr. Clinton's reform proposal as it winds its way through a labyrinth of committees this year and competes with several alternative proposals.
Mr. Clinton acknowledged AHA's disagreements with some aspects of the administration's reform plan but stressed a common commitment to achieving universal coverage.
"I implore you to take this debate to Congress," Mr. Clinton said. Hospital executives could appeal "with a perspective that is not ideological, not partisan, has no ax to grind, doesn't care who wins except the American people and the American healthcare system."
The administration will need all the help it can get advancing its reform plan in the wake of the endorsement of an alternative plan last week from the Business Roundtable, a group of 200 executives from Fortune 500 firms.
The group gave its seal of approval to legislation sponsored by Rep. Jim Cooper (D-Tenn.) and Sen. John Breaux (D-La.) that would encourage managed competition without a mandate for employers to finance insurance for their workers or a cap on private insurance premiums, both of which are central to the administration's plan.
"The legislation balances government-led reforms with market-oriented solutions," said John Ong, chairman of the group and chief executive officer of B.F. Goodrich.
The next day, the administration faced further opposition when Robert E. Patricelli, the chairman of the U.S. Chamber of Commerce's health and employee benefits committee, testified in Congress that his organization did not support the Clinton health plan.
Both moves were setbacks for the administration, which has been seeking a compromise with Mr. Cooper and his supporters. Mr. Clinton and his staff so far have refused to negotiate away the employer mandate, which is a key difference between the two bills, and one administration officials say is the only way to achieve the president's bottom line: universal coverage.
Despite this and other differences, Mr. Cooper last week said his plan was closer to the White House reform proposal than any other in Congress and would achieve universal coverage without any mandates by 1998, the same timetable as the White House plan.
He acknowledged though, that there was little room for compromise. "The middle ground may only be an inch wide," he said at a meeting of the American Association of Retired Persons. Mr. Cooper also told the group, which represents 33 million senior citizens, that he would soon introduce long-term-care legislation.
Mr. Cooper's bill is one of three which, along with the administration's plan and a proposal by moderate Senate Republicans, is expected to be the focal point for compromise legislation.
The AHA won't endorse any particular reform plan, executives said. But they did grade the three plans according to how well they met AHA reform principles. The group said Mr. Clinton's plan offered the best strategy for achieving universal coverage. The Senate bill-which differs from the administration's plan primarily in its omission of premium caps and a mandate for individuals, rather than businesses, to purchase insurance-and the Cooper plan would provide less rigid cost controls, the group said.
AHA President Richard Davidson said the association was trying to push liberal Democrats who favor a single-payer approach and conservative Republicans seeking limited reforms closer to the center, where a compromise will be forged.
The nation's governors last week demonstrated that while compromise is painful, it's not impossible. The National Governors' Association approved a health reform policy that called for employers to offer, but not pay for, a basic health insurance benefit plan similar to those offered by HMOs.
The group said low-income families and individuals should receive subsidies to help them afford insurance, which should eventually be sufficient to purchase the basic benefit package. Subsidies should be funded with revenues that would result from limiting the tax deductibility of health benefits to the value of the basic benefit plan, the group said.
The NGA also endorsed insurance reforms and measures that would give states greater flexibility to enact health reform programs and to make changes in their Medicaid plans.
The group began its deliberations deeply divided. Vermont Gov. Howard Dean, a Democrat, said at a news conference that Democratic governors approved their own reform plan-which amounted to an endorsement of the administration's bill-just in case the group failed to strike a compromise.
South Carolina Gov. Carroll A. Campbell, a Republican and chairman of the NGA, said the group's compromise might help members of Congress "bridge the (partisan) gap."
In fact, at a meeting with the governors before their vote, Mr. Clinton indicated to them that he would be willing negotiate on elements of his reform plan on which the NGA could not agree. Those include premium caps and mandatory enrollment in health alliances, the giant purchasing groups that would be in charge of buying insurance for individuals and businesses.
News of the meeting infuriated one member of Congress who has been a tireless advocate for the White House reform plan. Sen. John D. Rockefeller (D-W.Va.) said he and many other members would be "upset" if the president cut deals with governors while the legislation was a work-in-progress on Capitol Hill.
Mr. Clinton and White House staff later said the president's remarks had been misunderstood by the governors, and that he was not shifting his position on those issues.
With the ball squarely in Congress' court, political observers said a coalition of various factions-including single-payer supporters, moderate Republicans, conservative Democrats and backers of the administration's approach-must be forged to enact any reform plan. The AHA's Mr. Davidson said his biggest fear was inaction by Congress this year, which would eventually spur a frustrated public to pressure Congress into approving a plan that would include strict health budgets and government rate-setting.
AHA executives said the president's speech and his call to arms for hospital executives provided the perfect kick-off for the organization's grass-roots campaign (See related story, p. 4). In opening remarks at the group's meeting, Mr. Davidson warned that unless hospitals got involved in the organization's lobbying effort, "all other special-interest groups will drown our voice out."
While the president's appearance drew several rounds of applause and generated much good will, he failed to convert skeptics.