While the Clinton administration is struggling to rally public and congressional support for its health plan, one of the proposal's most powerful opponents has declared it close to dead and buried.
At a meeting of the National Association of Business Executives last week, John Motley, president of the National Federation of Independent Businesses, said the plan's chief financing mechanism-a requirement that employers pay 80% of workers' health insurance costs-had almost no chance of winning congressional approval.
The administration has touted the employer mandate as the only viable way to achieve the goal of private healthcare coverage for all Americans.
Administration officials have argued the only other two options for reaching that end would fail, because a single-payer program would result in a government-financed system and a mandate for individuals, rather than businesses, to purchase insurance would be too unwieldy and costly.
But while the White House will continue to influence the reform debate, the decisionmaking process has moved away from the executive branch to the congressional arena, where support for the mandate is weak at best, said NFIB's Mr. Motley.
"Right now, the majority of members of both (the Senate and House of Representatives) don't want to enact a program that's funded through an employer mandate," Mr. Motley told the NABE audience.
Support for the rejection of the mandate began building last year, when the American Medical Association's House of Delegates backed away from its long-standing support for the measure, Mr. Motley said.
Opposition accelerated recently, with decisions by several major business groups-including the Business Roundtable, the U.S. Chamber of Commerce, the National Association of Manufacturers and the Health Equity Action League-to oppose the Clinton plan.
The Clinton health plan "trades healthcare coverage for jobs on Main Street," Mr. Motley said. "That's a lousy trade if you have one of the jobs that's lost."
Comparing the president's reform plan to a "piece of meat," Mr. Motley said, "The longer it hangs, the more it smells."
NFIB, which opposes any type of health insurance mandate for employers, claims a mandate would cost jobs, particularly for low-wage workers, and suppress job creation.
Those claims were supported by a report issued last week by the Washington-based Employment Policies Institute, whose members are mainly large, low-wage employers, including hotels, restaurants and retailers.
The report, prepared by June and Dave O'Neill of Baruch College's Center for the Study of Business and Government in New York, predicted the loss of as many as 780,000 to 890,000 jobs under the Clinton plan.
The range reflects differing assumptions about employers' premium costs, which would drive decisions about employment levels. Job losses could be as high as 2.1 million if the plan failed to deliver on its promise to control health costs, the study said.
Half of the jobs lost under the plan would be in low-wage firms with more than 5,000 workers, the EPI report said. Only 35% of workers in the retail business, for example, now get insurance from their employers. As a result, those firms would experience enormous cost increases. Many would be unable to offset those costs with wage reductions, because workers already earn low wages, the report said. And, the report concluded, some employees would lose their jobs.
"There's only one reason we're wasting time talking about an employer mandate," said Carlos Bonilla, EPI's chief economist. "Politics."
Richard Wade, vice president of communications at the American Hospital Association, said it was far too early to declare the employer mandate dead on arrival, given the strong support in the House and Senate for some form of universal coverage.
"The fact that it's being declared dead this early is good, because it has time to come back to life," Mr. Wade said.