Congressional committees with jurisdiction over healthcare reform continued closed-door negotiations and horse-trading last week, but they apparently are far from agreement on a plan.
At a weekend retreat, Senate Majority Leader George Mitchell (D-Maine) outlined to Senate Finance Committee Democrats three reform options designed to create a less-costly plan than President Clinton's that would attract broader support.
One option would require employers to finance 50% of the cost of health insurance premiums for their workers, rather than the 80% mandate in the Clinton plan, and reduce the value of the benefits package, according to sources familiar with the retreat proceedings.
Implementing the two options would produce a reform initiative that's as much as $150 billion less expensive annually than the Clinton plan, according to some estimates.
In a speech at a meeting of the Independent Insurance Agents of America last week in Washington, Mr. Mitchell indicated that global spending caps, which would set national limits on health spending, also would have to be part of the bill.
He also said laws limiting damages in malpractice suits should continue to be the domain of state governments.
After a speech at a meeting of the AFL-CIO last week in Washington, Sen. John D. Rockefeller (D-W.Va.) told reporters that while committee members had met to discuss issues and options, no decisions had been made. The primary impact of Mr. Mitchell's options was to make clear to members of Congress that they have to reduce the cost of the program and both its short- and long-term effect on the federal deficit, Mr. Rockefeller said.
A fundamental issue that all committees have yet to resolve is whether an employer mandate to finance health insurance for workers should be a primary financing vehicle for universal coverage.
"There is no way that you get to universal coverage without an employer mandate," Mr. Rockefeller said.
But at a meeting with reporters, Sen. John Chafee (R-R.I.), a member of the Senate Finance Committee, said there weren't enough votes for an employer mandate because no Republicans on the panel support it, and some Democrats oppose it as well.
Rep. John Dingell (D-Mich.), chairman of the House Energy and Commerce Committee, continued efforts to build support for a scaled-back version of the Clinton plan last week, assuring two Democratic members that he would strike provisions from the president's plan designed to eliminate excessive prices for "breakthrough" prescription drugs.
Reps. Lynn Schenk (D-Calif.) and Marjorie Margolies-Mezvinsky (D-Pa.) had written to Mr. Dingell expressing opposition to measures in the Clinton plan that would establish a federal advisory council to monitor prices of new drugs and give HHS the authority to deny Medicare payment for products that it deems excessively priced. Both lawmakers represent districts with biotechnology companies.
Ms. Schenk had said the advisory council would have "an enormously chilling effect on private investment in biomedical research and development."
In a letter written on April 20, Mr. Dingell agreed and promised to strike the advisory council from his reform plan. In a separate letter, he assured Ms. Margolies-Mezvinsky that he wouldn't support the rejection of a new drug "based on its cost alone."
Elsewhere, the House Education and Labor labor-management relations subcommittee began formally drafting a reform bill from a plan written by Rep. Pat Williams (D-Mont.), chairman of the panel. Mr. Williams proposed reform measures similar to the Clinton bill, but his plan doesn't include mandatory health alliances, and it offers additional federal subsidies for small businesses and low-income workers.
In other developments, the hospital industry's four largest alliances joined forces last week in an unusual display of togetherness to support six major principles of healthcare reform.
A spokesman for the alliances, which represent 2,600 not-for-profit hospitals and healthcare systems, said their principles most closely resemble aspects of bills proposed by Rep. James Cooper (D-Tenn.) and Mr. Chafee.
However, the alliances aren't officially endorsing any bill at this time, said James Scott, an executive with American Healthcare Systems, one of the alliances.
The Cooper and Chafee bills allow providers and employers more flexibility than some other plans.
Besides San Diego-based AmHS, the four alliances include VHA Inc., Irving, Texas; SunHealth Alliance, Charlotte, N.C.; and Premier Health Alliance, Westchester, Ill.
The alliances' six principles are universal access, managed competition, incentives to provide preventive care, initiatives to promote healthy lifestyles and reduce poverty, minimal government control over healthcare delivery, and policies that encourage personal responsibility, provider efficiency and quality care.