Efforts on Capitol Hill to write a healthcare reform bill crept along last week as lawmakers sought to overcome objections to forcing businesses to provide coverage for workers.
The sense of urgency to pass healthcare reform legislation this year was heightened last week when Sen. David Boren (D-Okla.) said he would leave the Senate after this year's session to become president of the University of Oklahoma.
Mr. Boren's departure will open a seat on the Senate Finance Committee, a key panel with jurisdiction over healthcare issues, and it fueled speculation that the Democrats could lose control of the Senate after the November elections. Mr. Boren is the sixth Democratic senator to announce his re- tirement this year.
Senate Majority Leader George Mitchell (D-Maine), the most prominent of the departing Democrats, continued to seek a compromise on employer-mandated coverage, which is shaping up as the most contentious issue on every committee.
While Mr. Mitchell supports that approach to coverage, he used a closed-door meeting with Democratic senators and Clinton administration officials to offer three new alternatives for easing the pressure of employer-mandated coverage on small businesses. They include:
Completely exempting from the mandate businesses with fewer than 10 employees.
Increasing subsidies for businesses with fewer than 10 employees.
Reducing employers' share of premium costs to 50% from 80%, as proposed in the Clinton plan.
While Mr. Mitchell said no decisions were made at the meeting, some senators who oppose any mandate said the new options didn't make the approach more acceptable. Sen. John Breaux (D-La) said the complicated system of subsidies only "made a bad idea worse."
Mr. Mitchell said the senators discussed at length the assertion made in a recent speech by House Ways and Means Committee Chairman Dan Rostenkowski (D-Ill.) that universal coverage would necessitate "tens of billions of dollars a year" in new revenue and that "broad tax increases may be required." All the senators said new taxes weren't an option.
"None of the (tax) options are particularly palatable, so we're back on mandates," said Finance Committee member Sen. Thomas Daschle (D-S.D.).
Meanwhile, House Energy and Labor Committee Chairman John Dingell (D-Mich.) still was searching for support for his own plan after losing key voting support from Rep. Jim Slattery (D-Kan.), who announced that he couldn't support any plan that would require businesses to provide health insurance.
According to several lobbyists familiar with the committee's work, Mr. Dingell remains several votes short of approval for his proposal, which is similar to the Clinton plan but which has less onerous requirements for small businesses. They said Mr. Dingell may revise his bill to gain more support.
One panel that's moving along is the labor-management subcommittee of the House Education and Labor Committee, which last week continued working on a bill introduced by Chairman Pat Williams (D-Mont.) that has more generous benefits and subsidies than the Clinton administration plan.
The committee's ranking Republican, Rep. Marge Roukema (R-N.J.), announced that she would offer an alternative plan under which employers would have to offer, but not pay for, health insurance. The plan is based on a bill introduced earlier this year by Minority Leader Robert Michel (R-Ill.). It would establish voluntary purchasing pools for small employers and include many of the reforms of the insurance market contained in the Clinton plan. However, the Roukema plan doesn't have any direct cost-containment measures such as "global budgets" or national spending limits.
Committee staff said the Williams bill's increased subsidies for small businesses and the poor would cost $417 billion over a five-year period, or $21 billion more than the subsidy package in the Clinton plan.
The plan would raise additional revenues through corporate assessments. Both the Williams and Clinton plans would place a tax equal to 1% of payroll on companies with more than 5,000 employees that self-insure. However, because the Williams plan doesn't allow large firms to enter regional alliances, the tax would raise $33 billion, compared with only $8 billion under the Clinton plan, according to staff estimates.