The healthcare reform mountain began moving in Congress last week as two key committees started work on comprehensive legislation and a pivotal Senate Democrat turned 180 degrees to support employer-mandated coverage.
The activity ended, at least temporarily, widespread predictions that Congress would be unable to overcome political gridlock and pass a bill this year.
Such speculation had been fueled by the persistent inability of Democratic leaders and committee chairpersons to forge a consensus among their own members, much less woo Republicans. Many observers also have said healthcare reform would be imperiled by the potential indictment of House Ways and Means Committee Chairman Dan Rostenkowski (D-Ill.), who's considered essential to shepherding a bill through Congress. In addition, the ongoing political and personal scandals affecting President and Mrs. Clinton were seen as impediments.
"What it all adds up to is we are beginning to see signs that Congress is serious about finding a way to pass a healthcare reform bill this year that includes universal coverage," said William Cox, vice president of government services at the Catholic Health Association.
Like many with a stake in the outcome of health reform, Mr. Cox viewed the turnaround of Sen. John Breaux (D-La.), a longtime opponent of employer mandates, as the most significant development last week.
In a private meeting with fellow Democrats, Mr. Breaux offered a proposal that would exempt businesses with fewer than 11 workers from paying anything for healthcare. The measure would require employers with 11 to 15 employees to offer coverage or pay a 1% payroll tax, while businesses with 16 to 20 workers would provide insurance or pay a 2% payroll tax. Employers of 21 to 1,000 would be subject to a mandate only, and those larger than 1,000 would have to offer health insurance plus pay a 1% payroll tax.
A spokeswoman for Mr. Breaux said he had offered the alternative because he recognized that "something has to break on mandates" for Congress to enact a reform bill this year.
By exempting small firms completely, he hoped to strike a compromise that would quell resistance and attract some bipartisan support, the spokeswoman said.
Mr. Breaux's newfound support for a mandate was the first crack in the opposition by conservative Democrats. His endorsement was viewed as crucial because he's a member of the Senate Finance Committee, where Democrats hold a slender 11-9 majority. He also is the lead sponsor of a managed-competition bill that's the companion of a plan sponsored by Rep. Jim Cooper (D-Tenn.) in the House.
But some health interests were critical, charging that the Breaux compromise was inadequate.
The "unstated other half of that proposal is the taxes that would be necessary" to make up for the exemption granted to the smallest firms, said John Rother, chief lobbyist for the American Association of Retired Persons. "You could not do his proposal without raising some significant revenues."
As two key committees delved into drafting reform legislation, the goodwill required to begin making trade-offs between the political parties was in short supply.
On the House Ways and Means Committee, which isn't expected to begin writing a bill in earnest until early next month, members indulged in bitter partisan swipes. Rep. Fortney "Pete" Stark (D-Calif.), chairman of the Ways and Means health subcommittee, said healthcare reform had been "frustrated by Republican administrations for 12 years" and charged that "rich suburban Republicans" didn't have the same problems as "the broader coalition that we Democrats represent."
Rep. Bill Thomas (R-Calif.), the ranking Republican on the subcommittee, shot back that Republicans "have the fear that partisanship on your side will succeed, that is, you will pass the mother of all entitlements...paid for by business."
For now, the full Ways and Means panel is considering a bill passed by the health subcommittee, but Mr. Rostenkowski said he might prepare his own plan if he couldn't get sufficient votes for approval.
The Senate Labor and Human Resources Committee, meanwhile, began work on a reform plan drafted by its chairman, Edward Kennedy (D-Mass.). The measure is similar to Mr. Clinton's but includes less onerous financial requirements for small businesses and eliminates mandatory alliances.
In the first week of deliberations, Republicans prepared 91 amendments to the first section of the bill, which deals with universal coverage and basic benefits. The changes included proposals that would gut the proposal's employer mandate and exclude abortion coverage from standard benefit plans.
Late in the week, the panel unanimously approved a controversial amendment that would create an independent commission with broad authority to reduce benefits, if needed, to avoid a budget shortfall. The amendment's wording was so vague, however, that it appeared the commission also would have sweeping powers to alter insurance premium caps, the chief cost-control mechanism in the bill.
Republicans on the panel charged that the plan was too similar to Mr. Clinton's and represented a big-government, regulatory solution to healthcare woes. Democrats praised it for achieving universal coverage.
Despite the bitterness and slow pace of deliberations, Mr. Kennedy nevertheless predicted the committee would complete work in time for the Memorial Day recess.
The other House panel now considering healthcare reform, the Education and Labor Committee labor-management relations subcommittee, continued deliberations last week. It rejected several Republican amendments aimed at paring down the benefits package but approved amendments adding mental health and dental benefits.