They have been called everything from the saviors of healthcare reform to hokey gimmicks that do little except provide political cover for timid legislators.
Whatever they are, "triggers" are likely to be a growing part of the healthcare reform lexicon in coming weeks.
Simply put, triggers are goals or milestones that, if not met, cause something else to happen. Triggers are becoming the darlings of conservative Democrats who are caught between their dislike for employer mandates and their unwillingness to support their leadership's calls for universal coverage as a non-negotiable issue.
For example, triggers are included in a reform proposal released earlier this month by Finance Committee Chairman Daniel Patrick Moynihan (D-N.Y.). Mr. Moynihan's proposal exempts all firms with less than 20 workers from the employer mandate. Instead, they would face a payroll tax of up to 2%. If by 1998, however, 97% of all employees and their dependents are not covered by employer-provided health insurance, that exemption would be eliminated.
To complicate matters, there are numerous variations on the trigger theme, falling into two broad groups called "hard triggers" and "soft triggers." When a goal is not met, a hard trigger specifies some action that takes place automatically, such as a mandate that all firms begin providing healthcare insurance two years hence. A soft trigger does not prescribe action; it only requires Congress to study the issue should the goal not be met.
Last week, the White House signaled for the first time it might be willing to accept some trigger "mechanism." White House senior adviser David Gergen said on CBS-TV's "Face the Nation" that President Clinton was "open to any mechanism that gets us to universal coverage."
The same day, Senate Minority Leader Robert Dole (R-Kan.) called triggers "the biggest gimmick in town" and argued that they merely delayed the onset of an employer mandate.
What may be more palatable to conservatives is a soft trigger that would give Congress the opportunity to re-examine the issue if coverage goals are not met.
"There is no hard trigger that would be acceptable, but we would seriously consider some type of soft trigger," said Mike Roush, chief Senate lobbyist for the National Federation of Independent Businesses.
However, a plan that includes soft triggers may not be acceptable to liberals. Rep. Fortney "Pete" Stark (D-Calif.) said recently there were "at least 70 of us in the House" who would not accept such a proposal.
The real question, according to some observers, is what the White House is willing to accept. The ultimate trigger would have to be crafted carefully enough to be acceptable to business and conservatives but still give the Clinton administration an opportunity to say universal coverage was achieved.
"I sure hope these triggers are as good as advertised because everyone is counting on them," said a provider lobbyist who asked not to be identified.