As lawmakers drew closer to a June 30 deadline for completing committee work on healthcare reform, the winning formula for a bill that would meet President Clinton's goals and get bipartisan support in Congress appeared to slip further away.
The central political obstacle remained employer-mandated health coverage. It is the primary financing vehicle for universal coverage in both Mr. Clinton's proposal and in the health bills under consideration by virtually all the congressional panels now working on a plan.
Last week's public deliberations on the House Ways and Means Committee and closed-door negotiations among Senate Finance Committee members were fraught with the usual standoffs, with Republicans lined up against proposals requiring employers to finance insurance for their workers and moderate Democrats seeking less onerous variations of a mandate.
But politics-as-usual grew even more dicey when the White House signaled a willingness to compromise on mandates in a series of meetings between Mr. Clinton and congressional leaders from both parties last week.
In a meeting with Sens. Daniel Patrick Moynihan (D-N.Y.) and Bob Packwood (R-Ore.), the chairman and ranking minority member, respectively, of the Senate Finance Committee, Mr. Clinton asked that the panel refrain from an immediate vote on the bill drafted by Mr. Moynihan. That bill, which is similar to the president's, was intended as the starting point for the committee's legislation. But as it became apparent that support for a mandate was soft on the panel, Mr. Clinton sought to avoid an embarrassing political defeat and find an alternative to achieving his bottom line of universal coverage.
Mr. Clinton "obviously doesn't want any vote that would cause his plan to be defeated," Mr. Packwood told reporters after the meeting.
He said the president showed an interest in the so-called "trigger" alternatives to an employer mandate, which have been proposed in various forms by Finance members and are designed to give market-based reforms a chance to work before imposing government mandates (See related story, p. 33).
But word that the president might be willing to accept such an alternative to a flat mandate infuriated some Democrats on the House Ways and Means Committee, where leaders have been struggling for weeks to secure the votes needed to approve a Clinton-like reform plan.
Former Ways and Means Chairman Rep. Dan Rostenkowski (D-Ill.) told MODERN HEALTHCARE that White House statements indicating that "they are not putting as much emphasis on universal coverage" threatened to have a "destructive" effect on the panel's deliberations.
The fear is that after going out on a political limb to vote for an employer mandate, the president will agree to a much less sweeping bill from the Senate Finance Committee.
While Ways and Means Democrats still face a number of challenges, including votes over the financing of their reform bill, by late last week they were showing surprising unanimity. Panel Republicans seemed to acknowledge their opponents had the votes to pass the plan.
"The big fight is over," said Rep. Bill Thomas (R-Calif.), the ranking minority member of the Ways and Means health subcommittee.
The week was a roller coaster for committee Democrats and their new chairman, Rep. Sam Gibbons (D-Fla.). Early in the week, the Ways and Means Committee narrowly defeated two Republican attempts to strike employer mandates from the reform plan under consideration. The vote on both initiatives was 20-18, with four Democrats siding with the solid block of Republicans who voted for the amendments.
However, things did not look so good by mid-week when Mr. Gibbons was forced to halt the panel's deliberations because Democrats could not come to agreement over an amendment offered by Rep. William Jefferson (D-La.) that increased subsidies to small businesses by nearly $25 billion over a seven-year period and lowered revenues from tobacco taxes by nearly $12 billion. The provisions were funded by delaying the implementation of long-term-care coverage to the year 2000 from 1997.
But things then changed again. Angered by a comment from Rep. Fred Grandy (R-Iowa) that moderate Republicans were being told by their leadership not to assist Democrats in crafting a bill, Democrats passed the Jefferson measure 24-14 with no Democratic defectors.
However, Mr. Thomas warned that the while the fight may be over in the Ways and Means Committee, it would continue on the House floor and in the Senate Finance Committee, which last week continued daily closed-door meetings on less contentious issues, such as insurance market reforms and benefits. Mr. Moynihan told the president early in the week that there weren't yet enough votes on the panel to pass any plan.