Ideological discord characterized the final rounds of the healthcare reform debate last week on Capitol Hill, even as moderate senators tried to craft a compromise plan that could win approval.
Gina McDonald, an advocate for the Kansas Association of Centers for Independent Living, Topeka, said she was "not optimistic" about what she saw happening in Congress. Still, she hoped that if she and others could sway "a couple of senators courageous enough to stand up...eventually, we can win."
The Senate Finance Committee's best hope of winning a bill that would meet President Clinton's goal of universal coverage appeared to rest last week with an eight-member bipartisan faction, inauspiciously dubbed the "rump group."
The committee subgroup, which includes Sen. Bill Bradley (D-N.J.), Sen. John Breaux (D-La.), Sen. Kent Conrad (D-N.D.), Sen. David Durenberger (R-Minn.), Sen. John Chafee (R-R.I.), Sen. David Boren (D-Okla.), Sen. John Danforth (R-Mo.) and Sen. Max Baucus (D-Mont.), was formed to write a compromise health plan. Its members hoped that measure would serve as a starting point for drafting a full committee bill.
The plan initially written for that purpose by committee Chairman Daniel Patrick Moynihan (D-N.Y.) was modeled after Mr. Clinton's proposal and has roused little enthusiasm on the panel. A series of daily closed-door meetings held to discuss the plan have produced nothing more than general agreement on non-controversial elements such as insurance market reforms.
Congressional leaders have been pushing committees to complete work on healthcare reform by the weeklong July 4 recess to leave sufficient time to debate and enact legislation this year.
To expedite proceedings, the "rump group" coalesced around a proposal, crafted by Mr. Bradley, that rested on the notion that marketplace reforms should be given a chance to work before imposing government mandates to purchase insurance (See chart).
A draft version of the measure was expected to be modified before submission late last week. But even in its earliest form, the proposal was clearly aimed at incorporating key elements of various reform plans without abandoning Mr. Clinton's goal of universal coverage.
"Our first and overriding priority should be to clear the way for efficient operation of the healthcare marketplace as we move toward universal coverage," Mr. Bradley said.
But after several meetings last week, even the rump group members were having difficulty striking accord on what course of action to take if market reforms failed to achieve substantial coverage and on whether there should be a tax on high-cost health plans.
Mr. Moynihan said that while the group hadn't gotten very far in its deliberations, he wanted to "give them as much time as they need." The full Finance Committee was set to begin its public drafting sessions at the beginning of this week.
Speaking with reporters, rump group member Mr. Durenberger criticized his own Republican leaders for failing to negotiate on healthcare reform, saying they should either "be part of the solution" or trust others in the party to play a leadership role.
"The fear that Democrats have is that Republicans will pull them away from universal coverage," Mr. Durenberger said. "The fear Republicans have is that if we strike any kind of agreement now, (Democrats) will pull us to the left, and no one trusts anybody in the middle.
"At some point, you have to trust somebody to negotiate," he added. "That's the problem. Nobody trusts anyone."
In the House, the Education and Labor Committee, by a 26-17 vote late last week, became the second full committee in Congress to pass a healthcare reform bill, while the Ways and Means Committee leapt hurdles toward the conclusion of its work, possibly this week.
The latter panel overcame several controversial issues, including Republican attempts to strip abortion benefits from the plan. Members defeated by a vote of 23-15 an amendment by Rep. Jim Bunning (R-Ky.) that would have stripped abortion from the basic benefits package, except in cases of rape, incest or when the life of the mother is endangered.
While the Ways and Means Committee's new chairman, Rep. Sam Gibbons (D-Fla.), has been successful in keeping the Democrats on the committee together so far, a number of crucial votes remain, including votes to strip cost controls from the bill.
Tax observers also noted with great interest that the committee's reform plan to date would preserve tax-exempt status for not-for-profit hospitals. But the measure would place a 20% limit on physician and paid executive representation on hospitals' governing boards.
While most congressional watchers said the vote by the Education and Labor Committee was expected from the start, it took on added significance as it became apparent that the third House committee with jurisdiction over healthcare, the Energy and Commerce committee, wouldn't be able pass its own plan.
"It is interesting, there is the real possibility that what we may end up with is a bill from the Education and Labor Committee in the House and a bill from the Labor and Human Resources Committee in the Senate, both of which are very Clintonesque," said Charles Huntington, director of the Washington office of the American Academy of Family Physicians. "Both of those bills are very much to the left of what conventional wisdom said could pass.
"That could set up a very interesting floor fight as the bills are amended to move them back to the middle. It could be very messy and very time-consuming," Mr. Huntington said.
The White House, meanwhile, revitalized its push for healthcare reform.
Mr. Clinton and first lady Hillary Rodham Clinton reiterated last week their support for universal coverage and a willingness to back any plan that met that goal.
Mrs. Clinton lunched with about 20 Senate Democrats who are sponsors of the administration's bill, and gave them what Sen. David Pryor (D-Ark.) described as a "shot in the arm."
She did the same with representatives of several interest groups, whom she gathered for a meeting and urged to work harder on supporting universal coverage.
Ms. McDonald of the Kansas Association of Centers for Independent Living agreed that, while outspent and outnumbered by a well-financed health insurance industry, grass-roots groups should do more of the phone calling and lobbying Mrs. Clinton urged them to do.
The independent living groups, which are linked by the National Council of Independent Living Centers, will try to keep at least 10 activists on Capitol Hill until the July 4 recess and plan ongoing activities throughout the break. "People are making some real sacrifices," she said.