The Senate Finance Committee, which will be the last congressional panel to tackle healthcare reform this year, was poised last week to be the first to reject universal coverage.
Meanwhile, the House Ways and Means Committee approved its own reform legislation, which, in contrast, was designed to achieve coverage for all.
The Senate Finance Committee began public deliberations last week after a prolonged series of closed-door meetings that produced three radically different reform plans.
In the opening round of debates, none of those proposals had a majority of support. The dividing line among them continued to be whether and how to achieve universal coverage.
The panel's chairman, Sen. Daniel Patrick Moynihan (D-N.Y.), offered a plan as a starting point, which unlike every other committee bill that's been written, did not include a strict mandate on employers to finance insurance for their workers.
Instead, the measure would have given market reforms-including requirements to make private insurance more affordable and accessible-three to five years to work before subjecting businesses to a mandate.
But on the first day of votes, that so-called "hard trigger" mandate was stripped from the bill, leaving a proposal with no specific route to universal coverage. The amendment eliminating the trigger was sponsored by Sen. Bob Packwood (R-Ore.), the committee's ranking minority member. It was approved 14-6.
Without a mandate, the bill "makes a mockery of healthcare reform," said Sen. John D. Rockefeller (D-W.Va.).
But, illustrating the diversity of views within and between the political parties, Sen. John Breaux (D-La.) said a mandate was untenable because "we cannot project what can be done in the future."
Later, the committee voted 12-8 to approve a more moderate "trigger" proposed by a coalition of moderate Democrats and Republicans. It calls for a national commission to be established if 95% of the population isn't insured by the year 2002. That commission would make recommendations on how to achieve universal coverage, and Congress would be required to vote on the suggestions.
Senate Republicans, meanwhile, coalesced behind an alternative reform plan crafted by Minority Leader Robert Dole (R-Kan.), who's also a member of the Finance Committee. That proposal rejects mandates altogether in favor of insurance market reforms and federal subsidies for the poor as central strategies for enhancing coverage.
Sponsors of the Dole bill claimed to have at least 38 of the 44 Senate Republicans backing the measure. Supporters said the plan would go a long way toward expanding coverage without creating enormous bureaucracies or imposing crippling government mandates.
The initiative would provide $100 billion in federal subsidies for the poor, financed by $117 billion in Medicare and Medicaid cuts.
President Clinton has had a year to convince Americans that what the country needs is a "government-run healthcare system," said Sen. Phil Gramm (R-Texas), referring to Mr. Clinton's own reform plan. He hasn't "gotten the job done because that bill is not what people want," he added.
The Republican plan would provide financial aid to 17 million low-income Americans needing health insurance, Mr. Gramm said. Many more would be helped by insurance market reforms.
In the House Ways and Means Committee, lawmakers voted 20-18 to approve a healthcare reform plan that achieved nearly all of the administration's objectives. All 20 committee members voting for the measure were Democrats; the panel's 14 Republicans, as well as four Demo-crats, voted no.
Rep. Sam Gibbons (D-Fla.), acting chairman of the committee, passed his toughest hurdle when he reached an agreement on private-sector cost-containment that held together his fragile coalition of Democrats (See chart).
The past week produced one major loss for hospital groups in the Ways and Means deliberations. A measure pushed by the American Hospital Association to eliminate the Medicare cuts in the plan was defeated by a vote of 23-15.