A bipartisan coalition of moderate lawmakers on Capitol Hill last week huddled to push Congress toward adopting a middle-of-the-road approach to healthcare reform, a move that puts it at odds with the more liberal Democratic leadership.
The group was composed primarily of sponsors of either the "incremental" bill introduced by Reps. J. Roy Rowland (D-Ga.) and Michael Bilirakis (R-Fla.) or the managed-competition bill introduced by Reps. Jim Cooper (D-Tenn.) and Fred Grandy (R-Iowa). Both measures are alternatives to the Clinton administration plan, which centrist lawmakers complain relies too heavily on employer-mandated coverage and bureaucratic regulation of the healthcare market.
More than 70 members of the coalition met last week. Those leaving the conference said they made no attempt to actually devise a plan, although many expressed support for the plan passed recently by the Senate Finance Committee. They did agree, however, to push House Majority Leader Richard Gephardt (D-Mo.) to allow a vote by the full House on a moderate package that doesn't include an employer mandate or private-sector price controls.
Rep. Mike Andrews (D-Texas), who voted against the plan passed by the Ways and Means Committee earlier this month, said that "many of us support the Senate Finance Committee bill and would like to see the bill offered by Mr. Gephardt be closer to that bill than to the plan passed by the Ways and Means Committee."
Senate Finance Committee members John Breaux (D-La.) and John Danforth (R-Mo.) addressed the group and advised them to withstand the pressure Democratic and Republican leaders would put on them to abandon their plan.
"If they can stick together, they can control the debate," said Dave Kendall, senior analyst for health policy at the Progressive Policy Institute, a Washington think tank that supports market-based reforms. "You saw what moderates were able to do when they worked together in the Finance Committee."
The Senate Finance plan, which requires employers to offer, but not pay for, health insurance, is shaping up as a reference point for other plans. Mr. Cooper, speaking for the moderate group, said the Senate Finance plan formed "the narrow gate that all bills must pass through." He predicted that anything more liberal "is probably a waste of time."
However, Democratic leaders seem to be looking at the Senate Finance plan in a different way.
"The White House and the Democratic leadership are looking at (the Senate Finance bill) as the right-side bookend," said Brent Miller, director of government relations for the American Group Practice Association. "Everything they want to do is to the left of that."
According to several House members, including acting Ways and Means Committee Chairman Rep. Sam Gibbons (D-Fla.), Mr. Gephardt intends to use the bill passed by the Ways and Means Committee as his starting point. That plan includes an employer mandate and a major expansion of the Medicare program to cover the poor and uninsured.
"This is the most important time yet," said one healthcare lobbyist, who asked not to be identified. "The fate of healthcare reform is in the hands of a very few people, the White House and the Democratic and Republican leaders. If you don't get what you want now, your only option may be to try to defeat the whole bill, and that is not a good position."
One of the most intense efforts has been on the abortion issue. Last week, a group of Roman Catholic bishops warned Congress that they would begin a grass-roots fight against inclusion of abortions in the basic benefits package (See related story, p. 6, and editorial, p. 27). The clerics were supported by a group of 35 members of Congress who said they wouldn't vote for a healthcare plan that included abortion.
Not to be outdone, 72 pro-choice members of Congress staged their own rally to warn that they wouldn't vote for a healthcare bill that did not include abortion as a basic benefit.