Democratic congressional leaders late last week said they were drafting legislation that would slow President Clinton's reform initiative and make other changeds in his plan, which they branded as too bureaucratic.
The statements came after an evening huddle with Mr. Clinton at the White House. Clinton adviser George Stephanopoulos later said the president was in agreement with the lawmakers and "ready to go and ready to fight."
The meeting capped a week in which Mr. Clinton's apparent retreat from 100% healthcare coverage and employer mandates, and subsequent attempts at clarification, added confusion to an already chaotic congressional debate.
While few details of the plan being drafted by Senate Majority Leader George Mitchell (D-Maine) were known, provider group lobbyists said the plan includes more than $100 billion in Medicare spending restraints over a five-year period. Over nine years, Medicare growth would be slowed by $300 billion.
Those reductions are nearly as large as the reductions in the bill passed last month by the House Ways and Means Committee. It called for $110 billion in cuts over five years, climbing to $337 billion over a nine-year period.
That bill, which is being used as the framework for the House plan being developed by Majority Leader Richard Gephardt (D-Mo.), has been attacked by the American Hospital Association (See related story, p. 41).
Speaking to the National Governors' Association in Boston last week, Mr. Clinton said that "functional universal coverage," which he defined as "95% or upwards" of the population, might be reached through market reforms without a mandate that employers provide health insurance.
He quickly added that state attempts to reach universal coverage without mandates had, so far, failed.
Critics of Mr. Clinton's reform proposal have contended that it is impossible, for logistical and financial reasons, to guarantee coverage of the entire population. A reform bill recently approved by the Senate Finance Committee sets a 95% coverage target by the year 2000.
The day after the speech, as liberal Democrats threatened to vote against any plan that did not include universal coverage, the administration began trying to clarify what the president meant.
Vice President Al Gore said the administration had not changed its position and still supported universal coverage. Meanwhile, Mr. Clinton told congressional leaders in a meeting late last week that he did not support setting 95% as the goal for coverage but that inevitably some people, as much as 5% of the population, might remain uncovered.
But try as they might, officials were unable to ease the tension on Capitol Hill that the remarks created. Sen. Jay Rockefeller (D-W.Va.) said the confused message made it more difficult for Democratic leaders to gather votes.
"Mixed signals are never good," Mr. Rockefeller said. He also did his best to quash any talk that the administration was willing to deal on universal coverage.
"The position has not changed and will not change, I am certain of that," Mr. Rockefeller said.
But other members hailed it as a breakthrough.
Senate Minority Leader Robert Dole (R-Kan.) said it was "the beginning of an effort by the president to break the deadlock."
The president's apparent flip-flop had the greatest effect on liberals and members who are as yet undecided on the issue of employer mandates.
Rep. Jim McDermott (D-Wash.) criticized the president and said that for the first time, the votes of the House's more than 80 single-payer advocates were in doubt.
Other members, some of whom had not previously said they were against mandates, expressed concern that they would be betrayed by the White House. They feared the administration was changing positions, leaving them on record as having supported a politically unpopular idea.
Special-interest groups also were mobilized by the president's comments.
AFL-CIO President Lane Kirkland said he was concerned that Congress would "follow the course of least resistance....After many months of debate, the hour of decision will produce some kind of pseudo-reform."
Other groups, including members of the Health Care Reform Project, a coalition of labor, consumer and business groups that has been among the Clinton administration's strongest supporters, threatened to oppose any legislation that did not include universal coverage.
In a letter to Congress, the group's members said "incremental reform will hurt the middle class," citing a report released last week by the Catholic Health Association.
That study was prepared by the consulting firm of Lewin-VHI, which has conducted reform studies for a variety of clients, some with competing interests. The CHA-commissioned report said that families with annual incomes of from $20,000 to $75,000 would see increased healthcare spending under an incremental bill such as the one being supported by Mr. Dole. In total, those families, which constitute 60% of all insured families, would pay an additional $7.8 billion annually, the study said.
"What this information tells us is that the `go slow idea' on healthcare reform is the equivalent of putting a 10 mph speed limit on ambulances-it's costly, and it's dangerous," said Sen. Patricia Murray (D-Wash.).