The senators who are part of the "mainstream coalition" seeking to fashion a compromise healthcare reform plan say they have been brought together by one goal: cutting the federal deficit.
"This effort begins with a need to reduce the deficit," said Sen. Robert Kerrey (D-Neb.). "We don't feel there is fiscal responsibility in any of the (healthcare reform) bills out there now."
"We just can't bankrupt the government," added Sen. John Danforth (R-Mo.).
The decision to focus on deficit reduction and cost containment shaped the final product the coalition produced. It's a radical departure from the Clinton administration's goal of universal coverage. More importantly, it puts the group out of lock step with the other major reform plans in Congress, all of which seek to expand health insurance coverage and benefits. Should the coalition hold together, its work could have a significant impact on the final Senate plan.
That possibility has provider groups concerned.
"All of a sudden we are dealing with a budget bill," said Charles Huntington, director of the Washington office of the American Academy of Family Physicians. "Their plan isn't healthcare reform. When they talk about deficit reduction, what they really mean is cutting federal costs through Medicare cuts."
Said another provider lobbyist who asked not to be identified, "Deficit reduction always means more Medicare cuts with nothing in return."
The proposal offered by the group would, by its own estimates, reduce the deficit by $100 billion during a 10-year period. Despite hopes of doing more, members conceded that the plan would likely result in coverage for only 92% of Americans by the year 2004.
Much of the savings in the coalition's plan comes from constricting the growth in Medicare spending by more than $260 billion in a decade. The plan introduced by Senate Majority Leader George Mitchell (D-Maine) would reduce Medicare growth by $294 billion during the same period, according to the Congressional Budget Office.
The mainstream group's drive to attain deficit reduction shaped the decisions it made on its reform package. For example, the group dropped the prescription drug benefit included in the Mitchell plan and reduced the Mitchell plan's $48 billion long-term-care program to $10 billion.
"The purpose (of healthcare reform) supposedly, at least, was not to incur (Medicare) savings (only) to turn around and spend them on something else," said Sen. David Boren (D-Okla.), a member of the group.
The group said it hoped to decrease the number of uninsured primarily through subsidies for low-income people. But the level of subsidies would be dependent on budget deficit projections rather than on the number of uninsured or the need for the subsidies. That decision was made after the group met with Congressional Budget Office Director Robert Reischauer, who told the group that their early subsidy structure wouldn't result in deficit reduction.