Prospects for agreement on healthcare reform appeared to be slipping away last week as Democratic leaders in the Senate were stymied in efforts to find common ground.
The reform impasse was over whether Senate Majority Leader George Mitchell (D-Maine) will accept the proposal of the self-styled "mainstream coalition," effectively killing his own plan, or whether he and the coalition can agree on some provisions and resolve the areas of disagreement in votes on the Senate floor.
Passage of healthcare reform this year may hinge on the outcome of meetings between Mr. Mitchell and the mainstream group. Meetings last week yielded little in the way of concessions from either side of the reform front. Meanwhile, the Senate was preoccupied trying to complete action on the crime bill.
After a vote up or down on the crime measure, Mr. Mitchell said the Senate will adjourn until after Labor Day, a two-week break designed to give negotiators on reform some breathing room.
"The issue is whether the Mitchell bill or the mainstream coalition bill is the vehicle to be amended," said healthcare lobbyist Frederick Graefe. "That is the only issue right now. If they can't resolve this, then (healthcare reform) is at a stalemate."
According to those involved in the negotiations, members of the mainstream coalition, which was represented primarily by Sens. John Chafee (R-R.I.) and John Breaux (D-La.), took a hard line, arguing that their plan could not be split and that it should be brought to the Senate floor in place of the Mitchell plan.
"I tried to avoid words like `take it or leave it,"' Mr. Chafee said after meeting with Mr. Mitchell and other Democratic leaders. However, he added that he would be "distressed" if attempts were made to significantly alter his group's proposal.
Other senators present at the meetings had a different plan. Sen. John D. Rockefeller (D-W.Va.), a supporter of the Mitchell proposal, said the two groups should blend the bills where they agree, and where they do not, "let's take it to the Senate and vote it up or down.
"I'll win some. John Chafee will win some," Mr. Rockefeller added.
Few observers said they believed that Mr. Mitchell is likely to kill his bill in favor of the bipartisan mainstream proposal.
"I don't think (Mr.) Mitchell is willing to call his bill dead and just turn this thing over to the mainstream group. He risks losing too many votes," said one lobbyist, who asked not to be identified.
Adding to the mix of confusion last week was the unexpected-and, from many Democrats' point of view, unwelcome-call for passage of an employer mandate by the White House.
President Clinton called on senators to "look at the real world...and do something that will work."
The president also was critical of the mainstream group's package.
"It would be better not to do anything at all than to adopt a program that would actually increase costs of healthcare and reduce coverage," Mr. Clinton said.
When asked later at a White House press briefing if the president still intended to veto any plan that did not include universal coverage, Press Secretary Dee Dee Myers said there "has been no change in our position."
Mr. Breaux shot back that it was counterproductive to "be fighting battles that cannot be won."
While the decision to send senators home for two weeks puts even more time pressure on the process, optimists say it would give the members of the mainstream group and Democratic leaders time to negotiate in relative peace.
"I think it may be healthier for everyone to be able to take this break and to have the key parties continue to negotiate in what I think will be a quieter atmosphere, which is probably what we need," said Leon Panetta, White House chief of staff.
The plan developed by the mainstream coalition is far more modest than the Mitchell plan. The coalition's members, who numbered nearly 20 at one point, were brought together by a desire to reduce the deficit (See story, p. 54). Their goal, according to members, was to produce a plan that resulted in $100 billion in net deficit reduction over a 10-year period.
Much of that deficit reduction would come from more than $250 billion in Medicare spending restrictions.
Hospital Medicare-payment reductions in the mainstream group's plan include:
$48 billion in savings over a 10-year period from a 2% reduction in Medicare inpatient hospital services.
$34 billion saved by eliminating the current disproportionate-share program and replacing it with a system of vouchers for the uninsured.
$17 billion saved by reducing inpatient capital payments.
Physician payments under Medicare would be reduced by 3% in fiscal year 1995 for all services except primary-care services, for a 10-year reduction in Medicare growth of $6 billion. An additional $88 billion would be saved in the mainstream group's plan by altering the formula for the annual Part B Medicare update under the resource-based relative value scale.
The level of Medicare cuts in the mainstream plan have been a lightning rod for provider criticism.
Richard Pollack, executive vice president for federal relations at the American Hospital Association, said the mainstream plan "looks at Medicare cuts as the cash cow to finance healthcare reform, and we are against that, period."
The coalition's plan was criticized by a broad spectrum of groups. The U.S. Chamber of Commerce said the plan "relies far too much on taxes and government bureaucracy, and it contains unacceptable soft triggers that may lead down the slippery slope to employer mandates."
At the same time, the American Association of Retired Persons said it opposed the plan partly because the Medicare cuts would result in lower reimbursement rates to providers and increase cost-shifting.