Congress returned from its Labor Day recess last week, and it immediately became clear that most lawmakers have little enthusiasm left for healthcare reform.
The mood was set early in the week. Senate Democrats convened their weekly policy lunch and met for about two hours, considerably longer than usual. However, healthcare was not discussed at all. The situation in Haiti took the senators' full attention.
As members left, some were clearly frustrated.
Sen. John Breaux (D-La.) said he was "less optimistic" about reform legislation than he had been before Congress' recess. Mr. Breaux is one of the leaders of a self-styled "mainstream" coalition of Republican and Democratic senators seeking a compromise plan that can attract both liberals and conservatives (See related story, p. 26).
"I'm afraid we are developing a (healthcare reform) package with no constituency, something that will get hammered by the left and hammered by the right," said Mr. Breaux, shaking his head.
Sen. Joseph Lieberman (D-Conn.) said he and many of his colleagues found that most of their constituents would rather see Congress wait until next year to pass a reform plan.
While issues like Haiti took the spotlight away from healthcare reform, a small group of lawmakers continued to press for action.
Mr. Breaux and other members of the mainstream coalition, including Sen. John Chafee (R-R.I.), met last week with Senate Majority Leader George Mitchell (D-Maine) in an attempt to find a consensus plan that could garner the 60 votes needed to stop any Republican attempts to delay the issue until next year.
The members were discussing a plan developed by the mainstream coalition that would reform the insurance market and give low-income subsidies primarily by restraining future Medicare spending by more than $260 billion over 10 years. The plan also seeks to reduce the deficit by as much as $100 billion over the same period.
According to preliminary estimates by the Congressional Budget Office, the plan would raise the number of insured Americans to 92% from its current level of 85% by the year 2000. The plan does not include any requirements that employers pay for insurance for their workers.
As they left their meeting, the senators seemed determined to be as optimistic as possible.
"Healthcare reform is not dead, it's alive," said Mr. Breaux, sounding quite a bit more upbeat than he had earlier in the week.
Sen. Robert Kerrey (D-Neb.) said the group hoped to develop a plan that was "darn hard to vote no on."
Coming up with such a magic plan has proved elusive for months now and may not be any easier to find in the few weeks remaining in the congressional session, which is set to end before the November elections.
White House officials and many House liberals have been cool to the idea of insurance reforms in the absence of universal coverage, which they say could drive up the costs of insurance for the young and healthy as it did in New York state.
A report released last week by the Health Insurance Association of America bolstered that view. It found that health insurance premiums for small businesses could increase by as much as 30% if insurance reforms are enacted.
House members also seem less than enthusiastic about healthcare reform.
Speaker of the House Thomas Foley (D-Wash.) said the House would "probably await whatever the Senate might be doing."
For their part, lobbyists for providers were taking two different tacks. Some were actively pushing reform. But most were waiting to see how Senate negotiations progress and were spending the majority of their time trying to convince members that the Medicare reductions in the mainstream plan would hurt the quality of care.