Healthcare reform last week looked like the little engine that couldn't.
Despite a promising start, it seemed the reform engine, bogged down by opposition from many sides, wouldn't be able to climb Capitol Hill. At week's end, lawmakers and aides reported that Senate Democratic Leader George Mitchell of Maine was poised to declare the reform debate over for this year, arguing it was too late to pass any meaningful legislation in the few days remaining in the congressional session.
And the imminent death of reform spelled trouble for provider lobbyists, who foresaw big Medicare cuts resulting from the failure to overhaul the nation's health system.
Long road. The gloominess came after more than 18 months of intense and often bitter debate and almost one year to the day after the Clinton administration introduced its reform plan.
The final obstacle may have come in the form of a veiled threat by Rep. Newt Gingrich (R-Ga.). At a meeting between congressional leaders and President Clinton, Mr. Gingrich said that if Democrats continued to push healthcare reform, it would stir up partisan fighting and kill any chances of passing other Clinton administration priorities, such as the General Agreement on Tariffs and Trade and campaign finance reform.
Senate Minority Leader Robert Dole (R-Kan.) echoed Mr. Gingrich's remarks when he said that if healthcare reform came to the Senate floor, it would "eat up the rest of the time" Congress has left before its scheduled recess Oct. 7.
Soon after Mr. Gingrich's and Mr. Dole's comments, Democrats said it was clear that they would need 60 votes to pass healthcare reform in the Senate, the number of votes needed to overcome a filibuster, and that there was little chance of cobbling together that much support.
"I don't believe we should bring a bill up to certain defeat," Mr. Mitchell said at one point. Other members agreed that there was little chance of passage.
"I do not think we have 60 votes," said Sen. John Breaux (D-La.), a member of the bipartisan mainstream coalition. "We are at a point where politics have become more prevalent than the merits of the issue."
Trouble ahead. The apparent end of reform for 1994 had providers and senior citizens groups worried. They fear that with Republicans poised to make gains in both houses, when Congress returns next year it will be in a mood to cut the deficit, not reform healthcare.
"There will be a budget reconciliation next year that includes the largest Medicare and Medicaid cuts anyone has ever seen," predicted Frederick Graefe, a healthcare lobbyist with the law firm of Baker and Hostetler in Washington.
John Rother, lobbyist for the American Association of Retired Persons, agreed.
"That is our biggest concern now," Mr. Rother said. "If there is a balanced budget amendment, it will trigger massive Medicare cuts. No matter how you look at it, Medicare is going to be on the table next year."
For those groups, the prospect of huge Medicare cuts, without any of the money returning to the healthcare system in the form of increased insurance benefits or more services, is the worst of all possible worlds.
"We didn't like the Medicare cuts in the reform plans, but at least in the Clinton and Mitchell plans, most of the money stayed in the system. If it happens next year for deficit reduction, that money is just gone forever," said one healthcare lobbyist who asked not to be identified. "I guarantee we will never see it again."
Mr. Clinton's reform plan had called for restraining Medicare spending by $124 billion over six years.
Decent burial. Even before Mr. Mitchell was ready to halt action in the Senate, a leading House Democrat had sent a letter to Mr. Clinton asking him to "give healthcare reform a decent burial and provide for its rebirth."
Rep. John Dingell (D-Mich.), who has pushed for healthcare reform for nearly 40 years, wrote in his letter to Mr. Clinton that "the same forces that worked so diligently to defeat meaningful comprehensive reform remain determined to scuttle thoughtful incremental measures and will use the calender as an ally."
Other House members were concerned about being held in Washington trying to pass a healthcare reform plan that had little chance of success at the expense of campaigning at home for the November general elections. Those fears were heightened last week when eight-term Rep. Mike Synar (D-Okla.) lost in a primary to a 71-year-old retired school principal, Virgil Cooper, who campaigned primarily by stuffing cards under windshield wipers.
"Most of the members just want to go home. They don't want another partisan fight, especially if they can't win," said a House Democratic aide who asked not to be identified.
Even as healthcare reform ground to a halt, Mr. Mitchell and members of the mainstream coalition of moderate Democrats and Republicans continued to work last week to complete a compromise reform package built around insur-ance reforms and limited subsidies for the poor. The group in recent days had agreed to expand long-term-care coverage and funding for academic health centers in an effort to make the package more acceptable to liberals.
But while they touted the plan's merits in a letter to other Congress members, they acknowledged they were most likely laying the groundwork for next year.
"We ought to go to the (full Senate) with our basic package to help set the stage for the next Congress," Mr. Breaux said. "(The mainstream coalition plan) would establish a blueprint for next session."
"Next year, hopefully, someone will come back to it," said retiring Sen. David Durenberger (R-Minn.).
The group's plan picked up some additional support when four liberal senators, including Sens. Edward Kennedy (D-Mass.) and Thomas Daschle (D-S.D.), jumped on board. The group said it was supporting the plan in hopes of keeping healthcare reform alive.
Mr. Kennedy called the mainstream plan "a very important downpayment toward moving us toward universal coverage."
Although the mainstream plan gained some liberal support in Congress, it was losing support among groups that have traditionally supported comprehensive healthcare reform. In a letter to Mr. Mitchell, nearly 50 groups, including reform stalwarts such as the AARP and organized labor, criticized the mainstream plan.
"We believe strongly that it would be a grave mistake to bow to last-minute pressure to pass any `mainstream' healthcare legislation that is both unworkable and destined to cause real harm to millions of Americans," the groups wrote. "We are deeply disappointed by the failure to enact comprehensive healthcare reform legislation this year."
Over the last several weeks, it has become increasingly clear that the mainstream group, even if it could reach an agreement with Mr. Mitchell, likely would not be able to get a reform plan through the Senate.
Last week, as its members continued to toil on their healthcare reform plan, Mr. Breaux joked that the "mainstream group should now be considered the upstream group because we are really swimming upstream. It feels like we are swimming upstream Niagara Falls."
Out of gas. Other senators agreed that the reform movement seemed to lose momentum after the Senate took its two-week Labor Day recess.
"The mainstream Washington coalition ran out of gas," Sen. Phil Gramm (R-Texas) said.
Provider group representatives, who had ridden healthcare through uncountable ups and downs for almost two years, said they had mixed feelings as the efforts came to a close for 1994.
"It's frustrating in that we spent a lot of time, effort and money trying to accomplish a specific set of goals, and we didn't get those goals accomplished. We may have missed a once-in-a-lifetime opportunity," said Richard Pollack, executive vice president for federal relations at the American Hospital Association. "On the other hand, some bad things could have happened, and it's good that they didn't."
Other observers said the decision to call a halt to reform efforts was coming for some time.
"The body has been dead for a while, the only question was when were they going to bury it," Mr. Graefe said.