After a month of silence, the Clinton administration is back on the healthcare reform trail.
First lady Hillary Rodham Clinton last week renewed calls for extending insurance coverage to more Americans during a speech before the Washington Business Group on Health, while the White House announced some top-level changes to its reform team.
HHS Secretary Donna Shalala, meanwhile, said President Clinton would decide in December on his reform strategy for 1995 and hinted strongly that reform would be part of a federal budget package or paired with welfare reform. That's because of pressure from Congress to cut entitlement spending, which is growing rapidly and limiting the government's ability to finance other programs.
"(For) any changes that we want in the Medicare system or Medicaid system or in something linked to welfare reform...(the budget) is a natural vehicle," Ms. Shalala said. "This is not a budget in which we're going to do just the discretionary side. We're going to look at entitlements, too."
The December deadline will be linked to Mr. Clinton's decisions on final budget recommendations for the 1996 fiscal year, which he will likely unveil in January 1995.
Ms. Shalala said administration officials now are debating the strategy. However, she acknowledged that the administration may be lowering its expectations for the coming Congress given the opposition its comprehensive plan faced.
"Comprehensive (reform) can be taking the first strong steps in the direction you want to go," Ms. Shalala said. "Large targets, huge plans are very difficult to get through Congress."
Not everyone in the administration wants to tackle healthcare reform in 1995, administration officials acknowledged last week. Some advisers want to let Congress debate the issue and create a package without White House interference.
Others say the administration should avoid the issue in any substantive way next year. They advocate stumping for universal coverage and using healthcare reform as a campaign issue against Republicans.
Those decisions are being guided by a new reform team at the White House. Robert Rubin, head of the National Economic Council, and Carol Rasco, head of the Domestic Policy Council, will be heading the White House's reform efforts next year, according to Mr. Rubin.
The move diffuses power at the top of the Clinton administration's reform team. It also means healthcare adviser Ira Magaziner, who dominated the reform plan development last year, will have a significantly reduced role in next year's reform action.
Some critics in and outside the administration have blamed the demise of reform in part on Mr. Magaziner, who orchestrated the White House's task force on the issue. Those critics have contended the task force took too long to draft a plan, thus losing political momentum, and the document it produced was too bureaucratic. In addition, Mr. Magaziner's personal style reportedly rankled some members of Congress.
"(Mr. Magaziner) will certainly not be as visible," said an administration source who asked not to be identified.
"Ira Magaziner is a nonissue on healthcare reform now. The most powerful person on healthcare reform will be (White House Chief of Staff) Leon Panetta because all reports have to pass through him to the president," predicted Frederick Graefe, a healthcare lawyer with Baker & Hostetler in Washington.
Ms. Shalala, however, tried to play down the White House moves.
"Ira (Magaziner) is very much a part of that discussion," Ms. Shalala said.
Mrs. Clinton will continue to be an advocate for universal coverage and to lobby the public and Congress for reform, Mr. Rubin said in a recent speech. Critics also have said the first lady, who headed the reform effort, is in part responsible for the failure to enact a bill.