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Health Care: The Logjam May Loosen


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HEALTH CARE: THE LOGJAM MAY LOOSEN

It's a crisp October day. Hundreds of doctors, hospital executives, lobbyists, and staffers crowd the White House South Lawn. Members of Congress jostle for prime spots on the dais as President Clinton reaches for a stack of pens and begins signing into law the Comprehensive Health Insurance & Medical Security Act of 1994. Next to him is a beaming Hillary Rodham Clinton. Just imagining this scene brings mist to the eyes of a White House aide. "We will have an extravaganza on the South Lawn, with balloons," he muses. "We will have won."

An impossible dream? Much of Washington thinks so. Congress is weeks behind schedule on health-care legislation, public support is ebbing, and small business has all but sunk Clinton's mandate that employers pay for coverage. Meanwhile, Clinton ally and ex-House Ways & Means Committee Chairman Dan Rostenkowski (D-Ill.), has been sidelined by a May 31 corruption indictment.

But health-care reform refuses to die. Both parties fear facing voters in November's midterm elections without having passed something. The pressure to deliver is forcing Congress to float ideas that could form the basis for an eventual compromise. Just as important, the Administration is signaling flexibility to accept a deal--even if it means stretching to the limit Clinton's vow to veto any bill that doesn't guarantee coverage for every American.

The key to breaking the health-care deadlock: "triggers." To achieve universal coverage, Clinton has insisted that all employers must buy insurance for their workers within three years. The compromises being discussed in the Senate would postpone that requirement for up to five years. The bill also would require insurers to cover patients with preexisting conditions and lower premium payments for high-risk policyholders.

The big hope: to tempt individuals and employers to buy coverage voluntarily. But if the number of uninsured Americans doesn't fall below target levels within that time, the triggers would kick in, either imposing mandates automatically or forcing Congress to tackle the issue again. Price controls, too, could be set up on standby, to be triggered if reform doesn't rein in health costs.

FACE-SAVER. These trip-wire mechanisms are the brainchild of Senator John B. Breaux (D-La.). He faced intense lobbying from the White House Chief of Staff, his friend Thomas F. McLarty III, to sign on to Clinton's bill. But Breaux refused to accept Clinton's employer mandate. So Breaux developed the face-saving ploy: Clinton can claim that triggers guarantee universal coverage--eventually. And Republicans and conservative Democrats can claim that market forces will make mandates unnecessary.

The notion is gaining support. Treasury Secretary Lloyd M. Bentsen confirms that triggers "could be" the basis of a grand compromise on reform. And Senate Finance Committee Chairman Daniel P. Moynihan (D-N.Y.) is likely to include triggers in the compromise bill he's now drafting with Senator Bob Packwood (R-Ore.).

With the signs that Senate bipartisanship is budding, the White House is preparing to bypass the deadlocked House Energy & Commerce Committee, once Clinton's best hope for a compromise, and take the issue directly to the floor. The timetable now calls for committee work to be done by July 4, with bills to be passed on the House and Senate floor by mid-August.

Meanwhile, White House officials are balancing behind-the-scenes maneuvers with a stepped-up drive to bolster public support. In the past four months, support for Clinton's health plan has eroded from 57% to 43%. When the Clintons return from D-Day events in Europe on June 8, they'll begin an intensive coast-to-coast campaign to keep wavering Democrats in the fold and to pressure Republicans to sign on.

Even with some GOP support, though, reform won't sail through Congress. A deal built around Breaux's triggers, which could leave uncovered up to 4.2 million of today's uninsured workers, will anger liberal Democrats. And even if triggers break the logjam on coverage, Congress has just 65 legislative days to deal with hundreds of details on everything from insurance reforms to subsidies for the poor.

But those hurdles can be overcome. After all, Clinton can use fear to get his way. For wavering lawmakers, he can conjure up two images: spend an October afternoon at a White House signing ceremony, or go home to face voters angry that Washington failed once more.TABLE: HANDICAPPING HEALTH CARE

The odds on the Hill for central pieces of health-care reform

EMPLOYER MANDATE

On all companies 6 to 1

On big companies 2 to 1

"Triggered" mandate 3 to 2

COST CONTROL

Premium caps 9 to 1

Fee schedules 3 to 1

"Triggered" controls even

DATA: BUSINESS WEEK

Susan B. Garland, Mike McNamee, and Richard S. Dunham in Washington


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