A Bloody Clash of Egos

By Jill Smolowe

To everything there is a season. And on Capitol Hill, where legislators are eager to reap the rewards of passing landmark health-care legislation, this is the season to sow -- discord, that is. Currently, five Senate and House committees, each with jurisdiction over health-care legislation, are jostling over the details of "purchasing alliances," "payroll taxes" and "employer mandates," all in an effort to invent the plan that will eventually supplant the Clintons' hopelessly complicated 1,342-page proposal. The lawmakers all know the President is intractable on only one point: universal coverage. Each senses that the American public will balk at a plan that is too bureaucratic, too byzantine or too pricey for taxpayers. And each hopes to make the books as the brains behind historic legislation. Not surprisingly, all of this is rapidly giving way to a bloody clash of egos.

Take, for instance, the long knives that flashed last week. Eager to be the first legislators to craft a concrete proposal, the Democratic members of the House Subcommittee on Health have been slaving late nights for two months. But before the panel's four Republicans would let their objections go down to defeat, they staged a bit of theater last Wednesday that was pointedly designed to embarrass President Clinton. Calling for a formal vote on the White House plan, the Republicans each voted nay. The seven Democrats, as unwilling to join the mutiny as they were uneager to embrace Clinton's expensive proposal, were forced to vote "present."

Later that day, the Democrats got their revenge. Prodded by subcommittee chairman Fortney (Pete) Stark of California, they pushed through a plan that expands Medicare to achieve universal coverage while cutting back substantially on the White House's proposed benefits to hold down costs. Gone are such high-price items as long-term care and limits on out-of-pocket expenses for catastrophic illness. Under this plan, Medicare patients would foot 20% of their home-health-service bills, which is double what Clinton envisioned. The resulting savings of $6 billion, coupled with a cigarette-tax hike of $1.25 a pack, which would raise $16 billion in annual revenues, provides enough wiggle room to ease the burden on small-business owners. As Clinton had hoped, Stark's plan still requires all companies to pay 80% of insurance-premium costs for their employees; those with fewer than 100 employees have until 1998 to comply while larger employers must meet a 1996 target date.

The survival of two central elements of the White House plan -- universal coverage and employer mandates -- gives Clinton's health-care campaign a much needed boost. But the subcommittee's nipping and tucking bodes ill for some of the President's bolder schemes. Purchasing cooperatives, which would have been mandatory for small and mid-size companies, were made optional. Clinton's vague talk of a broadly-based payroll tax was trimmed back to a 1% levy on self-insured companies with more than 1,000 employees. And parity for mental- health costs was dropped. Still, says House majority leader Richard Gephardt, "it's clear that for all of the public pronouncements and cynical assessments, Congress is actually moving forward on health reform, quietly, deliberately and responsibly."

Not to mention rancorously. House Democrat Jim Cooper of Tennessee, whose stalled plan was upstaged at a moment when he is running hard to capture the Senate seat vacated by Vice President Gore, said dismissively that a bill that passes in committee "by a one-vote partisan majority is one that doesn't have any legs or wings." Stark rejoined sarcastically: "I just think he's exactly what Tennessee deserves, and I wish him Godspeed in the Senate." As for Cooper's plan, Stark says, "His bill is all pap and blather. Everybody's got to love it because it doesn't do anything."

Actually, what the Stark bill does is play to the same crucial audience that Cooper's plan targets: small-business owners, who are worried that mandatory health costs could force them out of business. This group is now the focus of others' attention as well. John Dingell, chairman of the House Energy and Commerce Committee, has begun circulating another proposal, similar to Stark's, which Cooper complains is a narrow effort designed simply to win half a dozen Democratic swing votes.

Clinton said last week that if the Stark plan crossed his desk, he would sign it "because it does what I ask." But that is unlikely to happen. House and Ways Committee chairman Dan Rostenkowski predicts that the bill that will ultimately pass muster with his 38-member panel will be "much more conservative" than Stark's plan. Though two Senate committees and three House committees are now jockeying for the spotlight, Senator Daniel Patrick Moynihan's Finance Committee is expected to emerge as the final arbiter of compromise. The question is just how badly the Hill's titans will wound each other in the process -- and whether enough health benefits will survive to handle their resulting medical bills.

With reporting by Julie Johnson and Dick Thompson/Washington