Is This the Last Best Hope?

By JAY CARNEY/WASHINGTON

The bleakest moment for Bill Clinton's No. 1 domestic goal came abruptly last Tuesday. Senator Daniel Patrick Moynihan suddenly adjourned his Finance Committee in frustration after just one hour of talking about health-care reform. Though two committees and a subcommittee in the House and Senate have already passed reform bills resembling President Clinton's proposal, even the supporters of those plans concede that none have the votes to become law. Moynihan's committee is key, in part because its composition -- 11 Democrats, half of whom are moderate to conservate, and nine Republicans -- closely mirrors the Senate as a whole. If a bill could clear the Finance Committee, it probably could pass the Senate. If not, health reform could have to wait for another year -- or maybe another President.

Yet on Wednesday, Moynihan sprang another surprise. Having failed to win more than half a dozen votes for his own version of the Clinton plan, Moynihan stunned members by announcing that the committee would begin voting on elements of a new plan by early this week. The committee's senior Republican, Bob Packwood, nearly jumped out of his seat with surprise. Vote on what? he asked. Moynihan turned to John Chafee, the Rhode Island Republican who had been working separately on a proposal with some Democratic members. "What do you guys have?" Moynihan asked.

At that moment, Chafee could have answered "not much." He and six other members of a self-styled "rump" group of moderate Democrats and Republicans had little more than a five-paragraph outline of a proposal. By week's end the group had lost one supporter but had forged ahead, led by Chafee and Louisiana Democrat John Breaux, and presented a 30-page draft plan to Moynihan. A 100- page draft was promised for this week.

Clustered around a table in a cramped second-floor room in the Capitol, the seven Senators -- three Republicans and four Democrats -- set out to piece together a proposal that would get as close to the President's commitment to guarantee insurance coverage for all Americans and still garner enough votes to pass through the committee and onto the Senate floor. After their staffs labored most of last Thursday night and sorted through disagreements that several times threatened to torpedo the process, the group emerged Friday with only New Jersey Democrat Bill Bradley expressing some displeasure with the results. Relying on some marketplace reforms, a cigarette tax and a levy on high-cost insurance plans, the group's proposal promised to provide coverage for 95% of Americans by 2002. The proposal is far less ambitious or intrusive than Clinton's. Most notably, the group rejected any kind of mandate requiring businesses or individuals to pay for coverage.

Oklahoma Democrat David Boren declared himself "enthusiastic" about his group's handiwork, adding that "it has a chance to become law." And his colleague David Durenberger, a Republican who, like Boren, is not running for re-election, said the proposal "clearly provides the best opportunity in my 16 years ((in the Senate)) to do genuine health reform."

This was no small achievement. Since Boren has refused to vote for any plan that doesn't have bipartisan support, Moynihan cannot hope to get a bill out of his committee without appealing to the G.O.P. "If we don't have Republicans walking down the aisle with us," says Breaux, a member of the group, "some Democrats won't even be in the church."

What's true in the Finance Committee may also prove true in the full Senate. Among Democrats, the rival idea to the bipartisan approach is to take a plan resembling Clinton's to a vote on the Senate floor. The critical question for supporters of this strategy is whether enough Democrats, at least 51 of the 56 in the Senate, would stick with the White House to pass a strictly partisan bill. Under this all-or-nothing approach, Senate majority leader George Mitchell would ignore the Finance Committee and take the bill that was shepherded through the liberal Labor Committee by Ted Kennedy to a vote on the floor. Lacking a filibuster-proof majority, Mitchell and the White House would then dare Republicans to kill the bill and take the blame for gridlock. "You don't have to mention the Clinton plan in order to blame the Republicans" for blocking reform, explained a White House aide.

Among the many risks in this strategy is that Mitchell still has nowhere near 51 votes. If the majority leader tries to muscle a partisan bill through, it would take just six more Democrats to join Boren's boycott to hand Clinton a defeat. In fact, many of the swing-vote Democrats the White House considers crucial to this strategy told Time last week that it would end in failure. Several White House officials privately concede that a deal coming out of the Finance Committee is essential, at least to keeping reform from stalling completely. And some White House aides even believe that a compromise bill from the Finance Committee is the only vehicle for success in the full Senate. "This has to be a bipartisan deal," says an aide to the President. "It can't be Democrat-only. It just can't be."

Even so, ardent supporters of Clinton's original plan, both in the White House and on the Hill, view the rump-group proposal as little more than a convenient, temporary tool for getting a proposal past the Finance Committee. Once that happens, they expect Mitchell to fashion a bill for consideration by the full Senate drawn largely from the Labor Committee proposal. That plan retains Clinton's provision requiring companies to pay for 80% of their workers' insurance premiums, an idea that small-business lobbyists have all but killed.

Pointing to opinion polls that show 60% to 70% public support for universal coverage, White House strategists and their allies in Congress believe lawmakers who are reluctant about Clinton's plan will change their mind once the public focuses on the debate later this summer and begins pressuring Congress to act. The all-or-nothing strategy, however, causes moderate Democrats like Breaux, whose support for a final bill is critical, to shake their head. "Legislating is finding the middle," he says. "You can't transfer an all-or-nothing strategy into the legislative process. It seldom works."

The proposal put forward by Breaux's group fell short of Clinton's bottom line. Instead of guaranteeing universal coverage, the Senators said, their bill works "towards" that goal. To bring the level of coverage to 95% of Americans, the complex plan would subsidize low-income people and impose insurance-market reforms, for example, making coverage portable from job to job and requiring insurers to accept customers with pre-existing medical conditions. Subsidies, given in the form of vouchers, would be financed by a $1-per-pack increase in the federal cigarette tax and a levy on the highest priced health plans. If the 95% goal isn't met by the year 2002, an independent commission would recommend legislative changes, which Congress would be required to vote on but not accept. There is no other mechanism to ensure that all Americans are eventually covered, a feature considered essential by most Democrats, including the President.

Supporters of firm guarantees for universal coverage sharply criticized the compromise. "We view the plan as gimmickry at its worst. It sells consumers down the river," said Bob Carolla, legislative counsel for Consumers Union. Reaction by the White House to the rump group's plan was muted. "Encouraging," said Lorrie McHugh, the White House's health-care spokeswoman. Earlier in the week, Hillary Rodham Clinton delivered a fiery call to arms to supporters of the Administration's plan, urging them to stand firm. "No other reform in our health-care system will work if we do not achieve guaranteed universal coverage," she declared. But she noted approvingly to Moynihan that "good things are happening in the Senate Finance Committee." On the Hill, neither Moynihan nor Mitchell endorsed the plan.

Another wild card in the effort at finding a compromise is Bob Dole. No one really knows when or how much he will deal. "I'm a pretty good judge of when to hold 'em and when to fold 'em," he said. "It's timing." The Senate minority leader is under pressure from his party's right wing to prevent moderate Republicans like Chafee, Durenberger and John Danforth of Missouri from signing on to any Democrat-brokered compromise that might give Clinton a victory. Of the Republican moderates, Dole said, "I like all of them, but we've got a party to think of." Dole announced that he and longtime ally Packwood would draft a G.O.P. alternative plan of their own.

Moynihan will take up the group's proposals this week in an attempt to massage them into passable form. Senate Democratic leaders have set the end of July as the deadline for getting a bill out of his committee and onto the floor. Between now and then, Clinton will have to decide whether to support a pale version of his plan or follow the advice of those aides who believe a partisan floor fight could be won. The decision will be one of the most important and risky of his presidency.

With reporting by Julie Johnson and Dick Thompson/Washington