Health Reform: The Moderates Have Taken The High Ground For Now

They've waited a year for this moment. Congressional moderates now have their best chance yet to seize control of the health-care debate. The centrists are poised to push through limited but realistic legislation that could let President Clinton claim victory on most of his reform goals. But Capitol Hill's Democratic leaders pose a huge hurdle for the bipartisan effort. The party's mandarins can't make much headway with their own ambitious plans, but they might let reform die rather than give in to the middle.

The moderates got a huge boost when House Majority Leader Richard A. Gephardt (D-Mo.) unveiled his legislation on July 29. It calls for a new federal program--dubbed Medicare Part C--to cover the unemployed and workers at small businesses. Conservative Democrats, appalled that Gephardt's bill could shepherd over half the population into a government health plan, rushed to embrace a bipartisan compromise being drafted by centrists. "When Gephardt plunged to the left, he gave us a lot more running room" to recruit supporters, says Representative Jim Cooper (D-Tenn.), one of a dozen Democrats and Republicans hammering out the centrist plan.

ROADBLOCKS. That compromise, based in part on an earlier Cooper bill, would try to boost insurance coverage voluntarily, rather than by government fiat. New federal rules would bar insurers from discriminating against the sick and make coverage portable. The bill would promote purchasing co-ops where small companies and individuals could shop for cheaper insurance. To hold Republican support, Cooper dropped his proposal to limit employers' tax deductions for premiums.

What's missing from the moderate plan is any pretense of arriving at universal coverage. Unlike Clinton or Gephardt, the moderates won't require employers to pay for it. Instead, they hope that subsidies for the poor will extend coverage to 91% of Americans--who account for 97% of medical costs.

The centrist coalition predicts that its mix will appeal to 60 to 80 House Democrats and virtually all 178 GOP members--a majority of the chamber. But they will have to withstand a withering attack expected from the Clintons and House leaders. "The Democratic leadership could squash us when we become a target," admits GOP negotiator Dennis J. Hastert (R-Ill.). The bipartisan group already is struggling with leadership roadblocks: It couldn't get an appointment with legislative drafters until 1 a.m. on Aug. 1, less than 48 hours before the deadline to submit a bill. "There's no doubt that the leadership will be taking names and twisting arms," says Representative J. Roy Rowland (D-Ga.).

But the House leaders' clout has been undercut by action in the Senate. A bill proposed on Aug. 2 by Majority Leader George J. Mitchell (D-Me.) is easier on employers than Gephardt's plan; it postpones a decision on requiring companies to buy insurance until 2000. Even that looser mandate could be wiped out soon after the Senate begins debate on Aug. 9. With the Senate unlikely to impose any cost burdens on employers, the House will drop Gephardt's stringent bill like the political hot potato it is.

Gephardt's loss, however, doesn't guarantee the moderates will win. With partisan arteries hardening, liberals in Congress and the White House are digging in against any compromise and urging the President to take the health issue to the voters in the November elections. Clinton knows the problem with that strategy: He will have fewer Democrats and even less influence in Congress next year. If Clinton wants to salvage his No.1 priority, he has no choice but to reach out to the center.

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