Look Who's Pushing Health Care Reform Now

The GOP, which marched to power on Capitol Hill in 1994 by stomping on Bill Clinton's health-care plan, is suddenly coming on like Clara Barton. Polls show voters are worried about the availability and quality of medical care--and are looking to the Democrats to do something about it. So these days, congressional Republicans are brimming with ideas to reform the health system.

GOP leaders are betting that their late-in-the-game proposals will prove that Republicans can deliver compassion without compromising smaller government. But Democrats aren't about to let the GOP walk off with the health-care issue in an election year. The ensuing struggle threatens to produce a stalemate that will make both voters and the pols losers.

The leading GOP idea: a $10 billion package of tax cuts, funded by higher tobacco levies, to subsidize health coverage for 41 million uninsured Americans. The package would make good on GOP promises of annual tax cuts while undermining the President's plan to spend $65 billion in tobacco funds on child care, education, and Medicare for early retirees.

"POLITICAL IMPERATIVE." House Speaker Newt Gingrich (R-Ga.) figures that tax changes to boost health coverage are a more politically palatable use of tobacco money than, say, another cut in capital-gains rates. And by focusing on access to insurance, the GOP hopes to divert attention from another hot health issue that has left the party sharply divided: protection for patients in managed-care plans.

Voter anger has created "a political imperative" for the GOP to deal with managed care, confesses one top Republican consultant. But what to do? Proposals for a "patient bill of rights" are popular with back-benchers, who hear their constituents complaining about HMOs. But the leadership is feeling heat from business, which fears new costs and red tape. A Republican House task force is trying to broker a compromise that will lead to "some modest patient choice" of plans, says Representative John Linder of Georgia, who heads the House GOP reelection committee. But "we'd sure rather talk about tax cuts," says a Republican strategist.

Democrats are fighting to keep the GOP from changing the subject. They've drafted a more sweeping bill of rights. And they're lining up behind a bill, introduced by Senator Edward M. Kennedy of Massachusetts on Apr. 22, that requires businesses with 50 or more employees to provide health insurance.

SMELLING A TRAP. Neither measure has much chance of passing--but Democrats expect to score points anyway. If the GOP compromises, the Dems figure, they can take credit for forcing the majority to cave. And if the bill of rights and insurance proposals fail, they can blast Republicans for obstructionism.

Aware of the potential trap, some Republicans are searching for a way out. On Apr. 21, House Commerce Committee Chairman Tom Bliley of Virginia revealed that he's drafting a plan to allow small and medium companies to join private insurance-purchasing pools. That would let businesses offer workers their choice of a dozen or more health plans, from old-fashioned fee-for-service insurance to restrictive HMOs. Bliley is pitching his proposal to the GOP task force as a twofer: Pooled coverage would be cheaper. And by letting workers choose, Republicans might defuse the prickly issue of patient protection.

But even Bliley's approach is more than GOP leaders want to tackle. They're hoping that tax cuts and a modest anti-HMO bill of rights--coupled with a strong economy and rising wages--will satisfy voters. It's a gamble that Democrats don't intend to let them win.