TIME: Almanac 1995

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<text id=94TT1045> <title> Aug. 15, 1994: Health Care:The 95% Solution </title> <history> TIME--The Weekly Newsmagazine--1994 Aug. 15, 1994 Infidelity--It may be in our genes </history> <article> <source>Time Magazine</source> <hdr> HEALTH CARE, Page 20 The 95% Solution </hdr> <body> As Clinton's reform heads for a cliffhanger, he turns it over to George Mitchell By Richard Lacayo--Reported by Laurence I. Barrett and Julie Johnson/Washington George Mitchell knew what he was talking about when he took himself out of the running as a Supreme Court nominee a few months ago. He argued then that it was more important for him to remain in the Senate as majority leader so he could push through the President's health-care plan. At the time, many people assumed that he was also keeping himself available to become major-league baseball commissioner after he retires from the Senate in January. Judging from the health-care proposal he introduced last week, a watered-down approximation of Clinton's universal-coverage plan, he might get to fulfill the first job and increase his chances at the next. If his intricate gambit can attract enough wavering Democrats to salvage part of the President's initial vision, Mitchell will not only have delivered the biggest victory of Clinton's term so far; he will also have proved to the baseball-team owners that he knows how to execute a spectacular save. If it works. With the Senate opening debate this week and the House set to follow on Aug. 15, the original Clinton plan is no longer on the table and the frantic Democratic leadership in both houses is without an alternative that has enough votes so far to pass. Having got the President's enthusiastic endorsement during his press conference last week, Mitchell's proposal now represents the only game in town for Senate Democrats--and one they have just begun to play. No sooner had he introduced his bill than Mitchell was calling it "a starting point." Translation: he could count on only about 40 or so votes to support it. Not just politics but principles are involved in this fight. Mitchell knows that if he cannot revise his plan sufficiently to attract a majority, it could be the end of Democratic hopes to shape health-care reform their way. Republicans would be happy to delay the passage of any bill until after the November elections, which are likely to strengthen their numbers in both houses. As a starting point, Mitchell's plan is full of ingenious devices for reconciling the conviction that health-care reform is a good thing with the no-less-common belief that paying for it is not. It aims to achieve coverage for 95% of all Americans by the year 2000, when a federal commission would make recommendations on how to cover the remaining uninsured. If Congress failed to take action, a provision would take effect in 2002 requiring employers in companies with more than 25 workers to pay 50% of their workers' insurance costs. That two-stage procedure manages to acknowledge Clinton's ever fainter insistence on universal coverage while it offers Congress one of those agreeably far-off target dates--the turn of the century, no less--that lawmakers cherish. The gist of Mitchell's idea is to have everybody buy his own insurance. As with the original Clinton plan, his would forbid insurers to reject any applicant because of pre-existing health problems. The bill would also place limits on how much premiums could rise, in part through a 25% tax on health-insurance plans whose premiums grow faster than an approved rate. The poor would get government help to pay for coverage, with the subsidies going first to poor children and pregnant women. Funding would come partly from a new tax on cigarettes of 45 cents a pack and through savings in Medicare and Medicaid. That was enough for the President, who started one-to-one meetings with Democratic legislators to get them to support the bill while pursuing a furious counteroffensive that includes commercials purchased by the Democratic National Committee, aired on CNN. At rallies last week in New Jersey and on the White House lawn, Clinton pounded the podiums with calls for the G.O.P. to get with the program. "If Bob Dole and the special interests win," Vice President Al Gore told another crowd on Capitol Hill, "millions of Americans will lose." Despite Clinton's pleas for bipartisanship, there has never been much hope of bringing many Republicans on board. But while they have enough votes to stop any bill through a filibuster, that's a tactic that minority leader Dole is reluctant to use. He fears it will anger voters who want a vote on health care, not a procedural coup de grace. As G.O.P. pollster Bill McInturff warns, if reform dies on the floor, "Republicans have to be careful to keep our fingerprints off the murder weapon." The real threat to the Mitchell plan comes from Democrats and their supporters on both left and right. Clinton's endorsement horrified House Democrats still committed to a bill that provides faster universal coverage, like the one introduced in the House two weeks ago by Democratic majority leader Dick Gephardt. In that plan employers would be required to pay 80% of their workers' insurance premiums. The jobless would be protected by an expansion of Medicare, which now covers all people over 65, to include the unemployed, the self-employed and the poor of any age. Liberals in both houses supported the Gephardt idea in the hope that it would be useful as leverage against a more conservative Senate bill when both went to the House-Senate conference committee to be reconciled. But Clinton's embrace of the Senate plan instantly made it harder to attract support for the Gephardt proposal, which is in competition with a minimalist plan sponsored by the G.O.P. leadership and two bipartisan alternatives, none of which feature employer mandates. Why should House members stick their neck out, they ask, by voting in favor of high employer mandates if the final House-Senate bill is more likely to resemble Mitchell's idea? With that in mind, House leaders postponed the start of their own debate to see how things would pan out in the Senate. The White House is more concerned about bringing along conservative Democrats like Georgia's Sam Nunn and David Boren of Oklahoma, who have made it clear that even a hint of employer mandates could be too much. "To have any chance," Boren insists, "we must knock out the triggered mandate." The fate of Mitchell's plan may lie in the hands of a dozen or so Senators in both parties, including Boren, Nebraska Democrat Bob Kerrey and Republicans John Chafee of Rhode Island and Missouri's John Danforth. Even a Democratic victory in both chambers could be a headache. If the House adopts a bill calling for universal coverage now and the Senate passes something resembling Mitchell's, the House-Senate conference will face an exercise in tricky coupling that could be like resting a cargo plane on a bicycle. But with the approach of Election Day, by which date many lawmakers want a health-care bill to offer voters, the pressure may rise sufficiently to seal all the points of attachment. "If we don't get this done this year," Mitchell warns, "it will be well into the next century before we do." He shouldn't put it that way. It sounds like another of those distant target dates that Congress is so fond of. GEPHARDT PLAN Coverage and Financing: Universal coverage by 1999. Employers pay 80%; employees pay 20%. Large companies must start paying their share by 1997. Creates a federal health-care program, Medicare Part C. Cigarette tax rises from 24 cents to 69 cents over five years; 2% tax on insurance premiums and expenses of self-insured plans. Benefits: Guaranteed coverage including preventive care, prescription drugs, substance-abuse services, mental health, long-term care for severely disabled persons. Providers: Employers offer at least one health plan with unlimited providers and one managed-care plan. Employees of small firms can buy insurance available to federal employees. Insurance Impact: No rejection for pre-existing conditions. Costs for plans with fewer than 100 persons determined by community rates. Cost Containment: If states exceed their spending targets, a cost containment mechanism could impose a federal fee schedule for all medical services. MITCHELL PLAN Coverage and Financing: By year 2000, 95% coverage; companies with 25 or more employees could be forced to insure their employees and pay 50% of premiums. Cigarette tax gradually rises to 69 cents; handgun ammunition taxe increases; growth slows, and much of Medicaid is eliminated; 1.75% tax on health-insurance premiums. Benefits: Preventive care, prescription drugs, substance-abuse services, mental health, family planning, hospice and home care, long-term care for elderly and disabled. Providers: Employers must offer at least three plans, including fee-for-service and managed care. Businesses with less than 500 employees can buy coverage through health-insurance purchasing cooperatives. Welfare recipients, the self-employed and employees of companies with less than 500 persons may purchase coverage through an insurance program for Federal Government employees. Insurance Impact: No rejection for pre-existing conditions; insurance is assured when switching jobs; policy renewals are guaranteed. Cost Containment: 25% tax on high-cost plans. National panel monitors expenditures and recommends cost controls. POLL: DO YOU FAVOR: YES Making sure all Americans are covered? 77% Having government regulate the costs? 49% Requiring employers to pay most costs? 46% From a telephone poll of 600 adult Americans taken for TIME/CNN on Aug.4 by Yankelovich Partners Inc. Sampling error is plus or minus 4%. Not Sures omitted. </body> </article> </text>