House Leaders Delay Action on Health Care Bill

WASHINGTON —  House Democratic leaders announced Thursday night that their debate on health care legislation will not begin as scheduled next week--a delay that casts additional doubt on whether Congress can enact sweeping health care legislation this year.

The leaders declined to say when they might vote on a bill, although speculation was that it may not happen until next month.

“I don’t know when the situation is going to be possible for us to consider health care,” a grim-faced House Speaker Thomas S. Foley (D-Wash.) told reporters after a meeting Thursday night with White House officials and Senate Majority Leader George J. Mitchell (D-Me.).

Throughout the day, it had become increasingly clear that the legislative process had disintegrated into something approaching chaos, with one undecided Democrat summing up the view of many in the House regarding the prospects for the health care bill: “It’s in free-fall right now.”

Officially, House Democratic leaders blamed the delay on the impossibly heavy crush of work that has been thrust upon the Congressional Budget Office, whose staff of less than 20 has been asked to perform detailed economic analyses on a host of alternative proposals. The leadership gave no indication when those analyses would be completed.

But opponents suggested that the postponement really was a desperation ploy by leaders who know they lack the votes to win.

“The big problem is the CBO cost accounting of those bills,” Foley insisted. “Any other explanation is a myth, total myth, absolutely false.”

Whatever the explanation, many say they believe that the delay could be fatal to the legislation because it will give the bill’s opponents the opportunity to mobilize as lawmakers return home to their districts for Congress’ summer recess.

“It helps us, because they are going to be out there talking to real people,” said Senate Minority Leader Bob Dole (R-Kan.).

By now, both houses are months behind the schedule they had set for themselves. As time has passed, opposition to the concept of national health insurance has strengthened, support has eroded and the public appears to have lost much of its sense of urgency on the issue.

“Time is the scarcest commodity we have right now,” said Rep. Pete Stark (D-Hayward), chairman of the Ways and Means health subcommittee, whose bill is the foundation of the legislation that was offered by Majority Leader Richard A. Gephardt. “We have a deadline of Nov. 8 (Election Day). The opponents don’t have any deadline.”

Signs now indicate that any legislation Congress might pass will be far less ambitious than the plan outlined last year by President Clinton, which would guarantee health coverage for all citizens. Indeed, even as the Democratic leaders were revamping their schedule, a bipartisan group of House members announced a proposal falling well short of the President’s goal of universal coverage and avoiding the more controversial elements of the House leadership proposal.

As the prospects for the legislation in the House grew more dicey, however, there were flickers of strength in the Senate, which was in the third day of debate on a health measure put forward by Mitchell.

In floor speeches, Sens. Herbert Kohl (D-Wis.) and Frank R. Lautenberg (D-N.J.) offered support for the Mitchell bill, although both said they wanted to change certain elements of it. Kohl and Lautenberg, both of whom are up for reelection this year, are among a small number of uncommitted Democrats--fewer than a dozen--who will determine whether Mitchell can get the 50 votes he needs to pass his legislation.

In an interview published Thursday by the New York Times, Clinton indicated that he would veto anything weaker than the Mitchell bill. That bill seeks to make the so-called employer mandate more palatable by making it a fallback and giving other incentives a chance to work first.

The bill’s requirement that most employers pay 50% of their workers’ health premiums would become effective only if voluntary measures did not succeed in producing 95% coverage by the year 2000. It also would not apply to firms employing 25 people or fewer.

Many House Democrats are reluctant to vote before they know the direction the Senate is headed. They fear that taking a politically risky stand in favor of the House bill’s mandatory 80% employer mandate unless they can be confident that the Senate will at least support the watered-down mandate in the Mitchell bill.

However, a Senate vote on that issue has yet to be scheduled.

A House delay could provide maneuvering room for a bipartisan group of moderates--five Republicans and five Democrats--who Thursday formally unveiled their own proposal for incremental reform.

Already, their more modest bill has won the endorsements of three giant health care industry groups: doctors, hospitals and insurers. If Gephardt’s bill were killed, the bipartisan bill--which proposes far less sweeping reforms--could become the political lifeboat for House members who do not want to go home empty-handed for the November elections.

The bill does not guarantee coverage to the 39 million uninsured Americans. Rather, it would rely on incremental reforms to break down barriers to insurance, such as banning discriminatory practices in order to enable consumers to take their insurance from job to job and to buy affordable policies even when family members have existing illnesses.

The bill also would expand rural and community health centers and provide subsidies to needy individuals and families on a sliding scale, up to 240% of the poverty level for pregnant women and children under age 18.

The subsidies would amount to $117 billion over five years and $340 billion over 10 years, most of which would come from savings in Medicare and Medicaid, according to those drafting the bill.

In announcing the legislation, the sponsors spent as much time talking about what their bill does not contain as what it does.

Said Rep. J. Roy Rowland (D-Ga.): “It does not rely on employer mandates, tax increases, price controls, new entitlements, rationing of care, limitations on choice or bureaucratic expansion.”

“Our bill,” added Rep. Michael Bilirakis (R-Fla.) “fixes the cracks in our system without tearing down the walls.”

One of the problems the bill faces, however, is that it is projected to attain only about 90% coverage by the year 2004--a potential obstacle to gaining broader support. Currently, an estimated 85% of the U.S. population has health insurance.

The bill is an amalgamation of two proposals introduced earlier: one by Rowland and Bilirakis, which had 74 sponsors (37 from each party) and the other by Reps. Jim Cooper (D-Tenn.) and Fred Grandy (R-Iowa), which had 57 co-sponsors from the two parties.

In many key ways, the bipartisan bill resembles the proposal introduced earlier in the week in the Senate by Dole.

The House bipartisan bill was immediately endorsed Thursday by two powerful health care interest groups: the Federation of American Health Systems, which represents 1,440 investor-owned hospitals, and the Alliance for Managed Competition, made up of the nation’s five largest insurers: Aetna, CIGNA, MetLife, Prudential and Travelers.

The powerful American Medical Assn. has also endorsed the plan. Among the provisions favored by the AMA is a cap of $250,000 on the amount any victim of medical malpractice may receive as compensation for non-economic damages.

As the new bill gained momentum, Gephardt continued to make modifications in his bill in hopes of picking up votes. Among them was the inclusion of a provision under which the government would subsidize health coverage for early retirees not yet covered by Medicare.

In another concession, Gephardt dropped a provision to require biotechnology companies to pay a 15% rebate to the government on biotech drugs covered under Medicare. He agreed to drop the provision largely at the behest of California Reps. Lynn Schenk (D-San Diego) and Anna G. Eshoo (D-Atherton).

Stark said the majority leader also decided to include coverage for Christian Science treatment, to waive out-of-pocket costs for mammograms and other tests and to set a lower limit on the amount that individuals and families would pay for medical care in a single year.

Stark complained, however, that no provisions were being made to pay for those additions. “The leadership thus far has been unable to say no to anybody, except their friends,” he said.

One senior Democratic aide said that the prospects for the bill have become so bleak that such modifications are pointless: “God love Dick Gephardt, but he’s doing organ transplants on a corpse.”

Times staff writer David Lauter contributed to this story.