Clintons Press Campaign for Health Care Reforms : Medicine: First Lady tells hospital group that antitrust rules may ease. President says overhaul is vital.

Stepping up the Clinton Administration’s drive to enact health care reform, Hillary Rodham Clinton appealed Monday for the support of the American Hospital Assn., telling the group that the President’s emerging program will restore “compassion and caring into our society.”

The First Lady also dangled before the association a quid pro quo for its backing: relief from antitrust regulations so that hospitals can discuss confidential business affairs with one another and with networks of doctors in an effort to reduce operating expenses and patient fees.

Separately on Monday, the President made a spirited public appeal for health care reform, telling a campaign-style rally in Charlestown, W.Va., that “we can never take the deficit down to zero” or provide uninterrupted health coverage to all Americans without a sweeping overhaul.

With the hard-won budget fight now over, the President and Mrs. Clinton’s strong appeals signaled their intention to move expeditiously on their proposals, initially promised by early May.

“They are finally poised to roll on this thing,” said one informed source.

The President is expected to make the final, key decisions on the major elements of his agenda by mid-September. Foremost among the choices is how to pay for the reforms and how quickly to phase in coverage for the 37 million uninsured Americans.

Senior Administration sources said that Clinton will seek a universal “employer mandate” requiring all businesses to provide at least 80% of the cost of every full-time worker’s health insurance premium.

The workers would have to pay the other 20%. While the ratio now varies, with some companies paying the entire premium and others paying none, the 80-20 split is fairly common, experts said. For many large companies, with more than 5,000 employees, the new ratio would amount to a reduction in the portion of premiums they pay.

Employers of part-time workers would be required to pay on a pro-rated formula. The self-employed would be allowed to take a full tax deduction on the cost of their health insurance premiums. To alleviate the burden on small businesses and low-wage earners, unspecified “discounts” or subsidies would be made available, sources said.

The Clinton plan also is expected to include millions of new dollars in research funding targeted for breast cancer, Alzheimer’s disease, birth defects and heart disease, sources said.

The President is scheduled to meet for more than 12 hours this week, starting today, to work out whether to concentrate first on health care or the North American Free Trade Agreement, now that Congress has adopted his five-year economic plan.

The current White House thinking calls for the President to unveil his health reform agenda in a speech to a joint session of Congress in late September and then formally submit legislation to Capitol Hill in October, officials said. That timetable means that no congressional action would be likely this year.

“They’ve virtually given up hope of passage this year,” said one informed source.

To set the stage for the plan’s formal introduction, the President is to deliver a speech on the need for health care reform next Monday at the National Governors Assn. meeting in Tulsa, Okla.

In Orlando, Fla., at the annual meeting of the American Hospital Assn., the First Lady was warmly received by the estimated 4,000 delegates and their guests.

She did not disclose any new details of the plan, but she hailed the progress many hospitals already have made in realigning themselves to deliver care more efficiently, calling them “positive arrangements.”

Mrs. Clinton acknowledged that many such hospitals, in seeking to merge or simply share expensive high-tech equipment, have felt stymied by their inability to “get quick and reliable advice from the enforcers of the antitrust laws.” The pharmaceutical industry and the American Medical Assn. also have asked the Justice Department for similar relief from antitrust regulations.

“We not only heard you. We’re going to do something about that,” said the First Lady, who chaired the White House Task Force on National Health Care Reform.

“The Justice Department right now is exploring guidelines for mergers, networks, joint ventures, purchasing cooperatives and information exchanges so that hospitals do not have to file hundreds of more forms and wait years and years to share an MRI (magnetic resonance imaging machine) or pool advanced ultrasound equipment,” she said.

“We intend to move on that. It will be part of the President’s health care reform package,” Mrs. Clinton added.

Dick Davidson, AHA president, called the First Lady’s address “a powerful speech” that “bodes well for health reform.”

In the past, he said, many hospitals have refrained from cooperating with one another or with physician networks for fear of being sued for antitrust violations by the government. “If we get (antitrust) guidelines, we will get more collaboration,” said Davidson, whose group represents more than 5,000 hospitals around the country.

Under Clinton’s emerging proposals, most Americans would be grouped into large purchasing alliances that would act as their agents in purchasing health insurance, ultimately making available to members an array of plans from which to choose.

The notion is that these alliances would have the clout to negotiate with networks of doctors and hospitals for low prices while ensuring high-quality care.

Other elements of the plan include:

* A uniform package of benefits for all citizens and legal residents, including numerous preventive services and some prescription drug coverage.

* A prohibition against insurers rejecting people because of pre-existing medical conditions.

* Gradual coverage for long-term care, starting with home- and community-based efforts.

Other than a cigarette tax of about $1 per pack, it is unclear what other revenue sources the Administration will propose to finance the reforms.