Staking out new ground in the debate over health care, a group of conservative Democrats and moderate Republicans in the House offered a reform proposal Wednesday that they described as "squarely in the middle."
The measure is similar to President Clinton's in many respects but rejects his proposal to require employers to pay the lion's share of their workers' health insurance premiums and his plan to impose federal controls on health costs.
Supporters of the proposal, led by Reps. Jim Cooper (D-Tenn.) and Fred Grandy (R-Iowa), also contend that the President's goal of "universal coverage" is not realistic and aim instead for the more modest "universal access" to medical care by making it more affordable for small businesses and offering government subsidies to the poor.
In related developments, chief White House economist Laura D'Andrea Tyson told a press conference that the Administration's health care plan could cost jobs in some parts of the economy, and Health and Human Services Secretary Donna Shalala said that preventive medicine is a major goal of the President's plan.
Rep. Cooper said that his bill, which has 27 Democratic and 19 Republican co-sponsors, is far closer to the theory of "managed competition" that underpins both Clinton's plan and that of the leading GOP alternative, which has been advanced by Sen. John H. Chafee (R-R.I.).
Sens. John B. Breaux (D-La.) and Dave Durenberger (R-Minn.) are expected to offer a similar proposal in the Senate.
The concept is based on the idea that consumers, by pooling their purchasing power into giant alliances, can gain enough clout in their search for low-cost, high-quality insurance plans to force down health care prices.
"The Administration started with managed competition and went to the left. The Republicans took managed competition and went to the right," Cooper said. "Our bill is squarely in the middle and is the only one with significant bipartisan support."
However, Rep. Henry A. Waxman (D-Los Angeles), a key House subcommittee chairman and crucial Administration ally, contended: "They're really on the right wing of the debate."
Under Cooper's proposal, businesses with fewer than 100 workers would be required to join health-purchasing cooperatives, although they would not have to pay for their employees' benefits. Employees would not be required to buy insurance, although presumably it would be available at lower cost.
By comparison, Clinton's plan would force companies with fewer than 5,000 workers into purchasing cooperatives and force all companies to pay at least 80% of the average cost of health insurance for their workers. Employees also would be required to participate.
Cooper said that his plan would cost significantly less than the President's--$40 billion over the first six years, compared with $350 billion--and would require fewer reductions in the growth of Medicare spending.
Waxman conceded that many lawmakers may find the Cooper-Grandy plan politically attractive.
"A lot of members may think it's appealing, because they don't have to face the business lobbyists (opposing the requirement for worker coverage) or the medical Establishment (opposing the government cost controls)," he said. "They think they can have a vote that's for reform without antagonizing the special interest groups."
However, he insisted that it would not be comprehensive enough to fix the health care problem and assure all Americans of high-quality medicine at lower costs.
Those sentiments were echoed by Consumer Union, which supports the so-called single-payer system. "It (Cooper's bill) is little more than a Band-Aid on a gaping wound. . . . It leaves 25 million consumers out in the cold," said Linda Lipsen, the organization's legislative director.
But the proposal was heartily endorsed by the nation's largest insurance firms.
"We have seen in the past that price controls don't work and that the heavy hand of government often distorts markets to the detriment of consumers," said the Alliance for Managed Competition, made up of Aetna, Cigna, Metropolitan Life, Prudential and Travelers.
Meanwhile, Tyson, who chairs the White House Council of Economic Advisers, told a press conference that Administration studies show the health care reform plan could reduce U.S. employment, which now totals about 110 million, by 0.5%. But, she said, it also is possible that the plan could increase employment by a similar amount.
And even in the worst-case scenario, she said, the reform package ultimately will make the United States more competitive by lowering costs and creating a healthier work force.
Tyson spoke in response to fears that the health care plan, which would restructure 14% of the economy, could have a wrenching impact on the nation. She said that the plan's impact on employment should not be the only measure by which Americans judge the Clinton program.
There will be a number of intangible economic benefits for businesses and workers that are not easy to fit into economic forecasts and calculations, she said. For example, the program should make it easier for Americans to move from one job to another without fear of losing health insurance, increasing job mobility and allowing workers to better live up to their career potentials.
The program will also reduce incentives for the poor to remain on welfare. Many recipients now turn down low-paying jobs that do not offer health insurance because they can qualify for Medicaid coverage while on welfare.
Health reform should lead to "a more productive, more flexible American work force," Tyson said.
In testimony before the Senate Labor and Human Resources Committee, Secretary Shalala said that the Administration is committed to making prevention the cornerstone of its health reform proposal.
"Our comprehensive benefit package is rich with preventive benefits that we believe will save lives and money," she said.
But she was challenged by several senators, most vocal among them Sen. Barbara A. Mikulski (D-Md.), for provisions in the package related to women's health, specifically how often Pap smears and breast cancer-detecting mammograms would be covered.
The comprehensive benefits package under the Clinton plan would provide free mammograms only to women 50 and older and only at two-year intervals. Many medical experts, including those at the National Cancer Institute and the American Cancer Society, recommend mammograms for women after 40, either annually or every other year, and yearly mammograms after 50.
Mikulski called the recommendations "far more skimpy" than those put forth by professional organizations and criticized Shalala for saying they were based on science.
Earlier in the week, First Lady Hillary Rodham Clinton fielded similar questions during a televised forum sponsored by Self magazine.
Shalala said that the package is still under review and insisted that "any woman who feels she ought to get a mammogram," would be able to obtain one, although "she might have a small co-pay" if she is not in a high-risk group or does not fall into the recommended age range for women who should be regularly screened.
The Administration's decision to emphasize prevention in health reform was backed in testimony by an array of organizations, including officials from the American Cancer Society, the American Heart Assn., the American College of Preventive Medicine and Olympic track star Florence Griffith Joyner, who co-chairs the President's Council on Physical Fitness and Sports.
The cancer society called for a $2 increase in the cigarette excise tax to help pay for reform. President Clinton has said that he would ask for a tax, but it is expected to be between 75 cents and $1.
Times staff writers James Risen and Edwin Chen contributed to this story.