Clinton’s Balancing Act Impresses Few : Congress: Health care plan’s changes do not produce many converts among either liberals or conservatives.

President Clinton’s most recent efforts to find a middle ground on his health care package left some of his allies uneasy Wednesday while others were reassured.

After a splashy Capitol Hill ceremony filled with promises of compromise and bipartisan cooperation, few in Congress appeared to have changed positions, with factions embracing at least half a dozen major alternatives to the White House plan and many remaining unalterably opposed to it.

“I have no interest in trying to make their bureaucratic monstrosity work, and I don’t think it’s possible,” said Rep. Newt Gingrich (R-Ga.), the second-ranking House Republican.

The last few weeks have seen the White House fine-tuning many elements of its proposals to answer concerns from the left and the right.

“They have gone nuts trying to find what the middle is,” said Rep. Jim McDermott (D-Wash.), the leader of a group of liberal legislators who support a government-run “single-payer” system. “They have made a lot of very carefully contrived decisions to try to find the exact middle, and I don’t think they can do it that way.”

The most controversial of the changes that Clinton has made in recent weeks was to limit the amount of money that may be spent on subsidies for retirees, poor people and small businesses. If costs exceed limits, the President would have to ask for additional funds from Congress.

Rep. Henry A. Waxman (D-Los Angeles), chairman of a crucial subcommittee and one of Congress’ most influential liberal voices on health care issues, called the limits “a very serious mistake” that could force the President to break his most basic promise: adequate health care coverage for all.

“It’s a real serious problem, a serious flaw in the Administration’s proposal,” he said. “It undermines the credibility of the Administration promise of universal coverage--health care security that will always be there--because it won’t be there if they run out of money.”

Yet others said the shift left them more confident of the financing underlying the plan and less fearful that it could fall victim to the runaway costs that have beset the government’s Medicare and Medicaid programs.

Sen. Dianne Feinstein (D-Calif.), one of the Clinton bill’s co-sponsors, said the President’s goal of curbing health care costs is at least as important as universal coverage.

“You can’t get both of those by being a good guy to everybody,” she said. “You can’t provide everybody with everything.”

Waxman, who despite his reservations has also signed on as a co-sponsor, said the modification in the President’s initial plan belies a weakness in the Administration’s political strategy.

“They’ve made a number of accommodations to conservative Democrats and Republicans as well as to some of the interest groups too early,” Waxman said. “They’ve made a lot of changes in the bill to try to accommodate groups that are still against them.”

Inevitably, McDermott said, a true middle ground will be defined in months of wrangling in Congress.

The plans advanced by the far left and the far right may be all but irrelevant. Most experts say they believe that liberals will have no choice but to join the Clinton plan and that it is hopeless to try to win the votes of the most conservative Republicans.

But at least two alternatives to Clinton’s plan appear to have a chance of playing a major role in the coming debate because each makes a credible claim of representing a centrist approach.

One, advanced by a group of moderate Senate Republicans led by Rhode Island Sen. John H. Chafee, contains many elements of the President’s plan but rejects its requirement that employers provide health coverage for employees. Instead, that responsibility would lie with individuals themselves.

Another, which is the only one that has public support in both parties and both houses in Congress, is far smaller in scope than the Clinton plan and does not guarantee health coverage for all Americans. But it does incorporate the Clinton plan’s premise of encouraging competition among health care providers.

The leading House backer of that alternative, Rep. Jim Cooper (D-Tenn.), said he is “increasingly optimistic that the Administration has the flexibility to work with Congress and get good health care reform passed.”

But one House strategist said that the political appeal of Cooper’s plan may make it more difficult for Clinton to win approval for universal coverage.

“What Cooper has done is give the moderate Republicans a place to hide on a plan that does not give universal coverage,” the aide said.

If Congress strays too far from the goal of universal coverage, it may lose in the end, Sen. Barbara Boxer (D-Calif.) warned.

“The basic tenets of the (Clinton) plan will remain, or we’re not going to have a bill, because the President’s not going to sign a bill that goes halfway there,” she said.

Times staff writer Michael Ross contributed to this story.