Health Care Reform Package Formally Introduced : Medicine: Centerpiece of Clinton’s domestic policy is expected to dominate the next congressional session.

Three weeks after President Clinton delivered his health care reform plan to Capitol Hill, Senate Majority Leader George J. Mitchell (D-Me.) late Saturday formally introduced the package that is likely to dominate all other issues in Congress next year.

The introduction was done with little fanfare in the waning hours of the congressional session, in sharp contrast to the splashy ceremony with which Clinton delivered the centerpiece of his domestic policy agenda to Congress.

Since that time, the bill has undergone dozens of changes, which the White House has characterized as technical in nature. Mitchell and House Speaker Thomas S. Foley (D-Wash.) have also used the time to quell what has amounted to a turf war among committee chairmen who have asserted claim to the legislation.

In a statement that he inserted into the Congressional Record, Mitchell described the bill as “an important first step toward protecting the health security of every American.”

However, Mitchell acknowledged that the plan is likely to undergo at least some change as it works its way through the legislative process. There are at least half a dozen credible alternatives already circulating on Capitol Hill.

In particular, the majority leader noted a proposal advanced by Sen. John H. Chafee (R-R.I.) and Minority Leader Bob Dole (R-Kan.). Where Clinton’s plan would require that all employers provide health insurance for their workers, the GOP proposal would put the legal mandate for health insurance on the individuals themselves.

Mitchell reiterated what Clinton has said is his bottom line on any health care bill: that it provide coverage for everyone.

But he noted that the goal of reining in soaring costs also is important and added: “It is the tension between expanding access and controlling the cost of health care which continues to present a challenge to those of us who are attempting to develop responsible public policy.”

The new modifications include a scaling back of some portions of the benefits that would be provided for mental health and substance abuse treatment. Those revisions already have generated controversy among lawmakers.

The other changes include extending the reductions in Medicare spending an additional three years, through 2003.

Meanwhile, parliamentary arrangements in the Senate have also made it more likely that the final package will bear a more conservative stamp than it might have otherwise. That is because of significant turf war won by Finance Committee Chairman Daniel Patrick Moynihan (D-N.Y.).

Mitchell said Friday that Moynihan’s committee would get primary jurisdiction over the bill. The other contestant for that role was the Labor and Human Resources Committee, whose chairman is Sen. Edward M. Kennedy (D-Mass.).

“I have been meeting, consulting, cajoling, and we’re very near the end of the process,” Mitchell said in a breakfast session with Times reporters.

Many in the White House had hoped that Kennedy’s Labor Committee would win the battle for principal jurisdiction. Kennedy has championed the cause of health care reform since the mid-1970s.

The committee also has a solid liberal majority and its Democrats have been quite supportive of the Clinton plan.

The Finance Committee, meanwhile, has been openly skeptical of many of the economic underpinnings of the plan and could be a less hospitable proving ground for the proposal. Democrats hold only a two-vote majority on the Finance Committee, and its membership also includes the chief sponsors of two leading alternatives to the Clinton plan, Sens. Chafee and John B. Breaux (D-La.).

A similar struggle has been under way in the House between three committees: Ways and Means, Energy and Commerce, and Education and Labor. There, however, the rules allow Speaker Foley to send virtually the entire bill to all three panels and work out their differences later.

While Mitchell conceded that the bill inevitably would undergo some modification, he insisted: “The principles that the President set forth (in his proposal) will remain intact.”

“Ultimately,” Mitchell added, “I think the choice will come down to the President’s plan as modified, or no action. I don’t think any alternative will rise to the level of being a substantial competitor.”