Clinton Allies Push Health Cooperatives : Congress: Lawmakers who back the idea say it is the only way to ensure choice. But a panel chairman predicts that the approach will fail.

President Clinton’s allies on Capitol Hill mounted an offensive Wednesday to rescue a central element of his health care reform plan: the gigantic purchasing cooperatives through which most Americans would be required to obtain their health coverage.

Sen. John D. (Jay) Rockefeller IV (D-W.Va.) insisted that the alliances must remain in the legislation because they are “the heart and soul of what health care reform is about.”

Only the purchasing cooperatives could assure that consumers would have a choice among health plans, said Rockefeller, Senate Labor and Human Resources Committee Chairman Edward M. Kennedy (D-Mass.) and several other key Democrats.

And only the purchasing cooperatives, they told reporters, would spread the risks of insuring certain groups, such as people with costly health conditions, who might otherwise be unable to find affordable care.

“There’s no way to replicate the advantages” of alliances, Sen. Thomas A. Daschle (D-S.D.) insisted. “You’ll lose efficiency. You may lose universal coverage.”

Yet, even as these senators showed their support for the concept, Rep. Pete Stark (D-Oakland), chairman of the House Ways and Means Committee’s subcommittee on health, repeated his prediction that the government-organized purchasing cooperatives would not be approved by his panel or by the House as a whole.

Stark, an opponent of the purchasing cooperatives and proponent of competing “single-payer” health care delivery, said no one on the subcommittee supports mandatory alliances. Some subcommittee members have complained that the alliances would inject big government into the health care system, he said, and others have said they believe that the alliances’ task would be more than they could manage.

“The President has great goals we’re going to try to achieve,” Stark said. “The alliances will not survive, so we’re going to have to find other ways to do what the alliances would have done.”

Stark’s subcommittee, which is scheduled to begin piecing together its version of the legislation next week, will be the first of at least two in the House and two more in the Senate that will be part of the bill-drafting process.

In the Senate, the Finance Committee’s views on the alliances are likely to become clearer today when it conducts a hearing on the subject. Daschle and Rockefeller--supporters of the concept--are on the panel but Chairman Daniel Patrick Moynihan (D-N.Y.) has made it clear that he is deeply skeptical of mandatory alliances.

With the health reform focus shifting to Capitol Hill, President Clinton met late Wednesday with about a dozen House members who support a rival Canadian-style single-payer proposal, assuring them that he remains committed to the principle that any reform plan must lead to universal coverage.

The President reiterated his intention--disclosed during a speech to Congress in January--to veto any bill that does not guarantee coverage for every American, said Rep. Jim McDermott (D-Wash.), author of the single-payer proposal.

“He realizes that the committees are starting their work, and he just wanted to hear where the single-payer people are,” McDermott said.

Another participant in the hourlong White House meeting said afterward: “We let the President know that, if he retreats from universal coverage, we’re not going to be with him.”

Also attending the meeting were Vice President Al Gore, First Lady Hillary Rodham Clinton, Deputy White House Chief of Staff Harold Ickes and senior advisers Ira Magaziner and George Stephanopoulos.

Earlier in the day, another senior Administration official, seeking to shore up support for another element of Clinton’s massive reform plan, told reporters that its long-term care provisions are essential to provide all Americans with “health security.”

When the plan is fully implemented by the year 2003, more than 3 million Americans would be eligible for home- and community-based care that would keep them out of nursing homes, said Judy Feder, a deputy assistant secretary at the Health and Human Services Department.

Sen. Russell D. Feingold (D-Wis.), a co-sponsor of the single-payer approach, also praised Clinton’s long-term care proposal, which would institute a new program financed largely by the federal government but designed and administered by state and local governments.

“It would be a big mistake” to eliminate the long-term care program, Feingold told a group of reporters. “We’ve got to work hard (to preserve it) because everything’s at risk.”

The President also intends next week to stage an event to highlight the long-term care provisions. Many elderly groups told Clinton during a White House meeting last week that, without long-term care coverage, they would not support his overall agenda.

The $65-billion program, to be phased in starting in 1996, would be financed mostly through anticipated savings from reductions in the growth of Medicare and Medicaid, Feder said.

The proposal is modeled after a 12-year-old program in Wisconsin that has saved the state significantly more than $100 million by keeping people at home instead of in nursing homes, where costs are much higher, said Feingold, the program’s creator.

Feingold said the average per-capita cost of providing home care subsidies in Wisconsin is $8,724 a year, contrasted with about $30,000 in a nursing home.

Also on Wednesday, the U.S. Chamber of Commerce, after much internal discussion, decided at least for now to adhere to its opposition to Clinton’s requirement that employers pay for the bulk of their workers’ health insurance costs.