Less-Than-Sweeping Health Care Plan Expected : Reform: Odds are against the Clinton program surviving intact in Congress. Veto a possibility, but White House still optimistic.

With President Clinton’s health care proposal under heavy fire in Congress and no other comprehensive alternative emerging so far to take its place, there is an increasing likelihood that lawmakers will turn toward the less-than-comprehensive reforms that Clinton has vowed to veto.

As key committees prepare to begin their work in earnest, there is growing speculation that Congress may pass only insurance market reforms and a watered-down measure to extend coverage to some of the 38 million uninsured Americans.

If that happens, Clinton will be left with a difficult choice: Make good on his threat to veto any bill that does not provide coverage to everyone, or take what he can get and declare victory.

“It’s getting to the point where everyone realizes that you just can’t fake it anymore,” said one Democratic congressional aide, conceding that the chances of a thorough overhaul of the health care system are growing smaller.

But don’t count the President out, warned senior White House adviser George Stephanopoulos. For now, he said, Clinton is content to let Congress do its “legislative handiwork” while he and First Lady Hillary Rodham Clinton continue campaigning for universal coverage.

Some analysts say such a hands-off strategy may doom the drive for comprehensive reform, but not Stephanopoulos. “I don’t think anybody knows exactly how it’s going to turn out,” he said.

Confusing the situation is the fact that several committees in both the House and the Senate will prepare competing versions of health care reform legislation, which will somehow have to be reconciled.

The House Ways and Means health subcommittee, which is scheduled to begin drafting its version of a health care bill this week, appears certain to reject the Clinton plan’s provision forcing most Americans to get their coverage through mandatory purchasing alliances. It is by means of these alliances that Clinton plans to achieve many of his goals, including containment of health costs.

But subcommittee Chairman Pete Stark (D-Oakland) has flatly declared the alliances dead, and other lawmakers say they view them as unworkable, forcing too much government intrusion into the health care system. If the alliances are to exist at all, many argue, membership in them should be voluntary and they should have no regulatory powers.

Clinton’s plan could face even tougher going in the Energy and Commerce health subcommittee, which is headed by Rep. Henry A. Waxman (D-Los Angeles). Although Waxman is squarely behind the Clinton plan, the moderate and conservative Democrats who populate the subcommittee are balking at two of its other pillars: requiring employers to provide health coverage for their workers and imposing price controls on health premiums.

Where will it all lead?

There may be a clue in the effort of two members of Waxman’s panel, J. Roy Rowland (D-Ga.) and Michael Bilirakis (R-Fla.), who plan to introduce what they describe as the only health legislation on which there is truly a consensus.

It cobbles together elements of the Clinton plan and the major alternatives written by various members of Congress.

Its features include allowing workers to take their health insurance with them when they leave a job, reining in malpractice lawsuits, forcing insurance companies to provide coverage to people with known health problems, making it easier for small businesses to pool their resources to purchase insurance for their workers and putting more emphasis on preventive care.

In this lowest-common-denominator approach, there would generally be a lot less government involvement in the health care system: no requirement that employers or individuals buy insurance, no premium caps to bring health care costs under control and no major changes in the tax code to encourage health consumers to buy more economical plans.

But Waxman said he has not given up hope of a more far-reaching bill.

“One of the ways to develop a consensus is to get legislation moving,” he said. “As bills start moving forward, the various groups that have been posturing up to now will have to start to figure out what they will support, and not merely to stand in opposition.”

Moreover, the President’s allies say they see opportunity in the apparent disarray among the congressional committees. “What’s good now is that we know where we need to work,” said Linda Lipsen of the Consumers Union, which dispatched a small army of its lobbyists to Capitol Hill last week.

The unsettled situation in the House has also thrown off political calculations in the Senate.

“There was a presumption that you could get all of the President’s bill through the House of Representatives, and that the Senate might want to pick at it somehow,” said Lawrence O’Donnell Jr., the Senate Finance Committee’s Democratic chief of staff. Now, he said, it is beginning to appear that the House “can’t deliver half.”

But that should not be viewed as a defeat for Clinton, he said. “It might start to look like much less to the (Administration aides) who designed this massive piece of legislation, but to me, it still and will always look like much more than we ever could have expected to do before Bill Clinton became President and made this Congress’ major job,” he said.

House Ways and Means Committee Chairman Dan Rostenkowski (D-Ill.) seemed to take the same view in an interview last week with USA Today. “We’re going to give it a helluva try,” Rostenkowski said. “We’ll do as much as we possibly can, and whatever that is, it’ll be a giant step in the direction of getting ultimately a bill similar to what the President wants us to get.”

But if that turns out to be “half a loaf” this year, Rostenkowski added, he would advise Clinton: “Don’t go around criticizing Congress and kicking the sand and looking down and saying: ‘Aw, shucks, I didn’t get all I want.’ I’d go out in the Rose Garden with a pen, sign it and say, ‘Boy, this is a big victory.’ ”

That is precisely the sort of speculation that Clinton must squelch, Waxman said.

“The President has said that he will not let us get away with something that does not provide as a bottom-line universal coverage,” he said. “It is so important that the President make it clear, as he did in the most forceful language possible in the State of the Union Address, that he will not accept that, and that if members of Congress think they can go home with half a loaf that the President will agree to, they are mistaken.”

Waxman conceded that a stripped-down health bill could have some political appeal for lawmakers seeking to dodge the difficult choices that lie ahead. But he insisted that it would not solve the nation’s central health care problem, which is that 38 million people remain out of the system.

The White House and its allies continue to insist that they can recoup any losses that are dealt them by the half a dozen or so committees that have jurisdiction over all or part of the bill.

Their opportunity, they say, will come in April or May, when the committees are through with their work and the Democratic leadership of both houses knits together a compromise version to take to the House and Senate floors.

“What counts is that the major pieces (of Clinton’s plan) are reported out by one committee or another,” one Administration strategist said. “We feel there are champions of all the major pieces somewhere in that mix. So there’s a real reason for some confidence that all the pieces of the plan are going to be on the table at conference.”

But before health reform can get to that stage, it will have to survive several months of pummeling in a series of committees.

“It’s going to be the Gettysburg of political battles. I’m hoping it doesn’t become the Verdun,” said Rep. Jim Slattery (D-Kan.), a member of Waxman’s subcommittee. The historical metaphor was a telling one: Gettysburg was a turning point in the Civil War, while Verdun is remembered as the most senseless blood bath of World War I.