Mitchell Serves Notice of Intent to Push Health Reform : Politics: Majority leader uses weekend retreat to spell out for Democrats his support for universal medical coverage.

Senate Majority Leader George J. Mitchell (D-Me.), having forestalled a chance at a seat on the Supreme Court to concentrate on health care reform, has put his Democratic colleagues on notice that it is time to confront the difficult trade-offs that lie ahead.

Painful as the choices may be, especially in a congressional election year, Mitchell has made it clear that he intends to hold Democrats accountable and do his best to force action on comprehensive universal health care before the year is out.

Mitchell signaled that the debate on health reform is entering this critical phase when he used the Democrats’ annual retreat last weekend to spell out an unusually detailed set of options aimed at paring the costs of the plan without sacrificing President Clinton’s goal of universal coverage.

For some senators, the meeting at Williamsburg, Va., marked the first time they really faced the specifics.

“In laying out the options, he really brought us to a better focus about what it is we have to decide and how we might reach consensus,” said Sen. Tom Daschle (D-S.D.), who has been one of the Senate’s leading backers of the President’s plan.

Daschle cautioned that three sets of alternatives being offered by Mitchell were primarily “for educational value” and were offered “without any expectation that we would adopt any of the options.”

However, all were aimed at lowering the cost of Clinton’s proposal without sacrificing his goal of universal coverage--a tack similar to that being pursued in the House, where Energy and Commerce Chairman John D. Dingell (D-Mich.) is trying to round up enough support on his panel to pass sweeping health legislation.

Lawmakers’ concerns over the cost of the Clinton plan heightened earlier this year, when the Congressional Budget Office estimated that the President’s proposal would add $74 billion to the federal deficit by the end of the century.

All three options outlined by Mitchell also include the most controversial proposal in Clinton’s plan: that all employers be required to pay some share of their workers’ health benefits.

One would pare that mandate from the minimum 80% employer contribution proposed by Clinton to 50%. It also would scale back benefits by 5% in overall value and allow firms with 1,000 or more workers to opt out of government-organized purchasing cooperatives. Under the President’s plan, far more firms--those with less than 5,000 workers--would be required to join the so-called “alliances.”

Another option would distribute government subsidies not to the small businesses with low-wage earners but to all low-wage workers, including those employed by big companies. Analysts said this alternative would be a more efficient and equitable way to provide assistance in buying insurance.

Administration officials said Mitchell’s weekend presentation was intended to provide Senate Democrats--especially on the Finance Committee--with “a sense of the options” and specifically to “accelerate their progress” toward drafting a bill.

Mitchell, a longtime advocate of health reform, acted independently of the White House, but Administration analysts “fell over themselves” whenever he or his staff sought information or technical advice, Administration sources said.

“What Mitchell was saying, in effect, was: ‘Focus, you guys. Time’s up. Think. Here we go!’ ” explained one Administration official. “In terms of what Mitchell was presenting, he used the core of the President’s plan, and from that he did some tweaking.”

To the extent that Mitchell’s action may expedite progress in the Senate, it also may persuade House members to proceed apace with their own health reform efforts. House members have been wary of getting too far out in front of the Senate on health care because they have not forgotten last year’s bruising budget battle in which they voted for an unpopular energy tax only to have the Senate kill it later.

Among those who sharply criticized Mitchell’s options was Rep. Jim McDermott (D-Wash.), the chief sponsor of the Canadian-style single-payer plan, in which the government pays most medical bills.

McDermott said he would not vote for a proposal that reduces the ratio of employer-employee contributions from 80%-20% to 50%-50%.

“There’s no way I’ll go back (to Washington state) and tell the aerospace mechanics that they are going to have to pay for half their health care,” he said. “This plan was clearly put out by someone who’s not going to run again.”

Also on Monday, senior White House officials expressed optimism that comprehensive health care reform will be enacted this year--in part, one said, because the Whitewater controversy appears to be receding as an issue.

But another senior Clinton adviser conceded that the President still must overcome a public perception that his plan means “big government is taking over the health care system.”

“Our job,” he added, is to ensure that Congress does not merely enact “a small package of insurance reforms” that do not provide universal coverage or control costs.

The President, meanwhile, continued a series of recent health care appearances with a speech in Milwaukee that stressed what his plan would do for small business.

Addressing about 1,000 employees of the Ameritech telecommunications company at Milwaukee’s Italian Community Center, Clinton said his proposals would cap the percentage of payroll that any business must pay for health benefits and would provide subsidies for small firms with low-wage earners. Under Clinton’s plan, no firm would have to pay more than 7.9% of payroll, while small firms with low-wage workers may pay as little as 3.5% of payroll.

Times staff writer Paul Richter contributed to this story from Milwaukee.