A Senate committee with a key role in crafting health care legislation voted Thursday for a cost containment provision that would establish a national board with the authority to trim benefits and raise out-of-pocket spending by consumers.
Under a bipartisan compromise approved by the Labor and Human Resources Committee, the board's actions could be reversed only if Congress acted within 45 legislative days after receiving the board's "recommendations."
The 17-0 committee vote, after nearly two days of partisan wrangling, left members elated--but confused over whether such a national health board could also reduce medical providers' fees and insurance premiums if health spending had to be reined in.
Senators vowed to clarify the issue next week.
Whether the provision will survive the long legislative process still ahead and ever become part of a final health care reform measure remains far from clear.
But that did little to dampen a can-do spirit that flowed from both sides of the aisle as members and their staffs congratulated one another for having produced the first bipartisan agreement on a difficult health care reform issue.
The action also raised hopes of breakthroughs on other, equally perplexing matters as the committee races toward the Clinton Administration's Memorial Day target for reporting out a comprehensive health care reform bill.
Sen. Nancy Landon Kassebaum (R-Kan.), the panel's ranking GOP member, called the vote "a victory for moderation . . . and fiscal responsibility." Chairman Edward M. Kennedy (D-Mass.) called it "a small step for health care but a giant leap for bipartisanship."
But it was Sen. James M. Jeffords (R-Vt.) who may prove the most prophetic, saying: "Without the ambiguity, there wouldn't have been unanimity."
The bipartisan good feelings will be put to the test today when the Republican National Committee launches a $500,000 national television campaign attacking President Clinton for having proposed "a government-run system."
Thursday's surprise agreement on a cost control mechanism was significant and telling in several aspects.
The vote was important because finding a consensus on how to control costs has been one of the toughest challenges facing Congress as it goes about overhauling America's $1-trillion-a-year health care system.
The vote also revealed the sort of individual compromises that members must make as they tackle the complex issues.
By voting to control costs as they did, conservative Republicans were at the same time endorsing a dramatic expansion of the powers of a new regulatory agency--a prospect that clearly unsettled some of them.
There is a deep and widespread fear that medical spending could rage out of control as the nation extends coverage to the estimated 38 million uninsured Americans--while guaranteeing all a comprehensive set of benefits that could include, for the first time, coverage for prescription drugs, mental-health and substance-abuse treatment and the beginnings of home- and community-based long-term care.
The Labor and Human Resources Committee is working on a bill drafted by Kennedy that is closely patterned after President Clinton's reform plan. But Kennedy proposes even broader benefits than Clinton, prompting Sen. Dan Coats (R-Ind.) to call Kennedy's benefits package "an extraordinary expansion" that he and Kassebaum said must be scaled back.
It was in that ensuing debate that a compromise to expand the cost containment authority of a national board was worked out between Kassebaum and Sen. Jeff Bingaman (D-N.M.).
The amendment would require the board to conduct annual fiscal analyses of the nation's health care system.
To make up for any shortfalls or drains on the federal budget, the board could recommend cuts in the benefits package. Such recommendations would automatically take effect unless Congress quickly acted to reject the recommendations or to somehow raise the needed revenues.
The possibility that medical providers and insurance companies may escape the purview of the board's cost containment authority--at least based on the amendment's ambiguous language--drew a sharp rebuke from Gail Shearer, a Consumers Union analyst.
"The committee has started down a slippery slope that could threaten consumer health care security," she said. "This action demonstrates how crucial it is that Congress build in real cost containment so that there won't be a deficit in the first place."