Capitol Hill Sends Warning to Clinton on Health Care Reform: Move It or Lose It : Congress: The legislation is still plodding in several committees. Some insiders say it’s up to the President to save it from a slow death.

With the fate of health care reform in Congress within weeks of being decided, some on Capitol Hill have concluded that the White House strategy for enactment is a disaster and that the entire effort may collapse unless a change is made now.

The White House has “an Alice in Wonderland perspective,” said Sen. John B. Breaux (D-La.), one of the key lawmakers positioned to help broker a deal. “It’s June in the last year of this Congress, and I would have hoped that the politics of health care would be in better shape.”

At this advanced stage of the legislative process, lawmakers had expected that several benchmarks would have been reached. There should have been a general understanding on the minimum elements of the program, at least among the majority Democrats. Committees negotiating the details should have produced their legislation or, at least, should be meeting regularly and making headway. And the outlines of the crucial compromises that would make the package salable should be clearly visible.

Tellingly, none of those auspicious signs are in sight. And insiders agree that if the five committees working on the issue cannot produce legislation by the end of the month, the idea of sweeping overhaul of the nation’s health care system is probably in trouble for now.

Despite the obvious danger signs, the Administration continues to insist that--while it is willing to provide analysis and guidance on policy questions--it will not get involved in the back-room negotiations until Congress formally presents it with a package.

Breaux and others say it is time for the White House to shift gears from its strategy of disengagement--which congressional leaders themselves had encouraged--and to send a strong signal of the kind of political deal it is willing to accept on health care.

They are particularly anxious to learn whether the President will remain determined to impose a mandate on all employers to pay for their workers’ health benefits and, if so, how the requirements will be applied. Opposition to mandatory coverage, particularly by small businesses, has become perhaps the biggest stumbling block to enactment of President Clinton’s plan.

The lawmakers also say that the President should set a benchmark for his bottom-line demand--universal coverage--by making it clear what percentage of the population must receive guaranteed benefits and how quickly the benefits must take effect. Only the most zealous reform advocates have argued that it would be technically possible for every person in the country to have health insurance.

“Before we decide how we are going to get someplace, we need to know where we want to get,” Breaux said in an interview last weekend in Louisiana.

Regardless of who is right, the fact that ostensible allies are at odds over strategy so late in the process is an indication of how tenuous the survival of the health care effort has become.

Lawmakers are keenly aware that this is the time in the life span of a major legislative initiative when they must practice their political craft. The time for policy debate and philosophical argument is past. The question now is a more simple one: Will there be a deal?

In many ways, it is like the monumental fight in 1986 over tax reform. Then, as now, the battle was a messy one and its outcome was uncertain until very close to the end. Ultimately, members of both houses raised the legislation from near death by abandoning their ideological purity in favor of closing a deal.

Although they would not speak on the record about health care reform’s dimming prospects, several key figures in Congress agreed that the Administration should become more deeply involved, at least in behind-the-scenes negotiations.

“We’ve arrived at the presidential moment here. It’s your bill, Mr. President, you got it started. Where are you really?” said one top Democratic congressional aide. “You’re going to hit a moment where everybody has to put their cards on the table, and the White House has cards.”

Much of the criticism has centered on the White House operation itself, particularly on the man who was brought in to bring coherence to the health care effort, Deputy Chief of Staff Harold M. Ickes.

“They’re so damned inept, it’s just pathetic. They can’t keep their eye on the ball,” said a Democratic lawmaker who has been one of the Administration’s most prominent allies on health care and who sits on one of the crucial committees where a deal is likely to be made.

Ickes, the legislator added, has “virtually no relationship with any members on the Hill.” Making the situation worse, he and others said, is the fact that Ickes’ portfolio, originally expected to center almost exclusively on health reform, has been expanded to include many other areas, including overseeing the midterm elections and White House embroilment in the Whitewater controversy. Lawmakers say they are uncertain who--if anyone--is really running the political show for the White House on an issue that is its priority.

In an interview, Ickes insisted that the White House is happy with its strategy and is convinced that it is working. He noted that last year, the Administration was criticized as “overly involved” in congressional deliberations over Clinton’s economic program--in effect, giving away the store and leaving less negotiating room for congressional committee chairmen.

“Once the committee process ends and bills are formed to go to the floor, you will see the Administration more actively involved,” Ickes added.

The majority leaders of both the House and the Senate also defended the Clinton team.

“I think the President has been handling the matter well. I don’t think it’s wise for him to get involved in this kind of one-on-one negotiations,” said Senate Majority Leader George J. Mitchell (D-Me.), who has taken the lead role on health care in the Senate. “Of course time is tight, but that’s not the President’s fault.”

Added House Majority Leader Richard A. Gephardt (D-Mo.): “I really see them as out of it, in terms of what we have to do. It really now is our job.”

Indeed, too heavy an involvement by the White House--particularly with senators--would likely make the House even more nervous about moving ahead. Democrats there have not forgotten the difficult votes they made last year on Clinton’s economic plan, only to see the President bargain away what had been achieved in the Senate.

Yet Breaux’s complaints are significant, given the position that he is in. For starters, he is a member of the Senate Finance Committee, the most difficult testing ground for health reform and the panel that skittish lawmakers in both the House and Senate are watching closely as the most likely place for a breakthrough.

More important, Breaux--the leading sponsor of a competing proposal that was once considered the chief competition for the Clinton plan--is now floating the compromise that many consider the best hope for breaking the deadlock over employer mandates.

“Sen. Breaux is playing a very constructive role in this process,” Ickes said.

Added Lawrence O’Donnell, the Finance Committee’s staff director: “Sen. Breaux’s frustrations are well-earned. He’s spent a year trying to come up with the right compromise to make this work.”

Clinton’s plan to require companies to pay for their workers’ health benefits is the single biggest stumbling block and has been all along.

The President and his allies insist that it is crucial to assuring that all Americans have health coverage. Opponents are just as adamant in their assertion that it would force businesses to lay off workers or shut down altogether.

Breaux’s idea is to give both sides political cover. With the legislation adding new incentives to help businesses provide coverage to their workers, market forces would have a chance to work for three to five years after the new system is put into place. Only if large numbers of workers remain uninsured after that time would the government require businesses to start paying for health insurance.

“I’m trying to find something that both sides can support and be true to their philosophies,” Breaux said.

A similar approach is under discussion in the House Energy and Commerce Committee, which has been the most paralyzed over the issue.

Yet the White House has yet to say whether such an approach would be acceptable. When asked, officials say that they will not comment on any part of the plan until they see it placed in the context of an entire bill.

But history also shows that gambling on a last-minute rescue does not always work. Thus, the Administration must step in now to help move things along, or risk losing the battle over an issue that Clinton himself raised to the top of the national agenda, Breaux said.

“Difficult problems have to be solved from the center out,” he said.