Talks on Health Legislation Take a Serious Turn

After weeks of stalemate, negotiations over health care reform legislation have suddenly become serious, with both the White House and key Senate Republicans drawing back from deadlock over the centerpiece of President Clinton’s domestic agenda.

Within the Administration, officials who support striking a deal, particularly Treasury Secretary Lloyd Bentsen, appear to be taking a more prominent role, reducing the impact of purists who have favored rejecting concessions even at the risk of a legislative defeat.

At the same time, Senate Republican leaders, who for weeks have flirted with a strategy of all-out opposition to Clinton, appear now to be more willing to negotiate, Administration and congressional officials said Tuesday. Although the talks still could fail, officials close to the negotiations said for the first time that both sides appear seriously engaged.

The moves came as President Clinton met Tuesday morning with two key senators--Finance Committee Chairman Daniel Patrick Moynihan (D-N.Y.) and the committee’s senior Republican, Bob Packwood (R-Ore.)--and received a blunt assessment of the opposition to the Administration’s original proposal.

“There is not now a majority for any health care reform plan in the Senate Finance Committee,” Moynihan told reporters after the meeting.

“At the moment, all plans are dead,” Packwood said. “Anybody’s plan.”

But that dire evaluation might have been the spur needed to start the negotiations that previously had proved elusive. Administration officials and congressional leaders of both parties have been talking on health care for months. But Tuesday’s meeting, in particular an exchange between Packwood and Bentsen, marked a turning point at which the discussions began to take the form of true negotiations, knowledgeable observers said.

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“The choice is now fairly clear,” said one senior Clinton adviser. The options are to either work out a deal with Packwood and other moderate Republicans, or accept defeat and hope to turn the November midterm elections into a referendum on “who killed health care.”

The deadline is also clear, officials said. At the least, the firm outlines of a deal must be decided by the end of this month or Congress almost certainly will run out of time to complete work on a bill this year.

As the negotiations heated up, First Lady Hillary Rodham Clinton moved to defuse a controversial side issue--abortion coverage. In an appearance before the League of Women Voters, Mrs. Clinton pointedly declined to say that abortion coverage would have to be included in any health care plan.

“That’s one of those questions that we just cannot even answer right now because we have to get to the forest of universal coverage first,” she said.

Meanwhile, one key provision of health reform narrowly crossed a major legislative barrier. The House Ways and Means Committee, by a 20-18 vote, rejected a Republican attempt to strip the health bill it is considering of a provision that would require companies to provide insurance to all their workers. Four Democrats joined all 14 committee Republicans in opposing the requirement.

The vote was a “do-or-die decision,” said the committee’s acting chairman, Rep. Sam Gibbons (D-Fla.), who added that he plans to complete committee action on the bill before Congress takes its July 4 recess.

The coverage requirement, known as an “employer mandate,” is at the heart of the current negotiations. Clinton has proposed a mandate that eventually would cover all companies. Republicans have united in opposition, arguing that the mandate would drive up costs and put some companies out of business.

“There is a strong, large feeling on the Republican side against compulsion that absolutely forces people to do things they don’t want to do,” Packwood said.

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Key members of Congress, led by Sen. John B. Breaux (D-La.), have tried to bridge the gap by proposing ways to postpone, and perhaps avoid, a mandate. Breaux has suggested what health care negotiators call a “hard trigger” mechanism.

Under that concept, Congress would pass reforms in the health insurance system now. If those reforms failed to result in a certain percentage of Americans being covered within a fixed length of time--75%-to-85% of workers within three-to-five years, for example--a mandate automatically would take effect.

The hard trigger proposal, or something like it, has picked up considerable support within the Administration and among leadingcongressional Democrats. House Majority Leader Richard A. Gephardt (D-Mo.) said Tuesday that he could support some kind of trigger. “My preference is to have an employer-employee requirement that goes into effect right away,” Gephardt said. But, he added, “there also is nothing wrong with considering the idea of phasing this in some way.”

Republicans have not embraced the Breaux idea. At Tuesday’s meeting, Packwood instead offered a “soft trigger.”

Under Packwood’s plan, if reforms do not result in sufficient coverage within several years, Congress would be asked to vote again on whether to approve a mandate, but one would not take effect automatically. Packwood would include certain procedural rules designed to guarantee that a vote actually takes place.

Clinton advisers argued that Packwood’s plan does not meet the President’s bottom line of universal coverage but noted that some variation might. “You have to be able to say at some point certain that it will be true that everyone will be guaranteed coverage,” said one Clinton aide. “The question is what’s ‘everyone,’ and what’s a ‘guarantee.’ ”

“We’re in an enhanced phase of negotiations,” said Clinton aide George Stephanopoulos. With the Breaux and Packwood proposals setting the parameters, “the question is whether there is a way to meet everyone’s demands.”

As an example of potential variations that could be considered, Bentsen at one point suggested turning Packwood’s idea upside down. Instead of requiring that Congress affirmatively vote to impose a mandate at some future point, Bentsen said, the President could be given the opportunity to propose mandates if reforms do not succeed in covering enough people and those mandates would go into effect unless Congress voted to kill them.

Packwood rejected the idea. “I said, ‘Lloyd, that’s a mandate,’ ” Packwood said later. Nonetheless, officials said, the exchange marked the first real give-and-take between the Administration and Congress.

Packwood conceded that his proposal would not meet Clinton’s bottom line. “Make no bones: It is not universal coverage,” he said. “The President has to make a decision. Does he want no bill? Does he want to ram on ahead, ramming this down the throats of a vociferous group that does not want it?”

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Times staff writer William J. Eaton contributed to this story.