Clinton Fights to Shore Up Eroding Health Plan : Reform: As lawmakers near a vote, they walk a tightrope, trying to balance action against inaction. White House sets PR blitz against changes.

As both houses of Congress brace to vote on health care legislation, the chief challenge confronting President Clinton and his allies is a growing perception that a marginal measure is the easy way out of the most difficult political bind that many lawmakers have ever faced.

On the one hand, members of Congress facing reelection this fall want proof to show voters that they are capable of doing something significant. But just as great or greater is their fear of taking too big a leap.

“The political calculus that ‘small is safer’ is the quick, knee-jerk reaction,” said one Senate aide. “The evidence (to the contrary) is rolling out slowly, and we need to pile it on in the next couple of weeks.”

Added Rep. Henry A. Waxman (D-Los Angeles): “Usually when you have something very controversial, if Congress is left to its own devices, it goes for the lowest common denominator. Only this time, the lowest common denominator won’t work.”

Clinton and his supporters will be turning up the heat as the health debate enters what amounts to its semifinal round. Both the House and Senate are expected to vote on legislation before Congress adjourns for its August recess, setting the stage for a final battle over a compromise version this fall.

The appeal of a modest, incremental approach is understandable because it steers clear of the most politically charged element of the Clinton plan, which is a requirement that employers pay as much as 80% of the costs of their workers’ health benefits. Small and weak businesses say that the additional cost of such an “employer mandate” would force them to lay off workers or shut down entirely.

“Americans want health care, but they don’t want to pay for it with their jobs,” Senate Minority Leader Bob Dole (R-Kan.), one of the chief backers of a more gradual approach, warned in a speech Tuesday on the Senate floor.

Without a mandate, however, it is unlikely that the health care system would ever reach Clinton’s bottom-line goal of universal coverage.

In coming days, Clinton’s backers will release a torrent of new studies aimed at convincing wavering members that fiddling with the health care system around the edges will only make the current problems worse. The more incremental reform plans would remedy the apparent shortcomings of today’s insurance system, requiring insurance companies to provide coverage at the same rate regardless of age or health, but not requiring everyone to carry insurance.

But, say Clinton backers, unless everyone has health insurance, marginal reforms are merely a recipe for more misery: Fewer and fewer people will have health coverage and those who do will pay more for it because the sick will be able to buy it, pushing up the premiums.

Meanwhile, with Clinton back in Washington from his European trip, the White House is planning to turn up the heat with a busy schedule of public appearances for both the President and First Lady Hillary Rodham Clinton.

Outside groups are also gearing up. One coalition of organizations that support the Clinton plan will launch bus caravans from four cities. Called the “Health Security Express,” it is clearly designed to evoke memories of the hugely popular bus trips taken during the 1992 presidential campaign by Clinton, running mate Al Gore and their wives.

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But if the outside groups want to convince lawmakers that there is a groundswell of demand for a Clinton-like plan, they clearly have their work cut out for them. Out of the confused signals that Sen. J. James Exon (D-Neb.) is getting from voters, he said, only one is coming through loudly and clearly: “The only consensus I see is that most of them are against the Clinton plan.”

John Rother, legislative director for the American Assn. of Retired Persons and a supporter of a comprehensive approach, said that he is puzzled by a seeming disconnection between public support for universal coverage--close to 75% in most polls--and its antipathy to what is labeled the Clinton plan.

Moreover, a June survey of AARP members--whom the Clinton Administration had once hoped would be among its most vocal advocates--now shows growing support for a more modest approach.