Mitchell, Gephardt Lead Charge for Health Bill : Legislation: Democratic chiefs from both houses must strike a balance that will appease Republicans but fulfill President’s promises on reform. Time is running out.

All week long, more than half the Senate--some members individually, others in groups--found its way into the second-floor office of Majority Leader George J. Mitchell (D-Me.) in the Capitol.

Across the rotunda, House Majority Leader Richard A. Gephardt (D-Mo.) huddled daily with key committee and subcommittee chairmen, other House leaders and individual members.

The two veteran legislators are fully engaged in perhaps the most difficult task they have ever faced: Each must sort his way through shifting internal factions, massive campaigns by powerful interest groups and intricate technical details to come up with a single, exquisitely balanced piece of health reform legislation that can withstand what promises to be a brutal fight on the floors of each house.

Two House and two Senate committees already have gone through the process of devising legislation designed to reform the nation’s health care system, and the results of their efforts are useful. So too is the cautionary lesson of one House committee that struggled for months and ultimately gave up.

But none has found the formula that can both meet President Clinton’s bottom-line goal of assuring health care coverage for everyone and win enough support to gain congressional approval.

Now time is running out. Both houses are racing to approve bills by mid-August--to give them enough time when Congress returns after its summer recess to put together and pass a final version. Lawmakers hope to adjourn for the year in early October, and the health legislation, or lack of it, is certain to be a major issue in fall election campaigns.

For Gephardt, the work is fairly straightforward.

“The fact of the matter is no Republican votes can be had in the House,” said one strategist who has worked closely with the Administration. “Gephardt’s task is to find 218 Democrats who will vote for something the President can, with a straight face, call universal coverage.”

In an interview, Gephardt put it this way: “It’s more or less what I do all the time, but it obviously is a bigger task, because the bill is more complicated, more important and it’s been a longer effort.”

But for Mitchell, who is working with a thinner Democratic majority and an institution whose rules give him very little control once the bill reaches the floor, the job is one of almost metaphysical dimensions.

He must offer legislation conciliatory enough to head off a potentially deadly GOP filibuster and avoid alienating the moderates and conservatives within his own party. At the same time, he cannot give up so much that the bill falls short of the President’s promise of universal coverage.

Mitchell also must worry about how his legislation is perceived in the House. Last year, many House members took the politically risky step of voting for the President’s controversial energy tax, only to see it die in the Senate. Many there have vowed that they will not again climb out on a limb unless they are certain the Senate will follow.

“We’ve got to contend with people keeping one eye on the Senate and the Senate keeping one eye on us,” said House Majority Whip David E. Bonior (D-Mich.). “Plus, the emotional issues involved here--mandates, revenues, abortion, employment issues--these are really hot items all by themselves. When lumped together, they really create a caldron of difficulties.”

And then, of course, there is ultimately the question of whether this entire process produces something that is, as Mitchell put it, “a coherent whole that represents the right policy for this country.”

“I’m not going to propose something just because somebody likes it,” he added. “There has to be an internal compass to these things.”

Yet Gephardt readily admits that he and other leaders are not seeking perfection. “The reality of health care today has a lot of flaws, but the solution to it is not without flaws and difficulties,” he said. “There’s no ideal thing you can do here.”

House leaders hope to produce at least an early draft of a bill this week. As its starting point, it will use the legislation produced by the House Ways and Means Committee, which would achieve universal coverage by expanding the Medicare program and requiring employers to pay 80% of their workers’ health costs.

That so-called employer mandate is the most controversial element of both the Clinton proposal and the Ways and Means bill. House leaders are exploring the possibility of phasing in the mandate more slowly, so that businesses and their workers could have more time to adjust to the idea. As an additional measure of reassurance, they are closely studying, with computer simulations, how best the government might subsidize businesses to help them offset the costs of providing coverage.

“One of the things we’ve done is run different hypothetical firms of different sizes, different wage mixes to see how, in reality, different firms would come out,” Gephardt said. “The analogy we’ve been using is the minimum wage increase, and that’s been a useful analysis to go through. We’re still working with different scenarios.”

Mitchell is also considering a range of ideas that might make it easier for his troops to support an employer mandate.

One, offered by Senate Labor and Human Resources Committee Chairman Edward M. Kennedy (D-Mass.), would reduce the employer obligation to 50% of their workers’ premium costs.

But even if they can find a way to pass the mandate, or a way to reach universal coverage without it, there are dozens of controversial issues to be resolved. They range from cost controls to abortion coverage to changes in malpractice and insurance laws to how Medicaid would be treated under a new health system.

“We’ve got 20 or 30 of these, and they all relate to one another,” Gephardt said.

And not all the behind-the-scenes action is happening within the leaderships of the two houses.

Informal networks are taking shape in both the House and the Senate, as like-minded lawmakers see if they can use their numbers for leverage as a group of moderate Republicans and conservative Democrats did in the Senate Finance Committee.

Because they held the swing votes and voted as a bloc, the seven senators who called themselves the “mainstream coalition” managed to take effective control of the panel and pass a relatively modest measure that falls well short of universal coverage. Of the four committee bills, it was the only one with significant support from both parties.

That group is seeking to do the same on the Senate floor and its numbers are growing. “What I would like to do is use the Finance Committee bill as the vehicle” for Senate debate, said Sen. Bob Kerrey (D-Neb.), who has joined the group. “The Finance Committee bill began as a bipartisan effort, and it has the greatest chance to end up as a bipartisan effort.”

Meanwhile, Sen. Max Baucus (D-Mont.), who defected from the Finance Committee group when the limits of its bill became clear, said there is sentiment for yet another approach.

“I’m finding, frankly, that a lot of (senators) want something between the Finance Committee bill and the President’s plan,” he said.

Right now, Baucus said, their discussions are informal and educational. “It may lead to something and it may not. We just don’t know.”

In the House, the biggest challenge to the leadership could come from a similar coalition that now claims almost a quarter of the House among its members. It is being organized by Reps. Jim Cooper (D-Tenn.) and Fred Grandy (R-Iowa), backers of a more conservative health care proposal that once had been considered the leading competitor to the Clinton plan.

Now they are working with supporters of a minimalist proposal that essentially would fix what have been considered the most egregious flaws of the current insurance system but would not reach universal coverage.

They, too, see the Finance Committee bill as their model. Cooper said it has given his group “new momentum.”

Added Grandy: “The best thing about the Senate Finance bill is that it lowers expectations.”

If they can manage to reach agreement and stay united, they could prove a formidable force on the House floor. In a letter Friday to Gephardt, they demanded that they at least be given a vote on their plan, if it materializes.

“We believe such an approach is an appropriate starting point for floor debate, and will attract broad-based support. . . . This alternative should be considered by the full House in the same manner as all other proposals,” the group wrote.