Clinton Says He’s for Full Coverage : Health reform: President clarifies remarks, insists he hasn’t diluted his pledge. White House aides seek to portray moderate bills as attractive, but unworkable.

President Clinton insisted Wednesday that he has not abandoned his goal of health coverage for all Americans.

“I’m sorry that after all my skills and efforts at communicating that the point I really made yesterday somehow didn’t get through,” Clinton told reporters before a meeting with congressional leaders.

In remarks Tuesday, Clinton had appeared to water down his pledge of universal coverage, suggesting that he would accept legislation that covered only 95% of Americans. But, Clinton and his aides insisted Wednesday, his words really were not intended to convey that message.

Instead, he said he meant to suggest that even legislation intended to provide coverage for 100% of the population would in fact fail to reach everyone. He said he did not mean that Congress should deliberately set out to reach only 95% coverage.

The President’s aides, meantime, attempted to refocus their strategy in an effort to convince members of Congress that alternative plans which have attracted support from congressional moderates may look good but cannot work.

Clinton’s efforts at damage control mollified some, but by no means all, of his congressional supporters. And advocates of universal coverage stepped up their pressure against any attempt to dilute the pledge.

“There is no doubt in my mind that the President has not moved from his original position,” said Sen. John D. (Jay) Rockefeller IV (D-W.Va.). “We will have to vote on 100% coverage.”

At the same time, advocates of universal coverage got a major boost when three of the nation’s most powerful lobbying organizations--the American Medical Assn., the AFL-CIO and the American Assn. of Retired Persons--joined forces to press Congress to pass legislation that would guarantee coverage for all by requiring companies to insure all their workers--the so-called employer mandate. The doctors group and labor unions often have been sharp antagonists in health care wars of the past, making the alliance particularly notable.

At the White House, despite the confusion of the last two days, the strategy that Clinton and his aides hope to pursue has begun to come into focus. It begins with the premise that in a head-to-head confrontation, Clinton can defeat the sort of minimalist alternatives proposed by conservative Republicans, including Senate Minority Leader Bob Dole (R-Kan.).

The greatest threat to achieving far-reaching reform of the health care system, White House officials believe, lies not in those conservative ideas but in the halfway approaches pushed by a loose coalition of moderates and conservatives in both houses.

Many members of Congress like the alternative proposals because they appear to offer a safe political middle ground. To defeat those proposals and return the debate to the head-to-head fight that Clinton and his aides prefer, they plan to argue that those plans are the equivalent of trying to jump halfway across a canyon.

“We now have a lot of evidence that if we tinker around with the system and don’t try to do something comprehensive, we could actually make it worse for ordinary Americans,” Clinton said Wednesday. “We could increase the cost to middle-class Americans and decrease coverage. We have to do something that works. That’s going to be my bottom line. Let’s don’t do something that won’t work.”

Clinton’s chief Senate ally, Majority Leader George J. Mitchell (D-Me.), made a similar point after the White House meeting--ticking off deficiencies in the alternative plans.

“One of the problems with the alternative plans that have been presented is that they don’t achieve any cost-control,” Mitchell said. “If we’re to do these things we must control costs.”

First Lady Hillary Rodham Clinton joined that chorus, telling a coalition of health care advocates that universal coverage is “the cornerstone of what it is we’re trying to do.”

“In the absence of national universal coverage, you will not get the results you want,” Mrs. Clinton said, holding in her arms a 7-year-old Nebraska boy who had undergone multiple surgeries for a rare medical condition. The boy’s father had lost his job, leaving the family with no insurance.

The target of the Administration’s strategy is a set of proposals--most of them not yet reduced to formal legislative language--that have attracted considerable congressional support because they appear to offer a way out of the stark choice between some version of the Administration’s plan and the much more modest offerings of Dole and his fellow Republicans. Those bills feed into the natural tendency of members of Congress to solve most problems by splitting the difference between opposing sides.

Last week, a group of 104 members of the House, led by Reps. Fred Grandy (R-Iowa) and Jim Cooper (D-Tenn.), sent a letter to House leaders demanding assurances that the full House would be allowed to vote on a proposal that they plan to offer which would not include employer mandates or government controls on insurance company rates. A somewhat similar plan passed the Senate Finance Committee at the beginning of this month.

The notion behind the alternative plans is to expand coverage with insurance market reforms plus incentives and subsidies aimed at lowering the cost of insurance for working families.

But critics, including Clinton and his allies, argue that the bills make an expensive promise that they do not fulfill. Clinton’s plan would put much of the cost of expanding insurance on business by requiring companies to provide insurance to workers. Replacing that requirement with subsidies puts the burden on taxpayers, argue the Administration and its allies.

“No one has picked up on the cost of no mandate,” said Sen. Tom Daschle (D-S.D.). Various analysts, he said, have estimated that it would cost as much as $1.3 trillion over the next five years to provide the subsidies necessary to meet the goals that Cooper, Grandy and others profess to want to meet--making insurance affordable to all Americans.

Over time, that argument could have considerable power in a deficit-leery Congress. Before truly being able to focus attention on that argument, however, Clinton must resolve the confusion in his own ranks that his remarks on Tuesday caused.

The fallout was apparent in comments by liberal Rep. David R. Obey (D-Wis.), chairman of the House Appropriations Committee. Obey said that, if Clinton’s remarks indicate he is “backing away from universal health care reform that covers every citizen in this country, then I will walk away from the Clinton health plan.”

Similarly, in the Senate, several liberal Democrats mocked Clinton’s references to 95% coverage by drawing the names of five of the 100 senators, saying that if Congress passes a plan covering only 95% of the population, then only 95% of the Senate and the White House staff should get health coverage.

Times staff writers Karen Tumulty and Jeffrey Leeds contributed to this story.

Where the President Stands

When introducing his health legislation to Congress last October, President Clinton said coverage for every American was an absolute requirement. But recently, he has appeared to soften his stance. A review of his statements:

DEC. 3, 1993: Clintons stresses that providing coverage to the 37 million uninsured was the cornerstone of reform. “Do not give up on universal coverage.”

JUNE 12, 1994: While President insists publicly that he’ll veto anything short of universal coverage, officials privately say he might be prepared to accept something less.

JUNE 21, 1994: Clinton vows to fight for universal coverage, saying that “it goes to the heart of whether we can make government work for ordinary people.”

JUNE 25, 1994: In weekly radio address, stands firmly behind his call for universal coverage, denouncing “Half-hearted measures” that would fall short of this.

TUESDAY, JULY 19: “We know we’re not going to get right at 100% (coverage) but we know that you’ve got to get somewhere in the ballpark of 95% or upwards.”

WEDNESDAY, JULY 20: “The point I was trying to make (Tuesday) is that we have no way of knowing ... that there is any available and affordable way to get close to 100% of coverage without some sort of requirement that involves everybody paying.”

Competing in Congress

Leaders in the House and Senate are currently sorting through the major plans, keeping what they like and discarding what they don’t. They will then present a single plan to their respective chambers. Here are the major plans now in Congress*:

Summary

Clinton Plan: Guaranteed coverage for all by 1998. Wide-ranging package of benefits. Employers would pay portion of premiums.

House Ways and Means: Less generous than Clinton plan. Establishes new program to cover Medicaid recipients.

Senate Finance: Two basic benefits packages. No employer mandate. Aims to cover 95% of Americans through subsidies and insurance reform.

Senate GOP (Dole plan): Voluntary. No guarantee of universal coverage.

* Two other plans--by the Senate Labor and House Education and Labor committees--are not listed here because they closely resemble the President’s plan

Before it Passes

Congressional leaders are hoping for passaage of a final bill this fall. The final bill would come out of this process:

1) Clinton introduces plan, which serves as a guide to Congress.

2) House subcommittees approve their own plans (no work done at subcommittee level in Senate)

3) House and Senate committees revise and approve varying plans.

4) House and Senate leaders take plans from their respective committees and blend the elements into one plan. (Current step)

5) Members debate bill in full sessions.

6) Bills go to conference committees to work out differences.

7) House and Senate vote on final version.

8) Bill goes to President’s desk for his signature.

Sources: Times staff reports

Researched by PAUL J. SINGLETON / Los Angeles Times