Budget Report May Back Lesser Health Reforms

In a development that could alter the balance of the health care debate, the Congressional Budget Office has tentatively determined that a modest approach to revamping the health care system would be significantly less expensive and more workable than initially believed, congressional sources said Monday.

If that is the conclusion in the CBO’s final report, it could add fuel to a movement among moderate Republicans and conservative Democrats toward more conservative reforms that would fall short of President Clinton’s goal of universal coverage. The report may be released as early as today.

A more modest measure, such as one approved earlier this month by the Senate Finance Committee, would contain no mandate that employers pay for any part of their workers’ health benefits and would contain no government-imposed price controls on insurance premiums--giving it strong appeal among lawmakers who see those elements of Clinton’s plan as too drastic.

The Senate Finance Committee bill, which is the only health care alternative to have significant support among members of both parties, is one of several that Senate Majority Leader George J. Mitchell (D-Me.) must consider as he prepares legislation to take to the Senate floor this week or next. Mitchell has insisted, however, that he will not back away from universal coverage.

Clinton and his allies in Congress have warned that an incremental approach would be unworkable because it would lack the necessary funding, particularly to provide subsidies to help poor and moderate-income people buy health insurance.

Because the bill lacked the controversial employer mandate, the subsidies were its chief means of assuring coverage to those who could not otherwise afford it.

The bill’s backers feared the budget office would find that the measure would fall short by as much as $100 billion over five years. Instead the CBO has tentatively determined that the gap is far more bridgeable--well under $20 billion, according to sources familiar with the early draft.

“What I’ve heard is too good to be true,” said Sen. Kent Conrad (D-N.D.), one of the bill’s supporters.

Added Sen. John H. Chafee (R-R.I.), the chief GOP architect of the legislation: “It just shows that our figures are good. It says that the figures show it can work. I just hope they’re right.”

However, the sources said, the Finance Committee bill also falls several percentage points short of its target of expanding coverage to 95% of the population. It would get to about 92%, up from the current level of about 85% but well short of Clinton’s goal of universal coverage.

Clinton’s allies, taken off guard when reports of the CBO draft swept Capitol Hill, strove to put the best face on them. “In many respects, it’s good news that we can do so much for so little,” said Sen. Tom Daschle (D-S.D.). However, he added, “93% is not 100%.”

“This takes us a little over halfway to where we want to go. In a sense, the first half is less costly,” Daschle said.

In the House, Majority Leader Richard A. Gephardt (D-Mo.) met with other members of the Democratic leadership to brief them on the bill that he is putting together to take to the House floor.

It will be based on legislation approved earlier by the House Ways and Means Committee, a measure that achieves universal coverage through a combination of an employer mandate and a vast expansion of the Medicare program. However, he said, “a lot of issues” remain to be decided.

One leadership aide said that Gephardt is under pressure from House Democrats to fashion a bill that would take effect more gradually and include more financial aid for small businesses.

“What he’s hearing from members is ‘We need more time and we need more subsidies,’ ” the aide said.

Gephardt told reporters that he expects to make a draft of his measure public by Friday.

In other developments Monday:

* A new study on the unprecedented advertising blitz by all sides in the controversy found that 59% of broadcast ads and 28% of print ads were “unfair, misleading or false” and designed mostly to play on public fears of change.

The worst ads were direct-mail campaigns that targeted the elderly, according to the study directed by Kathleen Hall Jamieson, dean of the University of Pennsylvania’s Annenberg Public Policy Center. The study was released here.

“A high percentage of the ads impugn the goodwill and integrity of those on the other side of the issue,” the study concluded.

Pro-Clinton-plan ads tended to overstate the extent of the problem or asserted that the Republican alternatives will do nothing to help individuals, Jamieson said.

Anti-Clinton-plan ads tended to exaggerate the effect of the President’s proposals on potential job loss and consumer choice of health care providers, she said.

Earlier this month, Jamieson reported that special-interest groups appear likely to spend more money on advertising linked to health care reform (more than $60 million) than was spent on ads by both the Clinton and George Bush campaigns during the 1992 presidential race.

* It was announced that several Cabinet secretaries will participate in the “Health Security Express” bus caravans, which are to bring “reform riders” to Washington in early August. The caravans are being organized by several groups that back comprehensive health reform.

* A federal judge in Washington ordered a trial to determine whether the records of the White House’s health care task force should be made public. The panel spent much of 1993 developing the President’s massive reform agenda behind closed doors.

U.S. District Judge Royce C. Lamberth said there are too many factual disputes that can only be resolved in a trial.

The case grew out of a lawsuit filed by the Assn. of American Physicians and Surgeons, the American Council for Health Care Reform and the National Legal Policy Center, seeking hundreds of thousands of transcripts, drafts, minutes and other documents generated by the 500-member-plus task force.

The three groups argue that the Federal Advisory Committee Act requires any such group to meet in public if it includes non-government members, citing the participation of First Lady Hillary Rodham Clinton.