Final Push on Health by Clinton Due : Congress: White House shifts focus to ‘best deal’ possible. The President will make last-ditch effort to retain employer mandate section of Mitchell bill. But he is said to be in a ‘compromising mode.’

President Clinton is resigned to salvaging whatever he can get from Congress on health care reform, but he is preparing to launch a last-ditch effort to save a key provision of a Senate bill that could eventually require large employers to insure their workers, Administration officials said.

“The mood at the White House definitely has shifted from ‘all or nothing,’ to ‘let’s take the best deal we can get,’ ” said one senior Clinton aide who spoke on condition of anonymity.

The priority at the White House is an all-out push for passage of the compromise health care bill crafted by Senate Majority Leader George J. Mitchell (D-Me.). The Clinton team is particularly anxious to preserve the provision that would trigger the so-called employer mandate in any state where less than 95% of the population enjoys health care coverage by the year 2000.

“We’re in two phases now in the campaign. First, we want to get a vote on the trigger,” the senior aide said. “We’re behind by several votes but trying to build enough pressure to win it. A vote for the trigger would steady the bill.

“But if it’s voted down, the President wants to get whatever he can get--and that’s the second phase,” the aide said.

Another White House aide agreed that the President is in a “compromising mode.”

The present White House stance is light-years away from the heady days of last winter, when First Lady Hillary Rodham Clinton and her health policy guru, Ira Magaziner, led a highly publicized effort to redesign the nation’s medical care system from top to bottom. Back then, the “policy wonk” was king; no element of medical care was too obscure, no proposal too ambitious for Administration officials and their army of experts to take up.

Now the experts are on the sidelines, and the political deal-makers are at center court.

Administration officials insist that the President has not abandoned everything he and the First Lady once held dear. They say he will not accept a health care bill that appears too flawed to work properly. “He won’t take just anything,” the senior aide said. “There are some scenarios that could make the health care situation worse; so it would have to be prudent.”

The President has stressed that incremental reforms seeking only to ban discriminatory insurance industry practices but not moving the nation toward guaranteed health coverage could increase the number of uninsured while driving up prices for everyone else.

Yet the need for a President with sagging poll ratings to obtain something he can call a victory on health care would be hard to exaggerate. And the political realities in Congress are rapidly narrowing the Administration’s range to maneuver.

Initially, White House strategists had hoped to secure House passage of a health care blueprint that is more ambitious than Mitchell’s Senate version. Then, they thought, a consensus bill falling somewhere in between could be negotiated in the House-Senate conference committee that will resolve differences between whatever measures emerge from each chamber.

That scenario still could materialize. But by embracing Mitchell’s bill, as he did in a prime-time press conference Wednesday, the President may have seriously undercut the House bill, which is championed by Majority Leader Richard A. Gephardt (D-Mo.) and tracks closely on Clinton’s own ideas.

Unlike the President’s proposal, which would have required employers to pay at least 80% of workers’ health insurance premiums, Mitchell’s plan would require them to pay only 50%. The bill exempts small businesses with fewer than 25 employees from the mandate.

Gephardt’s bill requires employers to provide 80% of the cost of an employee’s health insurance. That mandate is bitterly opposed by many businesses, most Republican lawmakers and even some moderate Democrats.

Many House Democrats were spooked by Clinton’s ready endorsement of Mitchell’s voluntary approach, with its standby employer mandate. They view the prospect of a vote in the House on the mandate as a needless political risk because it appears the Senate at most will adopt a watered-down version of workplace-based insurance.

A Clinton aide acknowledged that the President’s words left some Democrats in the House shaking their heads, and asking: “If the President wants the Mitchell bill, why should we vote for the Gephardt bill?”

“Everybody here’s in an uproar,” Rep. Patricia Schroeder (D-Colo.) said in an interview last week.

“I think you might see . . . we’ll cut out everything (from) Gephardt and slip in Mitchell,” she said.

Mitchell’s proposal, Clinton said during his press conference, is “the most ambitious bill” that could win Senate passage. It “says to the people who have not been supportive of our approach: ‘Look, we’ll try it in a competitive way first, and if that doesn’t work, then we’ll have a requirement.’ ”

During the past year, as comprehensive health care reform faced an increasingly uphill battle, the President has gradually retreated from the uncompromising position that he defined during his State of the Union Address on Jan. 25.

During that speech to a joint session of Congress, Clinton dramatically brandished a pen and vowed to veto any bill that did not “guarantee every American private health insurance.”

The next morning, Treasury Secretary Lloyd Bentsen said the White House was willing to back off on another controversial proposal in the President’s plan: creation of insurance-buying “alliances” that most consumers and employers would be required to join.

Clinton has repeatedly argued that an employer mandate would be the most conservative and efficient way of reaching universal coverage, because most Americans now get their coverage through employer-provided insurance. Moreover, a mandate could quickly extend coverage to millions of Americans who now lack it because more than 80% of the 39 million uninsured people are workers and their dependents.

But the employer mandate generated a firestorm on Capital Hill, and its chances of passage dimmed as the year wore on.

Last spring, when congressional committees began considering their own alternatives to Clinton’s health care agenda, lawmakers broached the possibility of passing a reform bill that would rely on voluntary measures to expand coverage and rein in health care costs.

The movement gained critical momentum after the Congressional Budget Office and a number of private analysts said purely voluntary approaches could increase coverage from roughly 85% of the population today to more than 90% after several years.

Since then, there has been increasing recognition--fanned in part by White House officials--that the President’s bottom-line goal of universal coverage would not necessarily provide benefits to 100% of the population.

The President himself said increasing coverage to 95% might be sufficient, couching his words in a talk to the National Governors’ Assn. that was widely interpreted as a signal of his willingness to settle for a plan that did not cover “every American.”

In embracing both the Gephardt and Mitchell bills, the President also could be open to charges that he has changed his tune on other key tenets of his reform agenda.

Although Clinton has repeatedly pushed for “private health insurance” for everyone, Gephardt’s bill would vastly expand Medicare, potentially enrolling tens of millions of additional Americans in the federally run health insurance program for the elderly.

In addition, the White House has strongly criticized a competing proposal by Rep. Jim Cooper (D-Tenn.) for, among other things, deferring to a national health board the controversial task of defining the elements of a standard benefits package.

That, it turns out, is also the approach being advocated by Mitchell.

Floor debate on health care legislation is scheduled to begin in the Senate this week and in the House the following week. Clinton aides say the President is willing to forgo his summer vacation at Martha’s Vineyard, Mass., if necessary, and to remain in Washington until Congress passes a bill he feels he can sign.

Mitchell said last week that he intends to keep the Senate in session six days a week, 12 hours a day, for “however long it takes” to complete action on health care reform. The Senate had been scheduled to begin a monthlong summer vacation at the end of this week.

The House is scheduled to begin its debate on Aug. 15, and Speaker Thomas S. Foley (D-Wash.) said he hopes to bring the legislation to a vote by Aug. 19.

Exactly what that legislation will contain is now more uncertain than ever. But one thing seems clear, whatever it provides, the President is likely to applaud.