Outlook Dims for Reviving Health Measure

For the second time in two years, a major health insurance reform bill is clinging tenuously to life as its chances of becoming law fade rapidly.

An outbreak of partisan finger pointing increased the odds against this year’s measure, which would allow workers to carry their health insurance with them from job to job more easily and make it more difficult for insurers to refuse coverage to those with existing medical problems.

Even Sen. Nancy Landon Kassebaum (R-Kan.), the bill’s leading proponent, conceded Wednesday that reviving the measure is “a tall order.” However, she continued meeting into the night with other lawmakers in an effort to devise a winning formula. A House-Senate conference committee is now trying to work out a compromise that will reconcile differing versions of the legislation.

“If we can work out an agreement, we can get the technical details worked out by Tuesday,” she said before meeting with House Republicans. Rep. Bill Archer (R-Texas) said that a compromise is “within reach”--a view that was not shared by a top Clinton administration operative, who said: “It doesn’t sound very encouraging.”

What is clear is that time has all but run out.

Most observers say that final passage of the bill must occur before the resignation of Senate Majority Leader Bob Dole (R-Kan.) takes effect Tuesday afternoon. His departure, they said, will remove whatever momentum still remains behind the bill.

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“If that time frame slips away, it’s going to be harder to get the same enthusiasm around the table again,” Kassebaum said.

“The next few days are critical,” added Willis D. Gradison, head of the influential Health Insurance Assn. of America.

The health reform bill is probably the most prominent example of how the presidential campaign is impeding legislation that has broad support. More so even than usual, both Democrats and Republicans now assiduously calculate the political risks and benefits of either supporting or opposing each measure that comes before them.

According to Robert Blendon, a Harvard polling expert on health issues, the insurance reform bill has not captured the public’s interest. He said that Clinton would stand to gain more than Dole from its passage, which would be climaxed by a high-profile White House signing ceremony.

The poor outlook for the legislation--passed overwhelmingly by the House and 100 to 0 by the Senate--persists despite a significant movement on the issue of medical savings accounts. The House version of the legislation provides for the accounts, which are not included in the Senate bill but are dear to Dole’s heart.

Medical savings accounts--tax-deferred accounts that could be used to meet health care costs--are the thorniest issue impeding the effort to craft a bill that can command majority support in both chambers.

In addition, the House bill but not the Senate bill contains controversial provisions to limit medical malpractice cases. Only the Senate bill would require insurance policies to offer the same scope of coverage for mental health as for physical health services.

“This is just the way it happened in 1994,” said a top Senate Democratic aide, recalling the death of Clinton’s massive health reform agenda two summers ago.

Clinton jumped into the fray Wednesday, making another pitch for the bill as he arrived for a Capitol Hill meeting with House Democrats. “I’m prepared to do whatever it takes in the next few days--meet with him [Dole], do whatever I can, to meet with other Republicans--to try to get the [Massachusetts Sen. Edward M.] Kennedy-Kassebaum bill passed before he leaves the Senate,” Clinton said.

Many House Republicans are holding out for a comprehensive medical savings account provision--possibly to the point of denying Dole what could be his final legislative achievement as he heads out on the campaign trail way behind Clinton in the polls.

Instead, Dole could leave Washington with a string of legislative defeats on issues that include a balanced-budget amendment, a missile-based defense system and repeal of the 4.3-cent-per-gallon increase enacted in 1993 in the gasoline tax.

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“This is not the send-off I’d want,” said Senate Minority Leader Tom Daschle of South Dakota.

The Democratic offer on medical savings accounts--to create a limited demonstration project--was conveyed to Dole two weeks ago but so far he has not been able to persuade House Republicans to agree.

The Democratic offer--containing principles but no details--would set limits on medical savings accounts, such as a specific length of time, an income cap on eligibility and a geographic limit--perhaps confined to some of the 15 states that have laws exempting such accounts from income tax.