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Republicans Offer Guarded Prognosis for Clinton Plan

September 13, 1993|KAREN TUMULTY | TIMES STAFF WRITER

WASHINGTON — Needing at least a handful of Republican votes for his sweeping health care proposal, President Clinton is gearing up for a struggle on Capitol Hill over two major issues: whether to require all employers to provide health insurance for their workers and whether to impose government-mandated limits on health care spending.

Clinton has proposed doing both, against virtually unanimous Republican opposition. Yet for now, both sides are expressing hope that they can reconcile their differences.

"We want, we need, and believe we will have bipartisan support for this plan," said Senate Majority Leader George J. Mitchell (D-Me.). "Many of the proposals included in the plan have been recommended by Republicans."

Indeed, many influential GOP lawmakers have been cautiously complimentary about the Clinton plan. "I commend the Clinton Administration for the steps they're taking, and I think it's going to result in some real progress," said Sen. John H. Chafee (R-R.I.), the head of a GOP Senate task force that plans to issue its own health care proposal on Wednesday.

Speaking on ABC-TV's "This Week With David Brinkley" about the near-final version of the Clinton plan now circulating in Washington, Chafee called it "a good basis on which to proceed."

Republicans have found much they can like in the Clinton plan because it includes many ideas that have won broad acceptance in their party, as well as with voters.

Among them: that a single package of health benefits should be available to all Americans, that soaring costs may be curbed only if greater competition is introduced into health care, that consumers should continue to have their choice of physicians, that people living in inner cities and rural areas should have better access to health care, and that health care should put greater emphasis on prevention.

"There really are many more areas in common than there are disagreements," Sen. Dave Durenberger (R-Minn.) said last week after a congressional briefing on the plan by First Lady Hillary Rodham Clinton.

Hillary Clinton, who is heading the Administration's health care reform task force, has been assiduously courting moderate Republicans such as Chafee and Durenberger because the White House is well aware that it cannot win without them.

In the Senate, Democrats are four votes short of the number they need to prevent the plan from being strangled by a filibuster.

In both houses, Democrats anticipate defections within their own ranks--particularly among lawmakers who support the more radical idea of a government-run health care system, known as single-payer, that is similar to the health care systems of Canada and Britain. Single-payer advocates warn that the Clinton plan is too complex and would create inequities in medical care.

Thus, the Administration cannot count on Democratic votes alone to carry the proposal to victory, as it did during the hard-fought battle over Clinton's economic plan, which passed without a single GOP vote in either house.

For now the Republicans, despite their misgivings, are saying that they are willing to keep their options open. "The time to say: 'Never' and 'I'll fight you with a filibuster,' is a long way away," one conservative GOP senator said.

Yet Chafee noted that Republicans believe that the Clinton plan has "really serious problems."

Clinton has proposed that all employers be required to pay 80% of their state's average health insurance premium cost for all of their workers--up to 7.9% of payroll costs for larger firms and as low as 3.5% for companies having 50 or fewer employees.

And even though the government would subsidize health coverage for smaller firms, Chafee insisted that the proposal "is going to be just devastating to a lot of small businesses in our country, and we just don't think that's the proper way to go."

Rep. Pete Stark (D-Oakland), chairman of the House Ways and Means Committee's health subcommittee that has jurisdiction over the health plan's financing, said U.S. companies that fail to pay health benefits are "just stingy. That's how they make money. . . . They won't pay 10 cents more for their utilities or their employees or anything else."

Workers in many foreign countries already enjoy universal health coverage, Stark noted on the ABC program. "If a business is so inefficient that they can't run against competitors who provide health care, with that marginal difference in their wage costs, they probably ought to get out of business anyway."

Republicans are also resisting Clinton's plan to put limits on the amounts that insurance companies can collect as premiums. While the Administration says the caps are needed to prevent insurance company profiteering, GOP lawmakers say they are an ill-disguised form of government-imposed price controls.

Chafee complained that it "is just not going to produce the competitive system that we really need to hold down the costs."

The Senate Republican task force's proposal is expected to be the most influential of several health care plans that are being circulated by GOP factions on Capitol Hill.

Like Clinton's proposal, it would have each state establish insurance-purchasing cooperatives, although it would not require that all companies participate. People too poor to afford insurance on their own would receive government vouchers to help them purchase it.

The Republicans also propose that a uniform benefits package be put together by a national commission, taking politically sensitive decisions, such as whether abortion procedures should be covered, out of the hands of politicians.

* HEALTH FRAUD CRACKDOWN: Clinton's health system would make it easier to spot overcharges and kickbacks. A10

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