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GOP's Health Care Specialist Has Long Sought Remedies : Congress: Sen. John H. Chafee focused colleagues on the problem three years ago. His reform plan may lay the groundwork for a compromise.


WASHINGTON — In the summer of 1990, before the debate over the nation's health care system had spread much beyond a small cadre of policy wonks, Sen. John H. Chafee approached Senate Minority Leader Bob Dole with a proposition.

The Rhode Island Republican offered to lead a GOP health care task force that would delve into the many-tentacled problem that he believed had the potential for ensnaring his party politically.

"I could see this coming down the pike," said Chafee of the subsequent explosion of the health care issue into the national consciousness. "In my own town meetings, I was getting many, many questions" on the subject.

Furthermore, Congress' disastrous effort to reform Medicare's catastrophic coverage--signed into law with much fanfare one year and repealed amid an outcry from senior citizens the next--had made it clear that the subject was fraught with pitfalls for the unschooled.

Dole took Chafee up on his offer. And from that point on, at 8:30 on most Thursday mornings when Congress was in session, about 20 ideologically diverse Republicans met for breakfast and slogged through the buzzwords and mind-numbing figures, weighing the various options that theoreticians had proposed for fixing the system.

At Chafee's insistence, the senators themselves--not their staffs--made the initial round of presentations spelling out the problems of the current system. He chuckles now when he recalls how his colleagues often tried to outdo one another, each in turn hauling in more charts, graphs and handouts than the one before.

"They were really struggling through the stuff," one aide recalled.

But three years later, Chafee's group--having consumed more bowls of Cheerios than anyone cares to count--has presented what many experts see as the leading political alternative to the health care proposal to be unveiled by President Clinton next week.

To many who know Chafee, this methodical, low-key effort is typical of his approach to issues.

"He's a problem-solver. He's looking for solutions, not headlines," said Bill Gradison, a former Republican congressman from Ohio who was considered one of his party's leading voices on health care. Gradison now heads the Health Insurance Assn. of America.

Chafee is also a politician who often has marched out of step with his party on such issues as civil rights, school prayer, a proposed ban on flag-burning and efforts to bar abortion counseling at federally funded clinics.

During the George Bush Administration, he was so often aligned with Democrats that his fellow Republicans ousted him from his position as third-ranking member of the party's Senate leadership.

But with a Democrat in power, Chafee's influence--and that of other moderate Republicans--is on the ascent again in the Senate.

The reason is arithmetic: To overcome the threat of a filibuster on any piece of legislation, Clinton needs at least four GOP votes in addition to the 56 Democrats in the chamber. He learned that lesson the hard way earlier this year, when he was unable to get his $16-billion jobs bill past a Republican filibuster.

Chafee's plan rejects Clinton's proposals for mandatory spending limits on health premiums and the President's proposal that all employers pay for most of their workers' benefits.

But it embraces other basic concepts of the Administration plan, including the notion that everyone should be required to have health insurance.

For that reason, and others, a group of conservatives led by Sen. Phil Gramm (R-Tex.) has decided to go its own way. Chafee says he never expected to win over everyone in his party, but more than half the Senate's 44 Republicans have signed on to his proposal.

Chafee says he does not believe that the health care debate will carry the same partisan tone as the bitter fight over Clinton's economic plan.

"The splits aren't going to be Republicans versus Democrats," he said. "The splits are going to come within the parties themselves--the middle-ground people and the fringes on either side."

Moderation is a matter of political survival for Chafee, 70, a Republican from a heavily Democratic state. In 1962, he won election to the first of his three terms as Rhode Island's governor by fewer than 400 votes.

After he was defeated for reelection in 1968, President Richard Nixon appointed him secretary of the Navy. In 1976, he was elected to the Senate on his second try.

Chafee's three-year project has seen an evolution in the thinking of many Republicans on the issue of health care. "All of us, as we have spent more time on this, have moved along," he said.

His task force offered a more modest health care reform package in 1991. "They didn't want to do taxes. They weren't sure about universal coverage," recalled one aide. "But even as we were introducing it, even the more conservative members said we had to do something more."

By the middle of last year, the task force was seriously contemplating the idea that has become known as "managed competition"--one in which consumers of health insurance would band together to increase their purchasing power over providers.

But around the same time, Clinton was touting the same concept, and the idea suddenly had the ring of treason. "That threw everybody into a tizzy because it was right before the election," the aide said. "Nobody wanted to embrace it."

With Clinton's inauguration, the group again switched course and ultimately produced a package that both Democrats and Republicans say offers what could be the first steps toward a compromise.

"Although our proposal has some striking differences from the Clinton proposal in terms of philosophy and policy, no issue is a deal-breaker," Chafee said in introducing the plan. "Every issue is, at this point, on the table and open for discussion."

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