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Once Again, Health Reform Takes Center Stage in Elections


WASHINGTON — Policy analysts will be sparring for months over President Clinton's plan to expand Medicare. But one thing is already settled: Insurance for older Americans will be a highly partisan issue in Campaign '98, making it the fourth straight election in which health-care reform plays a starring role.

This year's fight, like its predecessors, is rife with political land mines for Democrats and Republicans alike. But given the dramatic success that each party has had exploiting the issue in the past, it's no wonder health reform is back on the public agenda.

The escalating political rhetoric underscores a sobering reality: The modest reforms enacted by Congress in recent years have barely made a dent in alleviating the two most critical health-care problems confronting tens of millions of Americans--affordability and accessibility.

Indeed, analysts say matters are still deteriorating, with the number of uninsured Americans at an all-time high of 41.5 million; among them are several million kids who are eligible for Medicaid but unenrolled. Although medical inflation has slowed, the high cost of insurance remains a barrier to many. Meanwhile, dissatisfaction with managed care runs rampant as more Americans are herded into cost-conscious health-care delivery systems.

Clinton has roiled the waters by proposing to expand the Medicare program to take in certain displaced workers, early retirees and spouses between the ages of 55 and 65, a group that's losing coverage at a faster rate than any other age bracket.

The president's proposal appears relatively modest in scale. It would target an estimated 300,000 Americans, all of whom would be required to bear most of the additional cost of coverage.

Even so, it is likely to be portrayed by Republicans as an unprecedented expansion of "government health care." That, in turn, could evoke memories of Clinton's disastrous "universal coverage" crusade of 1993-94, a debacle that led to the GOP takeover of Congress in 1994. (Clinton was elected president in 1992 in part because incumbent George Bush failed to address health-care reform.)

But this time around, attacking "Clinton Care" will not be a risk-free proposition for Republicans. After the GOP tried unsuccessfully to cut Medicare growth to help balance the budget, Democrats waged a scorching campaign in 1996, led by Clinton, that put virtually every Republican candidate on the defensive.

Even now, Republicans chafe at those "Medi-scare" tactics. And many are gun-shy in the face of another potential political brawl over Medicare, unable to coalesce behind one strategy.

Reflecting that GOP ambivalence is Sen. Phil Gramm (R-Texas), who played a central role in killing what he called Clinton's plan to "nationalize health care."

"I don't delude myself into not believing that the president's proposal will be very, very popular. . . . It is very good politics," Gramm said.

Nevertheless, Gramm, who chairs a key Medicare subcommittee in the Senate, intends to try to block Clinton's initiative.

On the House side, a strategist for Speaker Newt Gingrich (R-Ga.) is urging members to resist being lured into a "bloody" fight with the White House over Clinton's "micro-initiatives."

Such a battle, Christina Martin warned in a memo, would only enable Democrats to portray Republicans as being against programs such as Medicare--a replay of 1996, in other words.

The president's proposal would open Medicare for the first time to some people as young as 55, a full decade before they otherwise would be eligible for the federal health insurance program. They would be required to pay a monthly base premium of $300.

Yet many Republicans are preparing to oppose the plan because, they say, it would create a new entitlement--one that could be expanded later, with the less well-to-do receiving public subsidies for their monthly premiums.

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