Foley Says He’d Accept Limited Health Reform

WASHINGTON — In a major concession that could alter the most fundamental elements of the health debate, House Speaker Thomas S. Foley (D-Wash.) indicated Tuesday that he would settle for a limited package of insurance reforms this year and put off more ambitious efforts for another day.

Foley, offering a candid assessment of President Clinton’s central domestic policy initiative during a breakfast with reporters, said that he still hopes to enact broad legislation to restructure the health care system and provide coverage to the 37 million people who lack it.

But failing that, he said, Congress would be better off sticking to minimal insurance reforms or a modest expansion of coverage, as long as those measures do not create inadvertent consequences, such as raising health premiums.

“If a bill could be found that deals with one or more of those issues in a significant way and doesn’t bar future improvements and consideration, I think that would be worth doing,” he said.

In the Senate, where progress on health reform has been stalled, Sen. Tom Daschle (D-S.D.), a strong Clinton supporter, sounded the same note. “Let’s not be captive of the rhetorical goals we’ve laid out . . . if there’s some way to make discernible progress,” he said.

The Senate’s attention this week has been diverted to crime legislation, and there is wide speculation that it may adjourn for what remains of its August recess without acting on health reform.

The sweeping change in the tone of the debate reflects an acceptance of the reality--increasingly apparent on Capitol Hill--that the likelihood of enacting broad health legislation this year appears less and less likely. But Foley’s comments marked the first time that a member of the Democratic leadership has conceded publicly that Congress may be left only two options: a minimal measure or none at all.

Moreover, his take-what-we-can-get stance stands in stark contrast to the bold--and, in retrospect, brash--vow that Clinton made in January, as he stood before both houses of Congress brandishing a pen.

“If you send me legislation that does not guarantee every American private health insurance that can never be taken away, you will force me to take this pen, veto the legislation and we’ll come right back here and start all over again,” the President had declared.

At that point, polls indicated the American people were ready for major changes in the way they receive and pay for health care. Now, they appear more concerned that Washington will make the current system even worse.

Sen. Dianne Feinstein (D-Calif.) said that of the almost 25,000 calls her office has received regarding health care, a heavy majority are urging that Congress do nothing or proceed slowly.

“Do it incrementally,” she said. “That’s what most people want.”

Foley conceded as much, saying that failure to pass a major bill would not cause a backlash among voters.

Sen. Bob Kerrey (D-Neb.) also agreed. “Permission has been withdrawn (by the public) to do a lot,” he said. “But permission is still there to do a little.”

Kerrey said he agrees with Foley about the acceptability of enacting a modest reform package. “It would be wrong not to do it,” he said. “That will improve immeasurably the lives of many Americans.”

The White House sought to downplay Foley’s remarks, noting that the Speaker had responded to a hypothetical question. “We believe that Speaker Foley will continue to fight for the leadership bill,” said Lorrie McHugh of the White House staff.

Foley said he could support a bill that does not guarantee universal coverage so long as it makes “real progress in coverage, real progress in insurance reform and protection without untoward consequences . . . “

Such a bill “has to show progress toward meeting some of these goals in order to justify passage,” he added.

“If that can’t be done, if we can’t find a consensus for that, the other instance is to probably say we have to pick it up in the next Congress.”

Foley’s remarks prompted skeptics of incremental reform to renew their warnings that such actions, particularly if phased in over a long period and unaccompanied by universal coverage requirements, might actually prove worse than doing nothing.

Rep. Jim McDermott (D-Wash.), the leading House backer of a government-financed, Canadian-style health system commonly called “single payer,” said he fears that Congress is headed toward “some meddling around the edges and phasing it in over 25 years.”

Such a “halfway job” might make it difficult for those who seek further changes in future years, McDermott said. “We’re almost to the point where it might be better to do nothing,” he said.

Yet the pressure to pass a bill remains intense, in large measure because Congress wants to convince the public that it is capable of action.

In that vein, Foley said he does not believe Congress ought to “just put something together that doesn’t really do anything at all and say this is health care reform, in order to satisfy the public that we’ve done something.”

The House will not reconsider the health issue until next month, after it returns from its August recess and receives estimates of the costs of the various proposals before it.

The House leadership is backing a bill offered by Majority Leader Richard A. Gephardt (D-Mo.), which claims to achieve Clinton’s goal of universal coverage through a version of his proposal to require employers to pay 80% of their workers’ health premium costs. At this point, many believe that the leaders are dozens of votes short of what they need to pass the bill.

In the Senate, Majority Leader George J. Mitchell (D-Me.) has put forward a proposal that falls well short of universal coverage. His legislation is projected to cover 95% of the population by the turn of the century, largely through market incentives and subsidizing people who cannot afford it.

If that does not work, the plan then would impose a so-called “employer mandate” of 50%, starting in the year 2002.

However, Mitchell’s plan appears increasingly unlikely to pass without major modification, and he has been meeting with a bipartisan group of about 20 “mainstream” senators who are offering a more modest reform package.