Senate Majority Leader Wins Nods for Health-Care Flexibility

ONE sign of how much the debate on health care has shifted to the right over the months:

A couple of months ago, almost half the Republicans in the Senate backed a bill that required every American to sign up for health insurance.

``They appear to have completely reversed their position on that,'' said Senate Majority Leader George Mitchell (D) of Maine at a Monitor breakfast yesterday.

The bill just drafted by Senator Mitchell makes no such requirements before the year 2002. And then, the mandates take effect only if other measures fail to expand coverage to 95 percent of the population.

As recently as the beginning of this year, Mr. Mitchell agrees, his reform bill would have won over many moderate votes in both parties as a mild, incremental proposal.

Now many moderates, such as Republican Sen. John Chafee of Rhode Island, are dubbing it a too heavy-handed a use of government.

Mitchell hopes to win back the support of such moderates in the debates ahead. ``I think I presented a sensible, reasonable, middle-ground approach,'' he says, which he drew heavily from the proposals of Senate moderates.

President Clinton gave a strong endorsement to Mitchell's bill at his prime-time press conference Wednesday evening. For Clinton, support of the Mitchell bill marks a downscaling of his insistence on achieving universal coverage.

Mitchell says that his bill will expand the ranks of people covered by health insurance by creating a system of incentives, including some subsidies, for businesses to help cover their employees.

Most of the uninsured currently work for small businesses. After meeting with hundreds of small business owners, Mitchell says, he believes that most of them want to offer health benefits to their employees, but they feel they just cannot afford to.

His plan would make insurance more affordable to such businesses through voluntary purchasing cooperatives that would offer the purchasing power of large corporations to smaller groups. His cost controls would largely work through enhanced competition.

The referee of all the claims of Mitchell's and other health plans is the Congressional Budget Office. He only introduced his bill in legislative language Wednesday evening, so the CBO has not produced a report on it yet.

But Mitchell says officials at the CBO have told him they project that his bill can reach 95 percent insurance coverage by 2002 and that it will not increase the budget deficit.

If that coverage target is not reached, then Mitchell's bill would require employers to pay for 50 percent of their employees' health benefits. This possible mandate is the most controversial aspect of his bill so far.