Return of Health-Care Reform

Health care looks set to be perhaps the most-discussed domestic issue in Washington this election-year summer.

One reason: The demise of sweeping antitobacco legislation has left both Republicans and Democrats searching for something popular they can do quickly. Health care is an obvious choice for action, as in many polls it rates near the top of late-20th-century US voters' concerns.

This doesn't mean that anything remotely resembling President Clinton's failed health-care-reform bill of 1994 will return to the legislative arena.

Instead, both parties are promoting incremental steps, such as protection of health maintenance organization patients' rights, or more punishment for insurance firms that illegally deny policy coverage.

It does mean that national politicians don't want to be outflanked on the issue. GOP legislators, in particular, are worried about their opponents portraying them as health-reform obstructionists.

"Now that the Republicans have moved into this it will be harder to differentiate among candidates on health care alone," says Robert Blendon, professor at Harvard University's School of Public Health in Boston.

If nothing else, this week's White House agenda points out the timeliness of the health-care issue.

President Clinton had barely returned from his trip to China before he was out in the Rose Garden July 6, pushing new outreach programs intended to make more low-income senior citizens aware of government aid that will help pay part of their Medicare premiums.

Between 3 million and 4 million beneficiaries aren't aware that they're eligible for such aid, Mr. Clinton said. This group is overpaying Medicare by a combined $2 billion a year, he said, citing a study by the organization Families USA.

Then on July 7, the president leaped into another health-care issue, promising to crack down on insurance firms that deny coverage on the basis of preexisting medical conditions. Most such actions are illegal under a 1996 health-insurance law - and firms that get caught will be denied lucrative government business, said Clinton.

Has the nation's chief executive been struck by an urge to impersonate a deputy secretary of Health and Human Services? Not likely. What's going on here, say experts, is that Clinton recognizes the political power of the phrase "health care." Thus he works to personally associate himself with any popular health-care reform the government may take, no matter how small.

A Time/CNN poll released July 5 found that three-quarters of Americans believe health-care reform should be a top priority for Congress, for instance. Only education reform and protection of Social Security ranked higher as national issues. Some 40 percent of poll respondents agreed that "there is a crisis" in the current US health-care delivery system.

FOR the GOP, the most ominous aspect of the poll was that 46 percent of respondents said they trusted the president more than Republicans in Congress on health-care issues. GOP lawmakers won the confidence of 30 percent of respondents.

Crunch those numbers, and you get a GOP leadership energized to do something about health care to protect its grip on Congress in the fall elections.

The leadership's legislative vehicle of choice: a bill to set federal standards in law to provide basic protections for health maintenance organization (HMO) patients. This mirrors the Democrats' long push for a Patient Bill of Rights.

"We think there are a lot of members of Congress on both sides of the aisle who are very much committed to ensuring those protections are there," said Christopher Jennings, deputy assistant to the president for health policy, at a July 6 briefing for reporters. "It would be almost beyond comprehension that the Congress couldn't pass a strong bipartisan piece of legislation this year."

The GOP unveiled its managed-care protection plan on June 24, in time for lawmakers to promote it during July trips home.

Its details range from a proposed appeals process that would allow patients to appeal insurers' coverage decisions to mandated coverage of emergency care a "prudent layperson" would deem necessary.

Democrats complain of holes in the GOP plan. Its appeals process would require patients to post 20 percent of the cost of the disputed procedure, for instance.

But from a political point of view, the important thing for GOP lawmakers is that the plan exists at all.

"Some bill will be passed. It will be relatively modest," predicts Mr. Blendon of Harvard.

The health-care issue could expand beyond the narrow confines of HMO reform in the 2000 presidential election, Blendon believes.

"In a chief executive race, you have more time to articulate the differences between the parties," he says. "In off-year congressional elections, it's a 30-second ad, with both candidates saying, 'We're going to help you with your health plan.' "