But the health-reform team’s secretive style of operation is what seems to be making people angry now. Although it is directed by Hillary Rodham Clinton and includes six members of the cabinet, the team has closed its working sessions to the public and to the many lobbyists who would like to affect its product. Last week the all-powerful American Medical Association appealed to be included-and was rebuffed, with only minimal courtesy, by the administration. “That would be like opening the White House at every staff meeting we have,” the president said, explaining that the team “would never … get anything done.” Clinton had a point-and since his plan must ultimately be debated by Congress, the AMA and every other interest group will have ample opportunity to influence the outcome on Capitol Hill.
Still, lobbyists all over Washing-ton are complaining that their views are being ignored, and three interest groups have tried to force the issue by filing suit. This lawsuit, by the Association of American Physicians and Surgeons, the American Council for Health Care Reform and the National Legal & Policy Center, contends that the administration is violating a 1972 law that says advisory-committee meetings must be open to the public. The health task force must comply with this law, these groups argue, because Hillary Clinton and Tipper Gore, who is also on the health team, are not federal employees-which forced White House spokesman George Stephanopoulos to reply that Hillary and Tipper “clearly are not ‘outside advisers’ in any reasonable interpretation of the law.”
Like the lobbyists’ grumbling, this controversy is probably only a symptom of the fact that everyone in Washington is anxious about health-care reform. The administration plans to release its proposals during the first week of May. But rumors are already rife, and lobbying groups representing virtually every sector of American society feel at risk. One trial balloon involves the possibility of increasing the federal tax on cigarettes by as much as $1 a pack-and that, according to one administration insider, has tobacco-state senators “going nuts.” NEWSWEEK has learned the Clinton team is considering new taxes on guns and ammunition, on the rationale that gun owners should help to pay for the health-care costs these weapons cause, particularly in inner-city emergency rooms. Contemplating the addition of the politically potent gun lobby to the array of groups already pitted against the plan, a White House aide quips darkly, “We’ll have to build a moat around the Old EOB.”
Despite the covert nature of the operation, some details have begun to emerge. Administration sources say the Clinton plan will allow patients to choose their own doctors, provide the states with some flexibility, include cost controls and spread the pain of new taxation as fairly as possible. They say that the plan will prohibit insurance companies from denying coverage to people with pre-existing conditions, and that reform will be phased in over six or eight years to lessen the upfront costs. In the first year or two, says one White House aide, the only difference anyone will notice is the reduced paperwork, a benefit that may rally the public for other changes.
The plan will be built around a core package of benefits, but key questions, such as whether dental care or abortions will be included, are still unresolved. If mental health is covered, as expected, where will Clinton draw the line? Full-blown psychoses are one thing, but how about garden-variety neuroses? How should long-term nursing care be defined? Will it include only the elderly, or will younger people with diseases like multiple sclerosis be eligible? If long-term care were offered to everyone who needs it, says an aide, it could cost as much as $150 billion a year.
Tactically, Clinton must decide whether to ask Congress to vote on his economic package and health reform at the same time, or whether it’s smarter to separate the two. House leaders don’t want to vote on that many taxes at once, but Senate leaders prefer a combined vote. They worry they can’t get a filibuster-proof 60 votes on Clinton’s economic plan but think they can pull it off if health care is included. Either way, the political risks are vast.
Clinton clearly prefers to have it all if he can. “If it doesn’t happen this year, there’s a huge political price to pay for Congress. That’s our message to them,” says an aide. Indeed, the Clinton PR machine is cranking up a series of hearings across the country beginning March 12 in Florida. These hearings are designed to build consensus and a sense of urgency-and they will pose a formidable test of Hillary Clinton’s ability to sell the public on a complex, costly and controversial program of reform.
In the revenue fight ahead, expect a face-off between Clinton and powerful special interests.
Because their products promote bad health, tobacco and gun lobbies may face a “sin tax.”
Clinton targeted pharmaceuticals first. Insurers, doctors and hospitals expect to be next.
Retirees are waiting to see what the plan does to Medicare.
Small businesses fear they won’t be able to afford mandated employer coverage.
