WHEN the Congress returns to work a week from today, the marathon molding of health-care reform moves to a new phase.
Initial proposals, including President Clinton's, were just raw material for the legislative sausage-grinder. What has finally emerged from four committees, two in each house, will be packed and molded into legislation that Democratic leaders believe can pass both the House and Senate.
The key players now become House Speaker Tom Foley (D) of Washington, Majority Leader Richard Gephardt (D) of Missouri, and Senate Majority Leader George Mitchell (D) of Maine. Best current guesses are that a floor vote will be held in late August. Then if reform bills pass each chamber, they will go to a House-Senate conference for reconciliation and then back to each chamber for another vote.
Five health-care bills now dominate the scene. Four have passed committees in the House or Senate, yet the fifth - unveiled last week by Senate Minority Leader Bob Dole (R) of Kansas - has the strongest unified bloc of support. Thirty-nine Republican senators signed onto his bill almost immediately.
Most of the bills have single-party support. The only one that has substantial bipartisan support is the bill passed the Senate Finance Committee on Saturday.
The reform plans as they now stand:
Senate Finance. This committee, run by Sen. Daniel Patrick Moynihan (D) of New York, has been the most-watched in the health-care debate because its bill, the only bipartisan one left in the game, occupies the center ground.
The big question was whether it would include an employer mandate, that is, a requirement that businesses pay most of the cost of their employees' health-insurance premiums. Senator Moynihan attempted to include the mandate, but it was voted down in his committee.
The plan would bar insurers from terminating coverage or denying coverage to people with health problems. It requires them to pool risks so that everyone pays similar premiums, with some adjustment for family size, age, and region.
Voluntary ``purchasing pools'' would be organized for individual buyers and people in companies of less than 500.
Low-income families with incomes up to twice the poverty level would get full government subsidies. Low-wage firms would get subsidies too, but only if they paid 80 percent of their employee premiums. These subsidies would be paid for with higher tobacco taxes, taxes on guns and ammunition, and a 1 percent tax on firms with more than 500 employees. The rest of the money would come from cuts in Medicare and Medicaid payments to health-care providers.
If at least 95 percent of Americans were not covered by 2001, then a commission would recommend further steps.
House Ways and Means. A plan passed this committee with all-Democratic votes, although four Democrats voted against it. It is much closer to the Clinton plan than is the Senate Finance bill.
This plan would guarantee universal coverage with a somewhat better-than-average package of benefits by 1998. Employers would pay 80 percent of the premiums for their employees, with government subsidies for low-income families and small businesses.
Others - the unemployed, the very poor, part-time workers, or those in small companies - could enroll in a vastly expanded version of Medicare, the government's fee-for-service insurance plan now open to the elderly.
Senate Labor. The first committee to report out a major health-care bill, all the Democrats on Sen. Edward M. Kennedy's panel voted for the bill, along with one Republican. The bill would require employers to pay 80 percent of employees' premiums on a fairly generous benefits package. Companies with less than 75 workers would get subsidies according to wage levels. Companies of less than 10 could pay a 1 to 2 percent payroll tax instead of paying premiums.
States would have to set up at least one purchasing cooperative to offer group-rate insurance plans to those left out of the employer-based system. To control costs, the bill would cap any increases in premiums. Major funding would come from a $1.49-per-pack cigarette tax.
House Education and Labor. Also with all-Democratic votes, this committee passed a bill similar to the Senate Labor bill, but with more generous benefits and subsidies. Also, buying insurance through the purchasing pools set up by states would be mandatory except for firms employing more than 1,000.
Senate Republicans. This plan, unveiled by Senator Dole and not passed through any committee, would change the health-care system the least. It would bar insurers from canceling coverage to those with health problems or those changing jobs. Small businesses and the self-employed could join the program that now offers a menu of insurance plans to federal employees. Subsidies for the poor to purchase private insurance would be extended to those too well-off for Medicaid but still poor or near-poor.