Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: MONDAY, September 20, 1993                   TAG: 9309200105
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A-1   EDITION: METRO 
SOURCE: Associated Press
DATELINE: WASHINGTON                                LENGTH: Medium

HEALTH FINANCING UNCERTAIN

It may be the last question he answers about the plan.

"You have to give me something to announce" Wednesday, Clinton told reporters when asked about his financing plans late last week.

Just days before Clinton formally unveils his health care plan in a nationally televised address to Congress, final figures on how he would pay for it were among the details still being decided.

How much to raise "sin" taxes? Should he relax the limits on Medicare and Medicaid spending? Should big companies that set up their own health purchasing systems pay a special assessment?

"I still have another round of meetings to attend that will go through one last time what our best estimates of costs are," Clinton told reporters Friday. He was meeting Sunday night with his speech-writing team to review a draft on Wednesday's address to Congress.

Spokesman Jeff Eller said the final decisions, including how to pay for the reforms, may not be made by Wednesday. He said there is bipartisan agreement on the administration's broad goals, "but that doesn't necessarily mean that we'll bring every last detail up to the Hill on Wednesday. I think we will, but I don't think it's fair to say we're running out of time" to make decisions.

Advocates for the poor and elderly were closely watching the financing formula, hoping to ease the impact on Medicaid and Medicare. The draft called for a $238 billion reduction in the expected growth of spending for the programs.

"We still are concerned about the adequacy of the proposed financing," said John Rother of the American Association of Retired Persons. He said he was hopeful the White House figures were under revision.

Sen. Daniel Moynihan, chairman of the Senate Finance Committee, called the $238 billion "fantasy, but accurate fantasy" coming out of administration computers.

"We're not going to get $238 billion out of Medicare and Medicaid in the next five years to which we'll add $91 billion in deficit reduction," Moynihan, D-N.Y., said Sunday on NBC's "Meet the Press." "That's not going to happen, needn't happen in order to get a better system."

Unlike the days leading up to unveiling his budget package, Clinton is not in a panic to nail down the specifics of his health care plan. Eller said the White House wants to show that Clinton is open to consultations.

Many items in the fine print of the health plan were still under review. Aides insist the basic structure of the plan and its financing system have long been in place, but allow that some details of the sweeping reform proposal still are evolving - and will continue to change even after it has been presented to Congress.

"It's not written in absolute stone," said Chief of Staff Mack McLarty.

Just over a week after submitting a 246-page draft to Congress, administration officials have made more than 150 changes.

"This is a consultative process," said spokesman Kevin Anderson. "You talk to people, you discuss changes, some of the changes you make."

But he hastened to add: "I don't want to create the impression that this is some kind of jellyfish that's in flux and forever changing. The shape and the fundamentals of this proposal have been in place for a number of months."

Even fine-tuning can have a big impact on affected parties.

For example, tobacco and alcohol interests were sweating over "sin taxes." A late draft of the plan called for $105 billion through the year 2000 but left unanswered whether the money would all come from tobacco or include a hit on alcohol.

"We're still trying to finalize in the next few days what the composition of that will be, but we will have some type of sin tax," Clinton health care director Ira Magaziner said Sunday on CNN.

Another big question was whether Clinton would impose a special levy on big companies that set up their own insurance-purchasing pools rather than joining regional health alliances.

A White House official, speaking on condition of anonymity Sunday, said Clinton had not ruled out the payroll assessment, "but it's not looking as likely now."