As a single mother of two children, Brenda Holstine brought home a little more than $160 a week from her assembly-line job at Louisville Manufacturing Co. So when her health insurance premiums were increased to $59.30 a week a little more than two years ago, she felt she had no choice but to cancel her insurance.

"There was no way I could make ends meet and pay for insurance for my kids," Holstine told an AFL-CIO health care hearing last October. "I've just kept my fingers crossed that my kids don't get sick."

Priscilla Brewer, a co-worker on Louisville Manufacturing's baseball cap production line, gave up coverage for her family after her daughter's leukemia had gone into remission because rising health insurance premiums had cut her take-home pay to $77 a week.

Since then, the two women have taken an additional cut in pay as the slumping economy forced the company to adopt a four-day workweek. Holstine said she now brings home $120 a week.

But medical costs continue to climb. Louisville Manufacturing, reflecting an increase in its own costs, now wants to charge employees $78 a week for family medical coverage.

Holstine and Brewer have become front-line troops in a growing political campaign for some form of government-imposed universal health care that would provide quality coverage for everyone. The idea, in various forms, is gaining the support of groups ranging on the political spectrum from the AFL-CIO and the American Association of Retired Persons to the National Association of Manufacturers and the American Medical Association.

For the first time since the mid-1970s, supporters of national health insurance believe they have a legitimate chance of winning congressional approval for a universal health care bill, if not this Congress, then next. "This is the best shot we've had in 15 years," said a key congressional aide.

With health care costs climbing more than 20 percent a year for major corporations and even more for many small businesses, disparate political groups are beginning to form a coalition for reform.

Although there is a growing coalition pushing for some form of universal health coverage, ideas vary widely on how to implement such a plan, particularly on the question of how best to contain costs.

Walter Maher, director of federal relations for Chrysler Corp., which has been a strong advocate of national health insurance, said the goal of any new program should be to "spread the cost of this {health care} throughout the economy" to avoid cost shifting from one segment of society to another.

Maher said that as major corporations have been putting pressure on doctors and hospitals to control costs, the medical community has simply been raising the costs they charge small companies or individuals who do not have the economic clout to fight back.

The major vehicle for any congressional debate is expected to be the product of negotiations among Democratic leaders on the Senate labor and finance committees. The negotiators, who include Sen. Edward M. Kennedy (D-Mass.) and Senate Majority Leader George J. Mitchell (D-Maine), are working on a bill patterned after the recommendations of the U.S. Bipartisan Commission on Comprehensive Health Care, the so-called Pepper Commission.

The commission recommendations, issued last fall, call for a plan that combines employer-backed insurance with a public insurance plan. The so-called "play or pay" approach would require companies to either provide minimum health coverage for their employees according to standards set by the government or pay a tax that would go into a public fund to provide health coverage for their employees.

Sources close to the committee negotiations said they expect agreement on a bill by mid-March. Although there are some Republicans involved in the negotiations, sources said they did not expect any Republicans to endorse the bill. "This will be a Democratic leadership bill," a congressional source said.

Once agreement is reached on legislation in the Senate, Democrats will introduce a comparable bill in the House.

So far, the White House has indicated it would oppose any national health legislation, but supporters of health care reform hope to make it enough of an issue in Congress to at least force it to become part of the debate in the next presidential elections.

Changing Positions Perhaps the best example of the changing political positions in the health care debate is the scheduled appearance today of AFL-CIO President Lane Kirkland at the leadership conference of the American Medical Association in Miami Beach to discuss labor's views on the need for national health insurance. It's the first time the president of the labor federation has ever been invited to address an AMA gathering.

Four months earlier, AMA President C. John Tupper made what he called an "historic first" appearance before an AFL-CIO panel in San Francisco investigating problems in the nation's health care system. Tupper used his appearance to outline the AMA's plan for universal health care and to urge the two organizations to join political forces to push for reform.

With health care costs increasingly taking center stage as labor contracts come due around the country, several major unions have banded together with influential members of the business community in a search for consensus on a way to address rising costs.

Last year, 55 unions, corporations, medical groups and public interest lobbying groups formed the National Leadership Coalition for Health Care Reform to develop a proposal to overhaul the nation's health care system. Among the 35 corporations in the coalition are American Telephone & Telegraph Co., Ford Motor Co., Time Warner Inc., Xerox Corp., Lockheed Corp., Du Pont Co., Eastman Kodak Co., Minnesota Mining and Manufacturing Co. and General Electric Co.

Peggy Rhoades, executive director of the Washington-based coalition, said the group hopes to have a proposal by spring. "The purpose is to develop a systematic reform plan, not patch it anymore," Rhoades said. But she said, "I don't have a sense yet of where everybody's going to go."

The leadership coalition also includes the American Association of Retired Persons (AARP), which has become a strong advocate of broad universal health care coverage as a way to protect the benefits of the elderly. Writing in the current AARP Bulletin, Executive Director Horace Deets said the message to political candidates is simple: "We need health care reform."

Lack of Consensus So far, general business support of legislation that would "mandate" companies to provide health care has been less than enthusiastic. Groups like the U.S. Chamber of Commerce and the National Federation of Independent Business, which primarily represent smaller businesses, oppose such legislation on the grounds that many small employers can't afford such coverage.

But a number of large corporations, particularly in the auto and steel industries, appear supportive of some form of national health legislation that would either shift their costs onto the government or spread the economic burden around by forcing all employers to pay the health care costs of their workers.

Large corporations figure that they end up paying more than their fair share of medical coverage. They argue that if a spouse has an inferior health plan or none at all, the couple's dependents get shifted to the plan of the larger company. Dependent care, even though some of it is usually paid by the employee, is one of the fastest-rising health care costs.

The lack of consensus on health care reform extends to even the most ardent advocates of national health insurance.

The AFL-CIO, for example, opens its annual midwinter leadership meeting in Florida this week unanimous on the need for national health care reform but bitterly divided over how to achieve it.

After a year of study, a special 16-member AFL-CIO Health Care Committee is split 8 to 8 over which approach to take toward national health insurance. The union leadership had hoped to use this week's meeting of the federation's Executive Council to outline its legislative position in the upcoming debate. There is now a better-than-even chance the union's leadership will not be able to reach a consensus position and will go their separate ways in the congressional debate.

Congressional supporters of health care reform are keeping a close eye on labor. "We can't pass a bill without them," said a congressional source close to the negotiations between the two Senate committees. "We're very hopeful that they can come together."

Which Approach? The split within the labor ranks centers on whether to have a national health insurance plan patterned after the Canadian system, where the government is the single payer, or an approach similar to the Pepper Commission recommendations, where the majority of the population receives health insurance coverage through their employers under a private, nonprofit insurance system regulated by the federal government.

Kirkland is reported to favor the Pepper Commission approach, which is being backed by Kennedy and Mitchell. Failure to reach a consensus this week could significantly weaken labor's lobbying power in the upcoming debate.

The unions have already spent several million dollars on a campaign aimed at stirring up grass-roots support for national health insurance. Over the past six months, the AFL-CIO has held hearings in eight cities on the health care issue, and it is about to embark on an initial $3 million television campaign with a half-hour program being offered to 300 stations on the Public Broadcasting System.

"We hope to influence the bidding," said Robert McGlotten, legislative director of the AFL-CIO. "All of us have a great stake in this."

McGlotten said he was hopeful the unions would be able to work out a consensus legislative position rather than have individual unions lobbying Congress for a number of different bills.

But even McGlotten concedes final passage of health care legislation this Congress is unlikely.

"Maybe lightning will strike and it will happen before the presidential debates," McGlotten said. "But I don't believe it."