IN THE budget he sent to Congress earlier this year, President Clinton embraced a bill by Senate Labor and Human Resources Committee Chairman James Jeffords and the panel's ranking Democrat, Edward M. Kennedy, to make it easier for disabled people to go to work. The measure would let the disabled keep their government health insurance -- Medicaid or Medicare -- if they leave the benefit rolls for jobs. Otherwise the gamble tends to be too great, since almost by definition these are people in serious need of insurance, which, by virtue of their condition, they generally can't get at affordable rates, if at all, in the private market.
The legislation now has 79 Senate cosponsors. The Congressional Budget Office estimates the cost would be modest, since the government would be saving disability benefits, gaining tax revenues, and not that many people would be able to make the move off the rolls even with the insurance. The Finance Committee, which has jurisdiction, sent the bill to the floor more than two months ago by a vote of 16 to 2.
But there it has languished since. The committee opponents happened to be Majority Leader Trent Lott and Assistant Majority Leader Don Nickles. Among other things, they appear to have been uneasy about expanding Medicaid and Medicare beyond their traditional boundaries. They wanted income ceilings placed on eligibility even to buy into Medicaid, which has been a program for the poor and near-poor. Some fairly high ceilings have now been negotiated, well up in the middle-income range. Mr. Nickles at one point suggested the committee also consider placing such limits on continuing eligibility for Medicare, but Sen. William V. Roth, one of the bill's sponsors, balked. The committee was not going to venture into the swamp of means-testing Medicare, he said, not in this political season.
Mr. Lott also objected to a small pilot program to extend insurance to people who have degenerative diseases that make it hard for them to get private insurance, but who are not yet disabled. Multiple sclerosis is one example, the virus that leads to AIDS another. "Why should you get insurance before you're disabled?" he asked.
When the leaders finally agreed to bring up a slightly altered version of the bill last week, another objection arose. Sen. Phil Gramm complained about a tightening of the tax code that was being used to cover the cost; Republicans want to use the same provision, having to do with the foreign tax credit, to cover the cost of a tax benefit to help parents pay for private school.
In the end, our guess is that the bill will pass in the Senate, as it should, and in the House as well. But the resistance is interesting as an indicator of where the health care debate is headed. Those like Mr. Kennedy -- and Mr. Clinton -- who favor universal health insurance have become committed incrementalists. They'll extend coverage to those who currently lack it a group at a time. A couple of Congresses ago it was low-income children; here it's disabled people who want to work.
None of the groups is easy to say no to. The resisters are right that traditional eligibility standards are being breached, and the advocates are likewise right that each of these steps merely puts a face on legitimate need. It's a messy, patchy way to do business, but that's how it's going to be for perhaps quite a while.