1993 Clinton health care plan

The Clinton health care plan, sometimes called "HillaryCare" by opponents, [cite book | last=Estrich | first=Susan | authorlink=Susan Estrich | title=The Case for Hillary Clinton | publisher=HarperCollins | year=2005 | isbn=0060839880 p. 104.] [cite book | last=Longman | first=Phillip | title=Best Care Anywhere: Why VA Health Care Is Better Than Yours | publisher=PoliPointPress | year=2007 | isbn=0977825302 p. vii.] [Gratzer, David. [http://www.weeklystandard.com/Content/Protected/Articles/000/000/005/617loflw.asp "The Return of HillaryCare"] "The Weekly Standard". 05/23/2005, Volume 010, Issue 34. Retrieved 2007-August-07.] was a 1993 healthcare reform package proposed by the administration of Bill Clinton, then President of the United States, and created and chaired by the First Lady of the United States, Hillary Rodham Clinton.

Background

The United States is the only wealthy, industrialized nation that does not provide universal health care. [ [http://www.iom.edu/?id=17848 Insuring America's Health: Principles and Recommendations] , Institute of Medicine at the National Academies of Science.] [ [http://cthealth.server101.com/the_case_for_universal_health_care_in_the_united_states.htm The Case For Single Payer, Universal Health Care For The United States] .] Although the United States has never had a universal health care system, it does have certain publicly funded health care programs that help to provide for the elderly and disabled (via Medicare), military service families, veterans (via the Veterans Health Administration), and some of the poor (via Medicaid). [ [http://www.cms.hhs.gov/MedicaidGenInfo/ Overview - What is Not Covered] , U.S. Department of Health & Human Services] Additionally, federal law guarantees public access to emergency services regardless of ability to pay. [Centers for Medicare & Medicaid Services. [http://www.cms.hhs.gov/EMTALA/ Emergency Medical Treatment & Labor Act.] Retrieved August 30, 2006.] Bill Clinton had campaigned heavily on health care in the 1992 election.

Provisions

The Clinton health plan required each US citizen and permanent resident alien to become enrolled in a qualified health plan and forbade their disenrollment until covered by another plan. It listed minimum coverages and maximum annual out-of-pocket expenses for each plan. It proposed the establishment of corporate "regional alliances" of health providers to be subject to a fee-for-service schedule. People below a certain set income level were to pay nothing. The act listed funding to be sent to the states for the administration of this plan, beginning at $13.5 billion in 1993 and reaching $38.3 billion in 2003.

Task Force

Once in office, Bill Clinton quickly set up the Task Force on National Health Care Reform, headed by First Lady Hillary Rodham Clinton, to come up with a comprehensive plan to provide universal health care for all Americans, which was to be a cornerstone of the administration's first-term agenda. A major health care speech was delivered by Clinton to a joint session of Congress on September 22 1993, [Clinton, Bill. [http://www.clintonpresidentialcenter.org/legacy/092293-speech-by-president-address-to-joint-session-of-congress-as-delivered.htm Address to Joint Session of Congress as Delivered] (2003-09-22).] with an overwhelmingly positive response. [http://www.pbs.org/newshour/forum/may96/background/health_debate_page1.html "Events leading up to Clinton's Healthcare Address to Congress,"] Timeline from PBS's "The System". Accessed June 10, 2007.] Cohn, Jonathan. [http://www.tnr.com/doc.mhtml?i=20070604&s=cohn060407 "Hillary was Right - The health care plan that dares not speak its name,"] "The New Republic", June 5, 2007. Accessed June 8, 2007.] In that speech, President Clinton explained the problem as follows:

Hillary Clinton's leading role in this project was unprecedented for a presidential spouse. [Hodgson, Godfrey. " [http://books.google.com/books?id=_S-5zbeget8C&pg=PA349&dq=unprecedented+and+%22health+care%22+and+%22hillary%22+and+clinton&num=100&sig=hCwWdLoliElAjkQcibWJO8nCWCw The Gentleman from New York: Daniel Patrick Moynihan: a Biography] ", page 349 (2000): "Hillary Clinton was out in front on this project to a degree unprecedented among presidential wives."] Bok, Derek. [http://books.google.com/books?id=hIo6Lo0vA3cC&pg=PA96&dq=unprecedented+and+%22health+care%22+and+%22hillary%22+and+clinton&num=100&sig=GJnVaqcCnzqRRTZbDaaAh82Ij9w#PPA96,M1 "Political Leadership in the Great Health Care Debate of 1993-1994"] in "Public Discourse in America: Conversation and Community in the Twenty-First Century" by Stephen P. Steinberg, Judith Rodin, page 96 (2003): "the President took the unprecedented step of naming his wife."] This unusual decision by President Clinton to put his wife in charge of the project has been attributed to several factors, including the President's desire to emphasize his personal commitment to the enterprise.

Litigation

The First Lady's role in the secret proceedings of the Health Care Task Force also sparked litigation in the U.S. Court of Appeals for the D.C. Circuit, in relation to the Federal Advisory Committee Act (FACA) which requires openness in government. The Clinton White House argued that the in Article II of the U.S. Constitution would make it unconstitutional to apply the procedural requirements of FACA to Hillary's participation in the meetings of the Task Force. Some constitutional experts argued to the court that such a legal theory was not supported by the text, history, or structure of the Constitution.cite web |url=http://papers.ssrn.com/sol3/papers.cfm?abstract_id=971067 |title=Amicus Brief of J. Gregory Sidak in Association of American Physicians & Surgeons v. Hillary Rodham Clinton |work=Social Science Research Network |first=J Gregory |last=Sidak |date=1993|accessdate=2007-08-21] Ultimately, Hillary Clinton won the litigation when the D.C. Circuit ruled narrowly that the First Lady of the United States can be deemed a government official (and not a mere private citizen) for purposes of not having to comply with the procedural requirements of FACA. [" [http://www.aapsonline.org/clinton/AAPS/APPOPIN.PDF Association of American Physicians and Surgeons, Inc. v. Hillary Rodham Clinton] ", 997 F.2d 898 (D.C. Cir. 1993).]

In 1993, the Association of American Physicians and Surgeons, along with several other groups, filed a lawsuit against Hillary Clinton and Donna Shalala‎ over closed-door meetings related to the health care plan. The AAPS sued to gain access to the list of members of the task force. Judge Royce C. Lamberth found in favor of the plaintiffs and awarded $285,864 to the AAPS for legal costs; Lamberth also harshly criticized the Clinton administration and Clinton aide Ira Magaziner in his ruling. [ [http://query.nytimes.com/gst/fullpage.html?res=9405E5DA1E3FF93AA25751C1A961958260 Judge Rules Government Covered Up Lies on Panel] , By Robert Pear. From the "New York Times", December 19 1997; accessed January 3 2008.] Subsequently, a federal appeals court overturned the award and the initial findings on the basis that Magaziner and the administration had not acted in bad faith. [ [http://query.nytimes.com/gst/fullpage.html?res=990DE7DB1F38F936A1575BC0A96F958260 Court Clears Clinton Aide In Lying Case] , by Neil A. Lewis. Published in the "New York Times", August 25 1999. Accessed January 3 2008.]

Debate

Starting on September 28, 1993, Hillary Clinton appeared for several days of testimony before five congressional committees on health care. Opponents of the bill organized against it before it was presented to the Democratic-controlled Congress on November 20, 1993. The bill was a complex proposal running more than 1,000 pages, the core element of which was an enforced mandate for employers to provide health insurance coverage to all of their employees through competitive but closely-regulated health maintenance organizations (HMOs). The full text of the November 20 bill (the "Health Security Act") is available online. [ [http://thomas.loc.gov/cgi-bin/query/z?c103:H.R.3600.IH: H.R. 3600, Health Security Act] (1993-11-20).]
Conservatives, libertarians, and the insurance industry staged a campaign against the "Health Security" plan and criticized it as being overly bureaucratic and restrictive of patient choice. [Moffit, Robert. [http://www.heritage.org/Research/HealthCare/tp00.cfm "A Guide to the Clinton Health Plan"] , Heritage Foundation (1993-11-19):

[T] he Clinton Administration is imposing a top-down, command-and-control system of global budgets and premium caps, a superintending National Health Board and a vast system of government sponsored regional alliances, along with a panoply of advisory boards, panels, and councils, interlaced with the expanded operations of the agencies of Department of Health and Human Services and the Department of Labor, issuing innumerable rules, regulations, guidelines, and standards.

] The effort included extensive advertising criticizing the plan, including the famous "Harry and Louise" ad paid for by the Health Insurance Association of America, which depicted a middle-class couple despairing over the plan's supposed complex, bureaucratic nature.Hernandez, Raymond and Pear, Robert. [http://www.nytimes.com/2006/07/12/nyregion/12donate.html?ex=1310356800&en=0882715139712152&ei=5088&partner=rssnyt&emc=rss "Once an Enemy, Health Industry Warms to Clinton,"] "The New York Times", July 12, 2006. Accessed June 9, 2007.] "Time", "CBS News", "CNN", the "Wall Street Journal" and the "Christian Science Monitor" ran stories questioning whether there really was a health-care crisis. [ [http://www.time.com/time/magazine/article/0,9171,980129,00.html "The Rise and Fall of the Political Catchphrase,"] "Time", February 14, 1994. Traces the origins of the Republican counter-argument "there is no health care crisis." Accessed June 8, 2007.] Op-eds were written against it, including one in "The Washington Post" by University of Virginia Professor Martha Derthick that said:cquote|In many years of studying American social policy, I have never read an official document that seemed so suffused with coercion and political naivete ... with its drastic prescriptions for controlling the conduct of state governments, employers, drug manufacturers, doctors, hospitals and you and me. [Will, George. [http://www.washingtonpost.com/wp-dyn/content/article/2006/11/09/AR2006110901875.html?nav=rss_opinion/columns "Inoculated for Exuberance?"] "The Washington Post", November 10, 2006. Accessed June 9, 2006.] U.S. Senator Daniel Patrick Moynihan qualified his agreement that "there is no health care crisis" by stating "there is an insurance crisis" but also indicated "anyone who thinks [the Clinton health care plan] can work in the real world as presently written isn't living in it." [Kramer, Michael. [http://www.time.com/time/magazine/article/0,9171,980052,00.html "The Political Interest,"] "Time", January 31, 1994. "Slowly but surely, Bill Clinton's health-care plan is headed for the triage unit." Accessed June 8, 2007.] Meanwhile, Democrats, instead of uniting behind the President's original proposal, offered a number of competing plans of their own. Some criticized the plan from the left, preferring a Canadian-style single payer system.

Defeat

In August 1994, Democratic Senate Majority Leader George J. Mitchell introduced a compromise proposal that would have delayed requirements of employers until 2002, and exempted small businesses. However, "Even with Mitchell’s bill, there were not enough Democratic Senators behind a single proposal to pass a bill, let alone stop a filibuster." [Pantel, Kant and Rushefsky, Mark. [http://books.google.com/books?id=wGEsQ_fXA9AC&pg=PA108&lpg=PA108&dq=mitchell+and+%22september+26+1994%22+and+health&source=web&ots=NuDif3Cuk8&sig=1BJAbQYGL8cgm8NqSm3_b3PLemk#PPA108,M1 Politics, Power, and Policy Making: The Case of Health Care Reform in the 1990s] (1997).]

A few weeks later, Mitchell announced that his compromise plan was dead, and that health care reform would have to wait at least until the next Congress. The defeat weakened Clinton politically, emboldened Republicans, and contributed to the notion that Hillary Clinton was a "big-government liberal" as decried by conservative opponents. [http://www.nytimes.com/2005/07/13/nyregion/13hillary.ready.html?ex=1278907200&en=ca200c39b840ad53&ei=5090&partner=rssuserland&emc=rss "The Evolution of Hillary Clinton,"] "New York Times", July 13, 2005. Accessed June 8, 2007.]

The 1994 mid-term election became a "referendum on big government — Hillary Clinton had launched a massive health-care reform plan that wound up strangled by its own red tape." [Thomas, Evan. [http://www.msnbc.msn.com/id/15674090/site/newsweek "Decline and Fall"] , "Newsweek". {2006-11-20).] In that 1994 election, the Republican revolution, led by Newt Gingrich, gave the GOP control of both the House of Representatives and the Senate for the first time since the 83rd Congress of 1953–1954, ending prospects for a Clinton-sponsored health care overhaul. Comprehensive reform aimed at creating universal health care in the United States has not been seriously considered by Congress since.

Controversy in retrospect and perspective

In 2004, as a U.S. senator from New York, Hillary Clinton argued in the "The New York Times" that the current health care system is unsustainable, and she offered several solutions. [Clinton, Hillary Rodham. [http://query.nytimes.com/gst/fullpage.html?res=9A00E7DE1E38F93BA25757C0A9629C8B63&sec=health&pagewanted=all "Now Can We Talk About Health Care?"] "The New York Times", April 18, 2004. Accessed June 8, 2007.] Her article also mentioned areas of agreement with one-time opponent Newt Gingrich, and likewise Gingrich has expressed agreement with Senator Clinton on some aspects of health care, including a bill to modernize medical record keeping. [ [http://www.washingtonpost.com/wp-dyn/content/article/2005/05/11/AR2005051101846.html "Gingrich, Clinton Collaborate on Health Care Bill,"] "Associated Press" in the "Washington Post", May 12, 2005. Accessed June 10, 2007.] [Milbank, Dana. [http://www.washingtonpost.com/wp-dyn/content/article/2005/07/21/AR2005072102272.html "The Reformer and the Gadfly Agree on Health Care,"] "Washington Post", July 22, 2005. Accessed June 10, 2007.]

In 2005, referring to her previous efforts at health care reform, Hillary Clinton said "I learned some valuable lessons about the legislative process, the importance of bipartisan cooperation and the wisdom of taking small steps to get a big job done." Again in 2007, she reflected on her role in 1993-1994: "I think that both the process and the plan were flawed. We were trying to do something that was very hard to do, and we made a lot of mistakes." [Toner, Robin and Kornblut, Anne. [http://www.nytimes.com/2006/06/10/washington/10hillary.html?ei=5070&en=b3e5eae2515beefd&ex=1181361600&pagewanted=print "Wounds Salved, Clinton Returns to Health Care,"] "The New York Times", June 10, 2006. Accessed June 8, 2007.]

Hillary Clinton received hundreds of thousands of dollars in campaign contributions from doctors, hospitals, drug companies, and insurance companies for her 2006 re-election in the Senate, including several insurance companies that were members of the Health Insurance Association of America that helped defeat the Clinton Health Plan in 1994. Charles N. Kahn III, a Republican who was executive vice president of the Health Insurance Association in 1993 and 1994, refers to his previous battles with Clinton as "ancient history," and says "she is extremely knowledgeable about health care and has become a Congressional leader on the issue."

In the years since the Clinton effort of 1993-1994, a combination of factors have kept health care off the top of the agenda. For example, politicians have not been eager to confront the forces that successfully frustrated the Clinton effort, and health maintenance organizations have been able to limit cost increases to some extent.Krugman, Paul, and Wells, Robin. [http://www.nybooks.com/articles/18802 "The Health Care Crisis and What to Do About It"] , New York Review of Books, March 23, 2006.]

The Clinton health care plan remains the most prominent national proposal associated with Hillary Clinton, and may have influenced her prospects in the 2008 presidential election. There are some similarities between the Clinton Health Plan and Republican Mitt Romney's health care plan that has been implemented in Massachusetts, [Cannon, Michael. [http://article.nationalreview.com/?q=ZTZlZWMzYjRmZTg5YzVhYTE2ZjNlMGI1MGU1NzRmZWI= "What Mitt and Hillary Have in Common,"] "The National Review Online", June 5, 2007. Accessed June 8, 2007.blockquote|If I were advising Sen. Clinton, I would be urging her to boast that her approach to health-care reform enjoys support from conservatives like the Heritage Foundation and Gov. Romney. If I were advising Gov. Romney, I would prescribe a severe case of amnesia and a health-care agenda that actually reduces the role of government.] though Romney has since distanced himself from Clinton on the issue, in particular arguing that his plan calls for more control at the state level and the private market, not from the federal government., [http://politicalticker.blogs.cnn.com/2007/09/17/romney-clinton-health-care-plan-is-bad-medicine "Romney: Clinton health care plan is 'bad medicine'"] , "CNN Political Ticker", 2007-09-17. Accessed 2007-09-20.]

In September 2007, former Clinton Administration senior health policy advisor Paul Starr published an article named "The Hillarycare Mythology",Paul Starr, [http://www.prospect.org/cs/articles?article=the_hillarycare_mythology "The Hillarycare Mythology"] , "The American Prospect", 2007-09-14. Accessed 2007-09-18.] where he asserted that Bill Clinton, not Hillary Clinton, was the driving force behind the plan at all stages of its origination and development; that the task force headed by Hillary Clinton quickly became useless and was not the primary force behind formulating the proposed policy; and that "Not only did the fiction of Hillary's personal responsibility for the health plan fail to protect the president at the time, it has also now come back to haunt her in her own quest for the presidency."

References

External links

* [http://inside.c-spanarchives.org:8080/cspan/cspan.csp?command=dprogram&record=198827147 C-SPAN3 Programming from 1993-94 on the Clinton Health Care Plan] "C-SPAN", Accessed June 8, 2007.
* Robin Toner, [http://query.nytimes.com/gst/fullpage.html?sec=health&res=9F0CEEDB113BF931A1575AC0A965958260 " Clinton's Health Plan; Poll on Changes in Health Care Finds Support Amid Skepticism,"] "New York Times", September 22, 1993. Accessed June 8, 2007.
* [http://www.annals.org/cgi/content/full/119/9/945 "The Clinton Health Care Plan: Fundamental or Incremental Reform?"] "Annals of Intern Med", 1993;119(9):945-947. Accessed June 8, 2007.
* William Kristol, [http://www.ashbrook.org/publicat/onprin/v2n1/kristol.html "How to Oppose the Health Plan - and Why,"] "Ashbrook Center", January 1994. Accessed June 8, 2007.
* [http://findarticles.com/p/articles/mi_m3225/is_n1_v49/ai_14786294 "AAFP calls Clinton health care plan a 'starting point for reform,"] "Findarticles.com" reprinting "American Family Physician", January 1994. Accessed June 8, 2007.
* Robert Pear, [http://query.nytimes.com/gst/fullpage.html?sec=health&res=9E06E6D61230F931A15752C0A962958260 "Health Care Plan Isn't Cast in Stone,"] "New York Times", January 22, 1994. Accessed June 8, 2007.
* Donna E. Shalala, [http://www.os.dhhs.gov/news/policy/94012501.txt "Let's Face It, There Is a Health Care Crisis,"] "U.S. Department of Health and Human Services". Reprinted from "The Washington Post", January 25, 1994. Accessed June 8, 2007.
* Adam Clymer, [http://query.nytimes.com/gst/fullpage.html?res=9C03E5D71739F93AA15752C0A962958260 "Hillary Clinton Tells Doctors Crisis in Health Care Is Real,"] "New York Times", January 29, 1994. Accessed June 8, 2007.
* [http://www.time.com/time/magazine/article/0,9171,980129,00.html "The Rise and Fall of the Political Catchphrase,"] "Time", February 14, 1994. Traces the origins of the Republican counter-argument "there is no health care crisis." Accessed June 8, 2007.
* Raymond Hernandez and Robert Pear, [http://www.nytimes.com/2006/07/12/nyregion/12donate.html?ex=1310356800&en=0882715139712152&ei=5088&partner=rssnyt&emc=rss "Once an Enemy, Health Industry Warms to Clinton,"] "The New York Times", July 12, 2006. Accessed June 9, 2007.
* Jonathan Cohn, [http://www.tnr.com/doc.mhtml?i=20070604&s=cohn060407 "Hillary was Right - The health care plan that dares not speak its name,"] "The New Republic", June 5, 2007. Accessed June 8, 2007.