"Hillarycare" (The proposed Health Security Act of 1993)
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In an attempt to get voters to associate the Affordable Care Act, also known as Obamacare, with her own efforts to reform the healthcare system as first lady, Hillary Clinton communicated to voters in 2016 that the fight to get the uninsured covered “was called Hillarycare before it was called Obamacare."[1][2][3][4]
The Heath Security Act of 1993, or "Hillarycare," as Republicans and those who opposed President Bill Clinton's failed healthcare plan called it, proposed providing Americans with universal healthcare coverage. According to Paul Starr, a Clinton administration senior health-policy advisor, Clinton's plan for universal coverage was "based on consumer choice among competing private health plans, operating under a cap on total spending (an approach known, in the shorthand of health policy, as 'managed competition within a budget')."[5] The effort to get the plan passed was spearheaded by Hillary Clinton.[2]
At a CNN town hall debate on February 4, 2016, Clinton told voters that she “fought really hard” to get the Health Security Act passed in 1993. She said, “Insurance companies and drug companies spent millions against me. I know what it is like to go up against the status quo and special interests, so when President Obama succeeded, I was thrilled.”[2]
What did the Health Security Act propose? What was Clinton’s role in trying to get the law passed? Was "Hillarycare" really the precursor to Obamacare? The following sections address these questions.
The Health Security Act
Reforming the healthcare system was a major first-term initiative for President Bill Clinton. Shortly after taking office, Clinton said that he would send a bill guaranteeing healthcare for every American to Congress in 90 days. In order to meet this deadline, Clinton appointed first lady Hillary Clinton to lead his Task Force on National Health Reform on January 25, 1993, five days after he was inaugurated. Hillary Clinton, six cabinet members, and Ira Magaziner—who as of 2016 worked as the vice chairman and chief executive officer of the Clinton Health Access Initiative—led the task force, which consisted of more that 500 people "who dealt with health-care policy, health-care experts from federal agencies and experts from across the country with both public- and private-sector backgrounds."[6][7][8]
In an effort to get healthcare reform through Congress, President Clinton initially asked Senator Robert Byrd (D-W.Va.) to introduce his healthcare bill as part of the budget reconciliation process, but Byrd refused. New York Times reporters, Adam Clymer, Robert Pear, and Robin Toner wrote that asking Byrd "to let national health insurance legislation be considered as part of that summer's budget bill" was "a move of remarkable hubris, a President elected with 43 percent of the vote expecting Congress to allow him to rearrange one-seventh of the American economy under the streamlined, fast-track procedures of a budget bill."[8]
Shortly after Hillary Clinton began leading the president's task force, the Association of American Physicians and Surgeons filed suit against the task force alleging that the Clinton administration violated the 1972 Federal Advisory Committee Act. According to CQ Almanac, “they charged that because Hillary Clinton was neither a public official nor a federal employee, the task force was forbidden to close its meetings to the media and the public.”[7] On June 23, 1993, a federal appellate court ruled that the task force’s meetings did not have to be made public simply because Hillary Clinton led them.[9]
Clinton's task force failed to produce legislation by his 90-day self-imposed deadline. The Clintons and members of his administration continued to work on drafting the bill throughout the summer of 1993, while Congress battled over the budget. On August 8, Congress finished debating the budget, which allowed President Clinton to return to healthcare reform. He unveiled the 245-page draft of the healthcare bill before a joint session of Congress on September 22, 1993. During the speech, Clinton said, "At long last, after decades of false starts, we must make this our most urgent priority: giving every American health security, health care that can never be taken away, health care that is always there."[8][7]
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According to CQ Almanac, “Clinton's proposal...had three guiding themes: that all Americans should be guaranteed access to affordable health-care services; that the rate of growth in health-care costs should slow; and that government and the market should work together to achieve those goals.”[7]
On November 20, 1993, Rep. Richard Gephardt (D-Mo.) introduced HR 3600 - the Health Security Act, the final 1,342-page health care bill, in the House, and Sen. George Mitchell (D-Maine) introduced an identical bill in the Senate.[10]
The bill proposed the following:
- Employers would be required to provide health insurance to their full-time employees. Small businesses would receive subsidies to help provide insurance.
- State-based cooperatives would sell approved health insurance plans to consumers and regulate insurance companies.
- The unemployed, self-employed, and part-time employees would receive subsidies to help them purchase insurance through the cooperatives.
- All Americans would be required to obtain health insurance. Any citizen who chose not to enroll could be enrolled automatically by the state cooperative and charged twice the normal premium.
- The federal government would set minimum standards all health insurance plans would be required to cover. Insurance companies would not be allowed to discriminate against pre-existing conditions.
| President Bill Clinton's healthcare speech to Congress, September 22, 1993. |
- A National Health Board would be established to control healthcare spending, oversee the state cooperatives, and establish new regulations.[11][12]
Failure
In September 1994, Senate Majority Leader George Mitchell said that President Clinton's healthcare reform bill was dead. The bill never came to a vote and failed for a number of reasons. It was large in scope, which made it difficult to explain to Congress and the public. There was little effort to get bipartisan support for the bill. President Clinton had to focus on other matters, including the economy, the North American Free Trade Agreement (NAFTA), and later Whitewater. Democratic lawmakers introduced alternative plans to reform healthcare. The healthcare plan also faced strong criticism from small-business lobbyists and the Health Insurance Association of America (HIAA). HIAA created the "Harry and Louise" advertisements, which "featured a couple agonizing over details of the Clinton plan." For these reasons, along with the divided political climate, President Clinton's attempt to provide Americans with universal healthcare coverage failed.[13][8][10]
| “Harry and Louise on Clinton's health plan." |
Clymer, Pear, and Toner wrote that the bill failed in part because President Clinton "was distracted by economic struggles, the North American Free Trade Agreement, Whitewater and foreign crises, and the window [for passing the bill] began to close. The Clinton health care plan became the captive of events, and politics, and an enormously complicated process headed by two figures making their debuts in national policy making -- Hillary Rodham Clinton, the impassioned First Lady, and Ira C. Magaziner, the cerebral policy guru and friend of Bill Clinton."[8]
In addition, Starr wrote that "The collapse of health care reform in the first two years of the Clinton administration will go down as one of the great lost political opportunities in American history. It is a story of compromises that never happened, of deals that were never closed, of Republicans, moderate Democrats, and key interest groups that backpedaled from proposals they themselves had earlier co-sponsored or endorsed. It is also a story of strategic miscalculation on the part of the president and those of us who advised him."[13]
According to James A. Morone, professor and chair of political science at Brown University and co-author of The Heart of Power: Health and Politics in the Oval Office, the failure of Clinton's healthcare reform bill led to historic losses for Democrats during the November 1994 midterm elections. Morone wrote, "The boomerang from the Clinton health care reform failure led, three months later, to the widest Republican midterm sweep in the 20th century (victories in the Senate, House, state legislatures, and governor's offices in November, 1994)."[14]
What was Hillary Clinton’s role in the Clinton administration’s healthcare plan?
| Clinton Presidential Library, “First Lady Hillary Rodham Clinton's PSA on Health Care,” March 17, 1993. |
While Hillary Clinton took much of the blame for the failure of President Clinton's healthcare bill, she also attempted to use "Hillarycare" to her advantage on the campaign trail in 2016 by associating it with Obamacare. Is it accurate to blame her for the bill's failure, as Republicans and members of the media did and still do? Can she take responsibility for creating the legislation, as she has done in campaign speeches and debates? To answer these questions, an examination of her role in the effort to pass the Health Security Act is necessary.
In 1993, President Clinton appointed first lady Hillary Clinton as the leader of the Task Force on National Health Reform. It was “the most powerful official post ever assigned to a first lady,” according to the Sarasota Herald-Tribune.[15][16] As leader of the task force, Hillary Clinton and Ira Magaziner, a close Clinton advisor, organized more than 500 healthcare policy professional into 15 "cluster groups," which studied "cost controls, coverage, benefits, long-term care and ethical foundations of the new health care system," according to The New York Times.[8] Hillary Clinton also testified before five congressional committees on the healthcare reform process and legislation, met with governors and members of Congress to persuade them to support the bill, and travelled the country to explain the healthcare bill to business owners and the American people. Essentially, she was responsible for the political and public relations effort to get the bill passed, but, according to reports, she was not involved in policy-making.[17][18]
In September 2007, Paul Starr, a senior White House health-policy advisor who participated in the task force discussions, wrote that although Hillary Clinton takes most of the blame for the failed legislation, Bill Clinton created the policy, not Hillary, a point that is often overlooked. Hillary Clinton and Magaziner were tasked with developing the plan “the president had already adopted.” Starr wrote, “By the time Hillary became involved in health-care reform in late January 1993, Bill Clinton's thinking about the problem was already well advanced. The previous September during his campaign, he had settled on the basic model for reform -- a plan for universal coverage based on consumer choice among competing private health plans, operating under a cap on total spending (an approach known, in the shorthand of health policy, as 'managed competition within a budget'). Though the media scarcely registered it at the time, Clinton had described this approach in a speech and referred to it in the presidential debates.”[5]
| AP Archive, “American First Lady, Hillary Clinton, presents her health care reform plan to Congress." |
Starr explained that members of the healthcare task force took their guidance from President Clinton, who was always in charge of the policy and decision-making, but "many reporters and the public thought that Bill Clinton had handed over the policy to Hillary and that she would report back to him, which was not the case.” Starr wrote that "[t]he overall direction of policy was not Hillary's choice," and that she referred to the plan as "my husband's plan."[5]
Similarly, Atul Gawande, a leader of one of the task force's groups, said that Hillary Clinton's role in managing the task force was to handle the political aspect of getting the bill passed, not actual policy. Gawande said, "Politics was not a major part of our task. That was what the President and the First Lady and their political advisers were supposed to be dealing with. We were there to pull together options for them."[8]
Despite not being in charge of creating the policy, Hillary Clinton took and still takes the blame for the failure of the bill. Some attribute this to the way she led the task force, but others dispute this point. According to The New York Times, the "secrecy" and manner in which Hillary Clinton and Magaziner lead the effort "planted the seeds of trouble for the President. ... Mrs. Clinton and Mr. Magaziner met with many outside groups, but did not confide in them. After one such meeting, in March 1993, Dr. Quentin D. Young, chairman of Physicians for a National Health Program, which represents 6,000 doctors, said, 'It was a magnificent exercise in pseudo openness.'"[8]
Starr disputed this account, writing that tensions between Clinton administration officials "led to persistent and damaging leaks and the appearance of disarray in the reform effort and to the countervailing efforts to maintain confidentiality and discipline that Hillary's critics have mistakenly attributed to her allegedly controlling and rigid personality."[5]
It is inaccurate to give Hillary Clinton credit for creating the Health Security Act. It is also inaccurate to blame her for the failure of the bill. Her role in the effort to pass healthcare reform was to help explain the plan to members of Congress and the American people. She was widely praised for her knowledge of the policy and her performance while testifying before Congress. According to CQ Almanac, when she appeared before five separate congressional committees, "She answered hundreds of questions about the plan over the course of the week, and while it was the first time that she had appeared publicly before Congress, her responses to members’ questions made it clear that she knew many of the lawmakers well. She filled her testimony with references to specific districts, hospitals and members’ backgrounds."[7] Describing her performance on Capitol Hill, Hartford Courant reporter John MacDonald wrote, "She came, she saw, and she conquered. ... Hillary Rodham Clinton took the health care reform plan she helped her husband develop to Capitol Hill Tuesday, where she charmed, cajoled and listened to the concerns of members of Congress."[19] Ultimately, it was President Clinton's policy that failed, not Hillary Clinton's.
Was “Hillarycare” a precursor to Obamacare?
Clinton has said numerous times that "Before it was called ‘Obamacare,’ it was called ‘Hillarycare,'" insinuating that her husband's healthcare plan led to President Obama's healthcare plan.[1][2][3][4] However, some healthcare experts and scholars disagree with Clinton's claim.
Bloomberg Politics national political reporter Sahil Kapur, wrote that Clinton’s claim that “Hillarycare” was a precursor to Obamacare, is “an oversimplification,” explaining that “Obama's plan more closely resembles the Massachusetts overhaul signed into law in 2006 by the state's then-governor, Mitt Romney."[3]
Similarly, Timothy Jost, a healthcare law expert, said, “The Affordable Care Act was modeled after Romney's Massachusetts plan, not the 1993 Bill Clinton plan. The 1993 plan and the ACA are very different proposals.”[3]
| “HillaryCare,” February 14, 2016. |
Obamacare is narrower in scope than the Clinton healthcare plan, which proposed universal health coverage. In addition, “The ACA leaves the current private insurance system largely unchanged for the majority of people who get coverage through their employers. The Clinton Health Security Act would have required most people to switch their health insurance coverage to new health insurance alliances, and it imposed caps on how fast premiums could rise,” according to Larry Levitt, “a health policy expert with the Kaiser Family Foundation who worked in the Clinton administration and helped develop the proposal.”[3]
Although Obamacare was not modeled on Hillarycare, some believe that the Clintons should get some credit for President Obama's signature healthcare plan. Kapur, wrote "But people who helped write the Affordable Care Act give Clinton credit for laying the political groundwork that helped Obama succeed where her husband, former President Bill Clinton, failed.”[3]
Jonathan Gruber, “a health care economist and MIT professor who advised both the Romney and Obama reform efforts,” said, “I think the success of the ACA would not have been possible without some of the key lessons learned during the Clinton era debates. So she gets important credit for setting the political groundwork.”[3]
Although Clinton's claim that Obamacare used to be called Hillarycare is somewhat misleading considering the differences in both plans, it seems that the political healthcare battle of 1993 helped pave the way for the passage of Obamacare.
Recent news
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See also
External links
- HR 3600 - The Health Security Act
- Transcript of the Senate Finance Committee Hearing on the "President's Health Care Plan," September 30, 1993
- "Hillary Clinton's Plan for Lowering Out-Of-Pocket Health Care Costs"
Footnotes
- ↑ 1.0 1.1 Mother Jones, “Chelsea Clinton Accuses Sanders of Trying to "Dismantle Obamacare",” accessed April 18, 2016
- ↑ 2.0 2.1 2.2 2.3 Real Clear Politics, “Clinton: Before It Was Called Obamacare, It Was Called Hillarycare,” accessed April 18, 2016
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Bloomberg, “How ‘Hillarycare’ Did, and Didn't, Lead to Obamacare,” accessed April 18, 2016
- ↑ 4.0 4.1 The New York Times, “'Hillarycare’ Failed, but Hillary Clinton Reminds Voters She Tried,” accessed April 18, 2016
- ↑ 5.0 5.1 5.2 5.3 The American Prospect, “The Hillarycare Mythology,” accessed April 18, 2016
- ↑ ClintonFoundation.org, "Ira Magaziner," accessed July 26, 2016
- ↑ 7.0 7.1 7.2 7.3 7.4 CQ Almanac, "Health-Care Debate Takes Off," accessed April 23, 2016
- ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 The New York Times, "The Health Care Debate: What Went Wrong? How the Health Care Campaign Collapsed," accessed April 18, 2016
- ↑ ‘’Eugene Register-Guard’’, “Task force not required to hold public meeting,” accessed April 25, 2016
- ↑ 10.0 10.1 CQ Almanac, "Clinton's Health Care Plan Laid to Rest," accessed April 23, 2016
- ↑ Jansson, B. (2001). The Reluctant Welfare State: American Social Welfare Policies. Wadsworth: Belmont, CA. (pages 366-367)
- ↑ Heritage Foundation, "A Guide to the Clinton Health Plan," accessed April 17, 2016
- ↑ 13.0 13.1 Prospect.org, "What Happened to Health Care Reform?" accessed April 20, 2016
- ↑ The Washington Post, "Why the Health Care Debate Is So Explosive," accessed July 26, 2016
- ↑ New York Times, "Hillary Clinton to Head Panel on Healthcare," January 26, 1993
- ↑ Sarasota Herald-Tribune, "First Lady Gets Health-care Rold," accessed April 17, 2016
- ↑ Hillary Clinton Quarterly, "Hillary's First Speech About Health Care Reform," accessed April 23, 2016
- ↑ Newsweek, "Hillary Clinton, First Lady: The 1993 'Newsweek' Cover Story," accessed April 23, 2016
- ↑ Hartford Courant, "First Lady Testifies At Health Hearings," accessed April 23, 2016
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