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Healthcare or Hillary-care? The Demise of the Clinton Administration’s Efforts to Reform the American Healthcare System.
Key Players / Bios:

Hillary Clinton

Ira Magaziner

Al Gore


George Stephanopolous

Leon Panetta

Bob Boorstin

Robert Rubin

Laura Tyson

David Gergen

Mack McLarty

Robert Altman

Stan Greenberg

“Harry and Louise”

Mike Lux

Newt Gingrich

Dick Armey

Robert Dole

John Chafee

Rep. Tom Foley

Rep. Richard Gephardt

Senator George Mitchell

Nancy Kassabaum

Ted Kennedy


Useful Web Sites:
1993
January 25 In a White House ceremony, President Bill Clinton announced that his wife Hillary would head up his administration’s efforts to reform the American health care system. The First Lady chaired the Task Force on National Health Care Reform, which included members of the Clinton cabinet and domestic policy staff, congressional staff, and non-governmental experts. Ira Magaziner, an old friend of the presidents and a health care expert himself, suggested the formation of the Task Force, and he coordinated its activities. The stated goals of the Task Force were to develop a proposal that would expand health care to all Americans – about 38 million Americans had no health insurance – and to reduce the rising rate of health care spending. President Clinton hoped that the Task Force’s work on a health care plan would be completed within ninety days – and that Congress would act on his plan this year. (1993 CQA, 335; Skocpol, 51)
February 7 At a meeting in the White House Roosevelt room with the administration’s economic team, Hillary Clinton and Ira Magaziner pressed for health care reform’s inclusion in the president’s budget plan, scheduled to be released on February 17. The First Lady and Magaziner also argued that health care reform needed to include price controls on health care costs. While the president saw health care reform as a priority, his economic and political advisers present at the meeting, including Vice President Gore, Leon Panetta, and George Stephanopolous, argued that the Administration should push health care reform only when it had assembled a full-fledged plan – which was not possible by February 17. They also argued, as did the president’s key economic advisers that price controls would be politically damaging. Clinton sided with Gore et al, much to the chagrin of his wife and Magaziner. (Woodward, 124-125)
March 10 Federal Judge Royce Lamberth ruled on a lawsuit filed by the Association of American Physicians and Surgeons that sought to make the Task Force’s meetings and records public. Lamberth ruled that the Task Force’s working groups, which gathered information and investigated policy options, were required by Federal law to be open to the public, but that the Task Force could make its recommendations to the President in private. Lamberth’s ruling bounced around the appeals system for most of 1993, and most of it was upheld. Lamberth, in November, threatened to hold the administration in contempt of court for failing to make public the working groups’ records. The episode was significant because it offered proof to many suspicious or opposed to the Task Force’s efforts that the process was being conducted in secret. (1993 CQA, 336-7)
Spring White House officials, including Ira Magaziner and Bob Boorstin, drew up extensive memos outlining political and communications plans that would sell the president’s health care initiative. These memos, however, were never translated into concrete plans, largely because of a lack of leadership from the Clinton administration’s upper-level of political advisers. (Skocpol, 90)
April 14 President Clinton, along with The First Lady, Gore, Panetta, Robert Rubin (Assistant to the President for Economic Policy), Laura Tyson (Chairman, White House Council of Economic Advisers) and others received a briefing from Ira Magaziner about the cost of health care reform. Magaziner reported that any significant reform of the health care system would cost between $50 and $100 billion dollars and would have to be financed through some sort of Value-Added-Tax, a national sales tax. That same day, Press Secretary George Stephanopolous stated that Clinton had not decided yet how to proceed on health care reform. (Woodward, 168-9)
May The health care Task Force dissolved, and decision-making about the intent, shape, and extent of reform – as well as the politics behind it – rested with the Clintons and their high-level White house advisers. (Skocpol, 60)
May 20 President Clinton, along with his wife, and key political, health care, and economic advisers met in the Roosevelt room to hear a mock debate about concerning two different health care reform proposals. “Plan A” was the smaller and less costly of the two, providing care for catastrophic and serious illness. “Plan B” was a comprehensive package that would provide health care for all Americans and set up a system similar to those found in Europe. It would also be much more expensive. Clinton’s political advisers, chiefly Gene Sperling, told him that “Plan B” was better because, with its promises of health care for all, it was a plan around which the White House could rally support. Clinton’s economic advisers did not make an endorsement of either plan, but note that they were troubled by the cost of “Plan B.” President Clinton, most observers felt, leaned toward “Plan B.” (Woodward, 199)
Several White House officials acknowledged to the press that the health care plan would not be released before the White House’s self-imposed ninety day deadline, admitting that several key decisions still needed to be made. (1993 CQA, 337)
July 22 Ira Magaziner wrote a memo to President Clinton’s political advisers David Gergen, Mack McLarty, and George Stephanopolous warning them that the president’s initiatives on health care have lost “momentum” and “credibility” because of the inability of the administration to devise a plan and sell it politically. (Skocpol, 81)
August President Clinton made a number of decisions this month regarding the size and scope of the health care reform efforts his administration he would undertake. He had already decided that the funding for reform would not come from any major new taxes, except a tax on cigarettes. A memo entitled “Presidential Level Health Care Decision for August” outlined at least five different reform options, all of which dismayed the President because they only slowed the growth of health care costs, instead of reducing them. Clinton worried health care reform might become a political loser. His economic advisers, including Robert Altman (Deputy Secretary of the Treasury), Rubin, and Tyson, all told him (and sometimes the First Lady) that the options on the table were “too big, too expensive, and too fast,” to quote Altman. (Woodward, 316)
Early September The “Harry and Louise” advertisements attacking Clinton-style health care reform appeared for the first time on television. Financed by the Health Insurance Association of America (HIAA), a collection of small and mid-sized insurance companies who would have been badly hurt by the Clinton plan, the ads told Americans that the Clinton plan would turn over health care decisions to “tens of thousands of new bureaucrats.” Harry and Louise both suggested, “There’s got to be a better way.” The ads, the substance of which was based on an interpretation of the details of the plan that had emerged in the press, were devastatingly effective and continued through the summer of 1994. (Skocpol, 137)

September 7 The White House deliberately leaked a “Working Group Draft” of its health care reform plan to Congress for its consultation. (Skocpol, 60)


September 14 White House political advisers, including pollster Stan Greenberg, urged the President, and his advisers like Magaziner, to stress in his speech to Congress, how health care reform would benefit working middle-class families. Greenberg also reported that field research had shown that the “Health Security Card” was the most attractive part of the plan to the public. (Skocpol, 117)
September 22 President Bill Clinton unveiled his proposal to reform the American health care system to a joint session of Congress. Clinton asserted that he wanted a reform effort that would be simple, would provide all Americans with health insurance, would maintain a high level of quality care, would control spiraling health care costs, and would preserve the right of Americans to choose their healthcare provider. Clinton symbolically unveiled a “health security card,” which looked like a credit card, that he promised would guarantee every American access to health insurance and health care. Clinton’s plan had Americans joining “health care alliances,” that would maximize individuals bargaining power against insurance companies. (1993 CQA, 339)
October 27 President Clinton formally delivered his health care reform bill to Congress. It had competition from all ends of the ideological spectrum, because liberal Democrats, moderates from both parties, and conservative Republicans offered their own bills. (1993 CQA, 343)
November 20 President Clinton’s health care reform bill was formally introduced in the House of Representatives as HR. 3600. In the Senate, it was introduced as S. 1757. Symbolic of how difficult it would be to pass a bill that involved so many sectors of American politics and the economy, House Democratic leaders referred the entire bill to three committees, each with important jurisdictional claims. In the Senate, the bill went to two committees. The bills remained in committee for the rest of the session. Health care reform would wait until the following year. (1993 CQA, 344)
December 15 President Clinton received a memo titled “Interest Group Positioning” from Mike Lux, an aide working on health care reform. Lux warned the President that while his party’s traditional liberal allies, such as the AFL-CIO, supported the president’s health care reform proposal, they would take a while to mobilize effectively and that they lacked the extensive finances of opposition groups. (In the case of the AFL-CIO, this was because they were upset with the Clinton for his support of NAFTA.) Overall, though, Lux painted a pessimistic picture for the President should the bill encounter stiff resistance, which was almost certain to happen. (Skocpol, 95-96)
1994
January 25 President Clinton symbolically relaunched his administration’s efforts at health care reform in his State of the Union address. Clinton vowed to veto any reform bill that did not provide for universal coverage. (1994 CQA)
February The Congressional Budget Office issued its analysis of the Clinton health care proposal, which stated that the plan, if implemented, would only begin to reduce the federal budget deficit beginning in 2005. President Clinton, of course, had argued publicly that health care reform would narrow the budget deficit much more quickly. (CQA 1994, 324)
Winter and Spring Congressional Committees began work on the Clinton health care plan. In the House, the main committees with jurisdiction over the legislation were Education and Labor, Ways and Means, and Energy and Commerce. In the Senate, the Labor and Human Resources Committee and the Finance Committee reviewed S. 1757. A handful of other committees, as well as subcommittees of the bodies mentioned above, all worked up the legislation, amending it to suit their members in the hope of getting the committee to report out a health care reform bill. (1994 CQA)
Late May Congressional Republicans, on a retreat over the Memorial Day holiday weekend, decided that it would be in the party’s best electoral interests to refuse to compromise with congressional Democrats on health care reform. Poll information showed that all-out opposition would strengthen the party heading in to the November mid-term elections. This strategic decision, pushed by the right-wing of the party, was supported most vigorously by Representatives Newt Gingrich (GA) and Dick Armey (TX), but it was also embraced by important Republicans like Senate minority leader Robert Dole (KA). A small number of Republican moderates, including Senators John Chafee (RI) and John Danforth (MO), continued to support compromise measures, but they were the exception. (Skocpol, 162-163) Is this account accurate – she does not footnote it. Check the newspapers. Nothing in the papers, except mention of Kristol’s growing influence as a prty strategist at this time, and his arguments that the Rep, should reject hc reform.
June 9 The Senate Labor and Human Resources Committee voted to approve a bill modeled on the Clinton proposal. They were the first full committee to finish work on the bill. On June 23, the House Education and Labor Committee approved a more liberal version of the Clinton plan. On June 28, the House Energy and Commerce Committee announced that it could not agree on which a health care bill to report. On June 30, the House Ways and Means Committee voted to report a health care bill that resembled Clinton’s original proposal. On July 2, the Senate Finance Committee approved a bi-partisan health care bill. The flurry of legislative activity was important for two reasons. First, voting on the bills, with the exception of the bipartisan Senate Finance bill, often broke down along party lines, or with a few Democrats defecting to the Republican side. This did not augur well for easy passage of the legislation. Second, each of the reported bills contained important, if sometimes highly technical, differences. This meant that reconciliation of the bills would be quite difficult. (CQA 1994, 321)
July 4 Following the July 4 recess, the Democratic leaderships in the House and Senate worked to craft compromise bills from the myriad of amended bills reported out of committee. The difficult goal of any compromise bill would be to provide universal coverage – a Clinton demand – and still garner enough votes for passage. The Senate hoped to begin debate on its compromise bill on July 25, the House shortly after that date. Significantly, the leadership meetings contained no Republicans. (1994 CQA)
July 21 President Bill Clinton met with Democratic congressional leaders Foley, Gephardt, and Mitchell, who told him that health care reform plans would have to be scaled back in terms of both the scope of reform and the timetable by which it would be implemented. The next day, in an encounter with reporters, Clinton seemed satisfied with the previous evening’s meeting, and signaled he was willing to accept changes to his original bill. (1994 CQA)
July 29 House Majority Leader Richard Gephardt released a House leadership bill. (1994 CQA)
August 2 Senate Majority Leader Mitchell unveiled a Senate leadership bill. (1994 CQA)
August 4 President Clinton announced that he would support the Mitchell bill. (NYT, 9/27/94)
August 9 The Senate began floor debate on Mitchell’s bill, S. 2351. Republican Senators as a group opposed Mitchell’s plan, and they were joined by a number of conservative Southern Democratic senators. Even at this early date, the Mitchell bill was in big trouble. (CQA, 1994)
August 19 A bipartisan group of senators, led by John Chafee (R-RI) and John Breaux (D-LA) announced a compromise health care reform bill. (1994 CQA)
August 25 The Senate began its August recess without voting on a health care bill. Any hope of passage of a health care bill died in the last days of the session, when the Senate took up the Clinton crime bill – which the Administration viewed, by this point, as a greater priority. The Crime bill passed on August 25, after four days of bitter debate, and the Senate adjourned. The Democratic leadership in both the House and Senate promised to continue to fight for passage of a health care bill in September, but few realistically held out hope for success, especially as Congress began to turn its full attention to the elections approaching in November. (1994 CQA)
August 26 Senate Majority leader George Mitchell announced that he had pulled his own health care bill, S. 2351. He also stated that comprehensive health care reform, the kind that the Administration supported, would most likely not occur in 1994. (1994 CQA)
Early September Mitchell negotiated with Senators Breaux and Chafee on the specifics of their bill, which with a few changes, all Democrats were willing to support, along with between 8 and 10 Republicans. However, this did not give Mitchell enough votes to break a threatened Republican filibuster of the legislation. (1994 CQA)
September 20 Senator Mitchell made a preliminary decision to abandon hopes of passing any health care reform legislation this session after Republican leaders Senator Bob Dole and Rep. Newt Gingrich told the president that they would block a new international trade pact – the GATT – if the president pursued health care reform in the waning days of the congressional session. (NYT, 9/21/94)
September 26 Senator Mitchell announced that he would not continue efforts to pass health care legislation in 1994. President Clinton, in a statement released by the White House, vowed to continue the fight for substantial health care reform next year, declaring “The journey is far, far from over.” (1994 CQA; LAT, 9/27/94)
November 5 The Republican Party won stunning gains in the congressional elections. For the first time in forty years, the Republicans won control of both houses of Congress. In the Senate, they held a 53 to 47 advantage, and in the House a 230 to 214 to 1 lead. Most observers, even liberal Democrats, believed that the failure of health care reform, and the political damage that defeat brought on the Clinton Administration and the Democratic party, helped produce the electoral debacle.
1995
August 2 A bipartisan health insurance bill offered by Senator Nancy Kassebaum and Senator Edward Kennedy that would make it easier for Americans to get and keep health insurance unanimously passed the Senate Labor Committee. The bill was much less ambitious than many of the previous year’s efforts, but it did have the advantage of bipartisan support. (1996 CQA; Hartford Courant, 8/3/95)
1996
January 23 President Clinton, in his State of the Union Address, took up the cause of health care reform once again. This time, in stark contrast to efforts in 1993 and 1994, Clinton did not ask for comprehensive reform that produced universal coverage, but only support for a bipartisan bill sponsored by Senators Nancy Kassebaum (R-KA) and Edward Kennedy (D-MA) that would make it easier for Americans to hold on to their existing health insurance if they changed jobs, started a small business, or got sick. (1996 CQA)
March 28 The House of Representatives passed its version of Kassabaum-Kennedy health insurance bill. (1996 CQA)
April 23 The Senate passed it version of the Kassebaum-Kennedy bill. (1996 CQA)
August 21 President Clinton signed the Kassabaum-Kennedy measure, declaring it “a long step towards the kind of health care reform our nation needs.” (NYT, 8/22/96)


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