Clinton health care plan of 1993

The Clinton health care plan, known officially as the Health Security Act, was a 1993 healthcare reform package proposed by the administration of President Bill Clinton and closely associated with the chair of the task force devising the plan, First Lady of the United States Hillary Rodham Clinton.

Bill Clinton had campaigned heavily on health care in the 1992 U.S. presidential election. The task force was created in January 1993, but its own processes were somewhat controversial and drew litigation. Its goal was 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 President Clinton to the U.S. Congress in September 1993. The core element of the proposed plan was an enforced mandate for employers to provide health insurance coverage to all of their employees through competitive but closely regulated health maintenance organizations.

Opposition to the plan was heavy from conservatives, libertarians, and the health insurance industry. The industry produced a highly effective television ad, "Harry and Louise", in an effort to rally public support against the plan. Instead of uniting behind the President's original proposal, Democrats offered a number of competing plans of their own. Hillary Clinton was drafted by the Clinton Administration to head a new Task Force and sell the plan to the American people, a plan which ultimately backfired amid the barrage of fire from the pharmaceutical and health insurance industries and considerably diminished her own popularity. By September 1994, the final compromise Democratic bill was declared dead by Senate Majority Leader George J. Mitchell.

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, President 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. Clinton delivered a major health care speech to a joint session of Congress on September 22, 1993. In that speech, Clinton explained the problem as follows:

"Millions of Americans are just a pink slip away from losing their health insurance, and one serious illness away from losing all their savings. Millions more are locked into the jobs they have now just because they or someone in their family has once been sick and they have what is called the preexisting condition. And on any given day, over 37 million Americans—most of them working people and their little children—have no health insurance at all. And in spite of all this, our medical bills are growing at over twice the rate of inflation, and the United States spends over a third more of its income on health care than any other nation on Earth."

Hillary Rodham Clinton's leading role in this project was unprecedented for a presidential spouse. This unusual decision by President Clinton to put his wife in charge of the project has been attributed to several factors, such as 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 Recommendation Clause 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. 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.

In 1997, 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. 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.

Criticism
Starting on September 28, 1993, Hillary Rodham 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.

Opposition to the Clinton plan was initiated by William Kristol and his policy group Project for the Republican Future, which is widely credited with orchestrating the plan's ultimate defeat through a series of now legendary "policy memos" faxed to Republican leaders. Conservatives, libertarians, and the health insurance industry proceeded to campaign against the plan, criticizing it as being overly bureaucratic and restrictive of patient choice: The conservative Heritage Foundation argued "the 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 also 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 complex, bureaucratic nature. Time, CBS News, CNN, the Wall Street Journal and the Christian Science Monitor ran stories questioning whether there really was a health-care crisis. Op-eds were written against it, including one in The Washington Post by University of Virginia Professor Martha Derthick that said: "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." Democratic 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." Meanwhile instead of uniting behind the President's original proposal,other Democrats offered a number of competing plans of their own. Some criticized the plan from the left, preferring a 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."

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.

The 1994 mid-term election became, in the opinion of one media observer, a "referendum on big government – Hillary Clinton had launched a massive health-care reform plan that wound up strangled by its own red tape." 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 health care reform in the United States was not seriously considered or enacted by Congress until Barack Obama's election in 2008.

Controversy in retrospect and perspective
In 2004, as a U.S. senator from New York, Hillary Clinton argued in The New York Times that the current health care system is unsustainable, and she offered several solutions. 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.

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."

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."

Until the Obama health care plan of 2009, a combination of factors kept health care off the top of the agenda. For example, politicians were not eager to confront the forces that successfully frustrated the Clinton effort, health maintenance organizations were able to limit cost increases to some extent, and a conservative Republican majority in Congress or a conservative Republican President was either in power or in office.

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, 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.

In September 2007, former Clinton Administration senior health policy advisor Paul Starr published an article named "The Hillarycare Mythology", 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."

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