The Clinton Administration’s Healthcare Reform Proposal

The Clinton Administration’s Healthcare Reform Proposal AinelBoonprakrong, MD Mayo Clinic Florida

In the Beginning… • On September 22, 1993, President Clinton appeared before the American people to discuss his plans to reform the health care system • Subsequently, on November 20, 1993, the Health Security Act ('HSA') was introduced into Congress • The Health Security Act sets the framework for a national health care system. It is a complex bill, over 1500 pages long

The Proposal… • The Clinton plan sought to build on and transform our mixed, public–private system of health care • It called for universal coverage, with all employers required to contribute toward the costs of insurance premiums for their workers. Americans would choose from multiple private insurance plans that would compete for their enrollment, and it was expected that the market would shift further toward managed care • Through regional purchasing pools, the government would strictly regulate insurance practices. It would also impose limits on the growth of insurance premiums to ensure cost control. • The Clinton plan was envisioned as a synthesis of liberal ends (universal coverage) and conservative means (managed competition among private insurers) • Other core elements were designed to maximize its political appeal: the plan built on the familiar system of employer-sponsored insurance, avoided any new taxes, retained private insurance, left Medicare intact, and promised Americans health security and choice.

Coverage… • Under the Clinton healthcare reform, coverage was extended to: • citizens or nationals of the United States; an alien permanently residing in the United States under color of law; or a long- term nonimmigrant. • Medicare-eligible individuals entitled to health benefits under the Medicare program, military personnel and families, veterans and Indians were to have a choice of health plan coverage • Prisoner and undocumented aliens, however, were ineligible for benefits

Benefits • The Health Security Act proposed to reform the health care system so that all Americans are guaranteed comprehensive health coverage. • The benefits package consists of: • hospital services • services of health professionals • clinical preventive services, home health care, ambulance services • outpatient laboratory, radiology, and diagnostic services. • outpatient prescription drugs • outpatient rehabilitation services • medical equipment and devices • vision care, dental care, • investigational treatments

First Lady’s Role • The First Lady's role in the secret proceedings of the Health Care Task Force 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 • 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

Opposition • 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 • A key turning point against the Clinton plan was a televised town hall meeting in April 1994. During the event, President Clinton was challenged by businessman Herman Cain on the effects on small businesses by the enforced mandate for employers to provide health insurance coverage to all of their employees

Opposition • Clinton’s proposal promised benefits for average Americans with tight, new regulations intended to push employers, doctors, hospitals, and insurance companies toward cost cutting • Interested parties in the health care economy became very worried about their profits and their freedom to maneuver. Privileged middle-class Americans who already had some kind of health coverage began to fear that Clinton's Health Security plan might make their health care more costly and cumbersome

Criticism • Clinton administration's greatest mistake was likely excessive ambition. The plan attempted simultaneously to: • secure universal coverage • regulate the private insurance market • change health care financing through an employer mandate • control costs to levels enforced by a national health board • transform the delivery system through managed care

Defeat • Support for the bill peaked at its introduction, with 59 percent of the populace in favor, but support never exceeded 50 percent after February 1994 and fell to 42 percent by June of that year • The basis was laid for an electoral upheaval in November 1994, bringing to power conservatives who wanted to dismantle rather than extend the federal government's role in the domestic economy and Social Security • 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. 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 • 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

Resources • http://en.wikipedia.org/wiki/Clinton_health_care_plan_of_1993 • http://academic.udayton.edu/health/02organ/clinton.htm • http://www.princeton.edu/~starr/20starr.html • http://www.nejm.org/doi/full/10.1056/NEJMp078201 • http://articles.cnn.com/2009-07-22/politics/obama.clinton.health.care_1_health-care-clinton-initiatives-hillary-clinton?_s=PM:POLITICS • http://www.rwjf.org/reports/grr/023490.htm

The Clinton Administration’s Healthcare Reform Proposal