Bill Clinton’s 1993 Attempt at Health Care Reform: Almost Sinking a Presidency

In 1993, President Bill Clinton spoke to Congress about the need for health care reform. He said,bill-clinton-healthcare

If Americans are to have the courage to change in a difficult time, we must first be secure in our most basic needs. Tonight, I want to talk to you about the most critical thing we can do to build that security. This health care system of ours is badly broken, and it is time to fix it.

Despite the dedication of literally millions of talented health care professionals, our health care is too uncertain and too expensive, too bureaucratic and too wasteful. It has too much fraud and too much greed. 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. That is what we must do tonight.

Later he added,

So tonight, I want to talk to you about the principles that I believe must embody our efforts to reform American health care system, security, simplicity, savings, choice, quality and responsibility.

That night, Clinton laid out the need for a reformed health care system. He would call it the Health Security Act. The attempt to pass this piece of legislation would almost sink his presidency. The story of the act actually begins on the campaign trail and would end in a crushing defeat of Democrats in the 1994 mid-term elections. It almost sank Clinton’s presidency…almost.

Bill Clinton would not be the first President to talk about health care reform. Teddy Roosevelt, Franklin Roosevelt, and Harry Truman had spoken about the need long before Clinton. In the spring of 1992, Bill Clinton began addressing the need to change the health care system while on the campaign trail. It was not a priority in the minds of many voters that year. The economy would be the big issue of the day. For Clinton, however, he kept the idea on the back burner. As to what Clinton’s plan was, it was ever-changing throughout 1992 and into 1993. Whether it was “managed competition” or “pay-for-play,” no one was really sure as it changed often.

Hillary Clinton addresses Congress on Health Care Reform in 1993

Shortly after his inauguration, Clinton announced the formation of “The President’s Task Force on National Health Reform.” It would be headed by his wife, Hillary Clinton. Bill Clinton initially wanted the health care reform package to be part of the next budget and gave a 100 day deadline to get both the budget and the plan, as part of the budget, passed. The plan did not make it far.

The spring saw Bill Clinton begin to assemble meetings on the issue of health care reform. Leaks from members sabotaged any progress or effort. At the end of May, the President disbanded the task force. That summer saw the President take a new initiative to handling the issue. He set up a war room to handle attacks on the forthcoming fall plan and to help get the word out about the benefits of the plan. Opponents, both Democratic and Republican, attacked the “employer mandate” section which would require all employers to provide health insurance. Presidential Adviser David Gergen tried to convince the President to postpone his fall attempt at Health Care for another year. Clinton did not adhere to the advice. After his budget was passed that summer, the Clintons were all in on health care.

On September 23, 1993, President Clinton laid out his plan before Congress.

The plan, called the Health Security Act, was to have a hard row to hoe. Five days after the address, Mrs. Clinton began several days of testimony before Congress. The soon to be 1300 page plan was not going to just sail through Congress. In addition, the Clintons began to shut out the outside the world, in particular, their own party. They wanted things done their way which meant relying on populist support. The problem was their perception of populist support was wrong.

Even before the plan was laid out for all the country to see, attack ads began airing on television. In addition, counter ads also played off of what became known as the “Harry and Louise” ads.

On November 20, 1993, the bill made its first official appearance. The 1300 page document laid out what Clinton thought was going to be his legacy. It almost ended it. The Health Security Act was government-run health care. The government was going to oversee and control every aspect of the health care industry. After having spent the 1980s listening to Ronald Reagan say that government was the problem, America was not going to support the plan.
Over the next year, the support for the bill waned.The Clintons still could not persuade their own party to sign on to the bill. Closed door meetings between the Clintons and Democratic congressional leaders were tense, terse, and non-compromising. Neither side budged. In fact, Democratic leaders began to assemble their own bills in 1994. Senator George Mitchell and Congressman Dick Gephardt lead the charges to revamp health care as they saw fit. The Clintons tried to use the public to pass their bill by marching citizen after citizen before the cameras to tell of their individual woe in regards to health care. It was all for naught.

Americans now had a new voice to listen to in the spring and summer of 1994. The Republicans drove home a message that the Health Security Act meant more “big government.” More government programs was something the public did not want. In addition, the Whitewater and Paula Jones Scandals became fodder for Republican candidates as they campaigned not for themselves, but against Clinton. By late fall and just before the elections, the plan was dead. It would not even come before either house of Congress for a vote.

The mid-term elections in 1994 were a disaster for Republicans as Democrats lost control of the House of Representatives for the first time since the 1950s. All the blame lay at Clinton’s feet and the Health Security Act.

The attempt to reform health care failed for several reasons. The biggest and most pronounced reason was the inability of the President to work with his own party to ensure passage. Instead, at every opportunity to forge alliances in his own party, President and Mrs. Clinton stood fast for fear of compromising what they thought was the integrity of their plan. Instead, it was the downfall.

Bill Clinton reflects on why the 1993 attempt to reform Health Care failed:

Despite the horrific political disaster that the attempt at Health Care was, it did have its lessons which Clinton quickly put to use in the next session of Congress from 1995-1996. Throughout the crisis, he developed a thick skin. By the end, he knew he had lost, but he also learned how the game of politics in Washington was played. When the Republicans take control in January of 1995, they begin pushing through their “Contract with America” and all its platforms. Clinton stood strong and chose his battles wisely. When a budget battle threatened to shut down the Government, the public blamed the Republicans under the leadership of Newt Gingrich and Bob Dole. Clinton became presidential. It may not be how he wanted, but nonetheless, he now knew how to fight back. Teh Republicans tried their own version of health care reform in 1995 and it failed, too. By the fall of 1995, eleven of the thirteen platforms in the “Contract with America” had failed to pass. The President may have lost the battle for health care reform in 1993 and 1994, but he won back the Presidency 2 years later in 1996. In his 1996 State of the Union speech, he declared that the era of  “big government was over.”

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