The Clinton health care plan of 1993, colloquially referred to as Hillarycare, was an American healthcare reform package proposed by the Clinton administration and closely associated with the chair of the task force devising the plan, first lady Hillary Clinton. Bill Clinton had campaigned heavily on health care in the 1992 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. President Clinton delivered a major health care speech to a joint session of the U.S. Congress on September 22, 1993, during which he proposed an enforced mandate for employers to provide health insurance coverage to all of their employees.
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 original proposal, many 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, which ultimately backfired amid the barrage from the pharmaceutical and health insurance industries and considerably diminished her own popularity. On September 26, 1994, the final compromise Democratic bill was declared dead by Senate majority leader George J. Mitchell.
Provisions
According to an address to Congress by President Clinton on September 22, 1993, the proposed bill would provide a "health care security card" to every citizen that would irrevocably entitle them to medical treatment and preventative services, including for pre-existing conditions. To achieve this, the Clinton health plan required each US citizen and permanent resident alien to become enrolled in a qualified health plan on his or her own or through programs mandated to be offered by businesses with more than 5,000 full-time employees. Subsidies were to be provided to those too poor to afford coverage, including complete subsidies for those below a set income level. Users would choose plans offered by regional health alliances to be established by each state. These alliances would purchase insurance coverage for the state's residents and could set fees for doctors who charge per procedure. The act provided funding to be sent to the states for the administration of the plan, beginning at $14 billion in 1993 and reaching $38 billion by 2003.
The plan specified which benefits must be offered; a National Health Board to oversee the quality of health care services; enhanced physician training; the creation of model information systems; federal funding in the case of the insolvency of state programs; rural health programs; long-term care programs; coverage for abortions, with a "conscience clause" to exempt practitioners with religious objections; malpractice and antitrust reform; fraud prevention measures; and a prescription drug benefit for Medicare, among other features.
Task Force
Once in office, President Bill Clinton quickly set up the Task Force on National Health Care Reform, headed by First Lady Hillary 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. He delivered a major health care speech to a joint session of the U.S. Congress on September 22, 1993.Clinton, Bill Address to Joint Session of Congress as Delivered (September 22, 2003). In that speech, he explained the problem:
Her leading role in the project was unprecedented for a presidential spouse.Hodgson, Godfrey. The Gentleman from New York: Daniel Patrick Moynihan: a Biography, page 349 (2000): "Hillary Clinton was out in front on this project to a degree unprecedented among presidential wives."Bok, Derek. "Political Leadership in the Great Health Care Debate of 1993–1994" in Public Discourse in America: Conversation and Community in the Twenty-First Century by Stephen P. Steinberg, Judith Rodin, page 96 (2003): "the President took the unprecedented step of naming his wife." This unusual decision by the president to put his wife in charge of the project has been attributed to several factors, such as his desire to emphasize his personal commitment to the enterprise.
Deliberations
After President Clinton announced the formation of the Task Force, media began to criticize the secrecy surrounding its deliberations, eventually leading to a public disclosure of the names of those involved. Starting on September 28, 1993, Hillary Clinton appeared for several days of testimony before five congressional committees on health care."Events leading up to Clinton's Healthcare Address to Congress," Timeline from PBS's The System. Accessed June 10, 2007. 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 of 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. The full text of the November 20 bill (the Health Security Act) remains publicly available.H.R.3600 - Health Security Act < (November 20, 1993).
Prominent opposition to the Clinton plan was led by William Kristol and his policy group Project for the Republican Future, which is widely credited with orchestrating the plan's 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 Heritage Foundation argued that "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."Moffit, Robert. , The Heritage Foundation (November 19, 1993)
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.Cohn, Jonathan. "Hillary was Right – The health care plan that dares not speak its name," The New Republic, June 5, 2007. Accessed June 8, 2007.Hernandez, Raymond and Pear, Robert. "Once an Enemy, Health Industry Warms to Clinton," The New York Times, July 12, 2006. Accessed June 9, 2007. Time, CBS News, CNN, The Wall Street Journal, and The Christian Science Monitor ran stories questioning whether there really was a health care crisis."The Rise and Fall of the Political Catchphrase," Time, February 14, 1994. Traces the origins of the Republican counter-argument "there is no health care crisis." Accessed June 8, 2007. Op-eds were written against it, including one in The Washington Post by conservativeEric Patashnik, "Political scientist Martha Derthick has died ", The Washington Post, January 25, 2015. University of Virginia Professor Martha Derthick that said, 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."Kramer, Michael. "The Political Interest," Time, January 31, 1994. "Slowly but surely, Bill Clinton's health-care plan is headed for the triage unit." Accessed June 8, 2007. 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 healthcare system.
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 US Constitution would make it unconstitutional to apply the procedural requirements of FACA to her 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, the history, or the structure of the Constitution. Ultimately, Hillary Clinton won the litigation in June 1993, when the D.C. Circuit ruled narrowly that the First Lady could be deemed a government official (and not a mere private citizen) for the purpose of not having to comply with the procedural requirements of FACA.Association of American Physicians and Surgeons, Inc. v. Hillary Rodham Clinton , 997 F.2d 898 (D.C. Cir. 1993)."Task force not required to hold public meetings" , Associated Press via Eugene Register-Guard, June 23, 1993. Page 5A.
Also in February 1993, 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. In 1997, 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."Judge Rules Government Covered Up Lies on Panel" , By Robert Pear. From The New York Times, December 19, 1997; accessed January 3, 2008. Subsequently, in 1999, 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."Court Clears Clinton Aide In Lying Case" , by Neil A. Lewis. Published in The New York Times, August 25, 1999. Accessed January 3, 2008.
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."Pantel, Kant and Rushefsky, Mark.Politics, Power, and Policy Making: The Case of Health Care Reform in the 1990s (1997). 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 was embarrassing for the administration, emboldened Republicans, and contributed to the notion that Hillary Clinton was a "big-government liberal" as decried by conservative opponents."The Evolution of Hillary Clinton," The New York Times, July 13, 2005. Accessed June 8, 2007.