Health Care Reform Initiative
In 1992, the Clinton/Gore campaign platform focused on issues important to the middle class, such as improving access to home loans, negotiating tough trade laws, improving education and reforming the American Health Care System. Candidate Clinton’s plan to reform the health care system had the support of the majority of the American middle class during the campaign, but President Clinton watched support dwindle until the Health Security Act’s ultimate demise more than a year after taking office.
President Clinton acted immediately in the wake of his historic election to put into action his Health Care Reform Initiative. Clinton simultaneously created the Task Force on National Health Care Reform and the White House Health Care Interdepartmental Working Group on January 25, 1993.
Health Care Task Force
The cabinet-level Task Force was given primary responsibility for providing advice and making recommendations to the President regarding the national health care reform package. President Clinton designated the First Lady, Hillary Rodham Clinton, as its chair. The Task Force aimed to create a plan for comprehensive reform of the American health care system, aided by the recommendations of the White House Interdepartmental Working Group.
Interdepartmental Working Group
The Interdepartmental Working Group, a separate entity from the Task Force, was created to gather information on previous health care reform initiatives, generate ideas and formulate alternative options, and present those options for consideration by the Task Force. The scope of their research included state and international health care policies. The Interdepartmental Working Group was loosely organized into a hierarchical structure of cluster groups, working groups, and subgroups. It included over 500 participants from both the public and private sector. The participants represented federal agencies, state agencies, congressional offices, non-profit organizations, health care professionals and activists. The concept of membership in working groups was loosely defined and extremely fluid; individuals moved from one group to another or new participants were added when their knowledge on an issue was needed. Overall responsibility for the organic design of the Interdepartmental Working Group rested with Ira Magaziner, White House Senior Domestic Policy Advisor. Later, Magaziner took a role as an advisor to the working groups, a “sounding board” for new ideas from various participants, and a representative who forwarded the working groups’ final proposals to the Task Force.
The Health Security Act
Both the Task Force and the Interdepartmental Working Group received instructions to fulfill their duties in consideration of President Clinton’s goal to have a comprehensive national health care reform bill passed within the first hundred days of his administration. The Task Force had worked hard to deliver their findings so that the President could propose a bill to Congress within months of his Inauguration, but the Administration delayed the bill’s presentation. While the bill had the support of Democrats, the Administration was concerned that the bill would face a possible filibuster from Republican senators. The Administration then considered presenting the reforms as part of a budget bill. Ultimately, however, President Clinton waited until after the Budget Bill passed to present the Health Care Bill.
On September 22, 1993, President Clinton presented his vision to overhaul the nation’s health care system to a joint session of Congress. President Clinton acknowledged the hard work of the Task Force and Working Group. Clinton stated:
“Over the last eight months, Hillary and those working with her have talked to literally thousands of Americans to understand the strengths and the frailties of this system of ours. They met with over 1,100 health care organizations. They talked with doctors and nurses, pharmacists and drug company representatives, hospital administrators, insurance company executives and small and large businesses. They spoke with self-employed people. They talked with people who had insurance and people who didn't. They talked with union members and older Americans and advocates for our children. The First Lady also consulted, as all of you know, extensively with governmental leaders in both parties in the states of our nation, and especially here on Capitol Hill.”
In his message, President Clinton called for bipartisan support for “universal, comprehensive health care.”
Following the President’s message, on September 28, First Lady and chair of the Health Care Task Force, Hillary Rodham Clinton gave testimony and answered questions before a full congressional committee. During her opening remarks, she challenged the Congress to pass health care legislation that would “control health care costs and provide every American affordable, high quality medical care.”
On November 20, 1993, HR. 3600, the President’s health care bill was introduced. It was sponsored by Richard Gephardt, Democratic Congressman from Missouri. S. 1757 the Health Security Act was introduced November 22, 1993. It was sponsored by George Mitchell, Democratic Senator from Maine.
One of the major highlights of the bill was Universal Coverage that would require every citizen to enroll in the health plan. Employers would be required to pay 80 percent of the average cost of their employee’s health plans. The government would subsidize small businesses, the unemployed, underemployed, and self-employed individuals. Universal coverage was paramount to the bill and President Clinton threatened to veto any health bill that did not include this component.
The Administration’s health care reform initiative was not without controversy. Organized opposition to the Health Security Act from Health Care Organizations, the Health Insurance Industry, and the right wing of the Republican Party ultimately prevented its passage in 1994.
One of the criticisms of the Health Security Act was that the Task Force and the Working Group deliberated in private and the White House did not disclose the identities of Working Group members. In February 1993, the Association of American Physicians and Surgeons (AAPS) filed suit against the Task Force and working groups. The AAPS cited the Federal Advisory Committee Act (FACA), claiming that the Task Force should make meetings public and publish meeting minutes in the Federal Register.
Another common criticism of the bill was the bill’s length. The bill’s 1,342-pages were lampooned as too complex. The infamous “Harry and Louise” ads, paid for by the Health Insurance Association of America, featured a married couple discussing their frustration with features of the Health Security Act. By 1994, the bill even faced Democratic opposition for being too complicated and even for being too moderate.
Throughout the summer of 1994, as the bill was debated in congressional committee, the Health Security Act gradually lost bi-partisan consensus support. September 26, 1994, the bill’s sponsor George Mitchell declared the bill dead after several attempts to negotiate a compromise.
Digitized Collections Concerning President Clinton’s Health Care Reform Initiative
2006-0223-F: This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and Working Group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Rodham Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force. View digitized documents from this collection
2006-0225-F: This collection contains White House correspondence to and from Congress concerning the Health Care Task Force between July 1993 to December 1993. President Clinton created the Task Force on National Health Care Reform in 1993 and charged it with developing a comprehensive national health care reform package. First Lady Hillary Rodham Clinton chaired the Task Force. The majority of the congressional letters were written to express the concerns of constituents, as well as correspondence regarding the maintenance of the Health Care Task Force's records and requests by Congress to view those records. View digitized documents in the collection
2006-0770-F: This collection contains materials from the files of Ira Magaziner, Office of Policy Development. This collection includes draft reports produced by the numerous working groups Magaziner formed to advise the Task Force. View digitized documents in this collection
- Segment 1: This collection contains materials regarding First Lady Hillary Rodham Clinton’s involvement in the Clinton Administration’s efforts to enact health care reforms between 1993 and 1996. In January 1993, President Clinton announced the creation of the Task Force on National Health Care Reform and designated the First Lady as its chair. View digitized documents from this segment
- Segment 2: This collection contains material on Health Care Reform from 1993 through 1996 from the First Lady’s Office. The records include correspondence, memoranda, talking points, reports, charts, publications, research material, schedules, newspaper and magazine clippings, briefing books, press releases, background material and speeches maintained by individual offices and staff members.View digitized documents from this segment
2006-0885-F: This collection contains records specific to the Health Care Task Force and contains the largest number of responsive records concerning the topic.
- Segment 1: This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. View digitized documents from this segment
- Segment 2: This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.View digitized documents from this segment
- Segment 3: The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.View digitized documents from this segment
- Segment 4: This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act.View digitized documents from this segment
- Segment 5: This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes.View digitized documents from this segment
- Segment 6: This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records focus largely on relevant figures, statistics, and calculations, including many graphs and charts illustrating the effect reform of the health care system would have on the federal budget. As a Senior Policy Analyst on the Domestic Policy Council, Margherio’s records include documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House.View digitized documents from this segment
- Segment 7: This collection consists of records related to the Health Care Task Force. It contains articles, briefing papers, news clippings, lists, memoranda, notes, presentations, press reports, statements, and talking points from the Staff and Office files of Catherine Balsam-Schwaber and Steven Edelstein. The records concern the Health Security Act and Congressional action on Health Care Reform.View digitized documents from this segment
- Segment 8: This collection consists of records dealing with the attempt of the Clinton Administration to transform the health care system of the United States. This segment focuses on the Staff and Office Files of Arnold Epstein, Charlotte Hayes, Paul Jamieson, Kelcey Kintner, Amanda Merryman, Meeghan Prunty, and Jason Solomon. The records include reports, drafts of speeches, talking points, press releases, memoranda, newspaper articles, handwritten notes, statistical charts, publications, and correspondence. The documents highlight the history of health care, the “Health Care Express Tour,” and other proposed health care legislation.View digitized documents from this segment
- Segment 9: This collection consists of the first portion of the Health Care Task Force's Delivery Room Central Files, also referred to as the General Files. These alphabetized folders contain records concerning a variety of issues associated with health care reform in 1993 and 1994. The records primarily contain press clippings and other reference material (such as analysis, publications, correspondence, legislative materials, press materials, notes, position papers, reports, and scheduling materials).View digitized documents from this segment
- Segment 10: This collection contains the files of Robert Boorstin, Alice Dunscomb, and the Health Care Delivery Room Central Files, also referred to as the General Files. The collection contains calendars, correspondence, memoranda, newsletters, polls, reports, statements, talking points, and drafts of Health Care Economics, Health Care Reform and the Health Security Act. The General Files primarily contain clippings regarding various issues associated with the Health Care Task Force as well as advertisements, analysis, articles, correspondence, draft legislation, fact sheets, legislative summaries, notes, position papers, press releases, publications, reports, scheduling materials, statements, tables, talking points, testimonies, and transcripts.View digitized documents from this segment
- Segment 11: This collection has not been digitized. This collection consists of material regarding the Health Care Task Force (HCTF). It contains the records of staffers Robert Boorstin, Roger Goldblatt, Marjorie Tarmey, Catherine Balsam-Schwaber, Simone Rueschemeyer, and Cindi Tauber. Also included are General Files, also known as the Health Care Delivery Room Central Files. The collection contains publications, correspondence, books, bulletins, drafts, testimony, memoranda, talking points, notes, reports, and newspaper articles. Most of the publications are of an official governmental nature and can be found in Tarmey’s files. View collection finding aid
- Segment 12: This collection has not been digitized. This collection is the twelfth segment of materials related to the Health Care Task Force. It includes the files of Robert Boorstin, Alan Hoffman, Marjorie Tarmey, Simone Reuschemeyer, and Susannah Wellford as well as some material from the General Files and Health Care Interns. The files contain briefing materials, chron files, correspondence, legislation, press materials, scheduling materials, and speeches. View collection finding aid
- Segment 13: This collection has not been digitized. This collection consists of records regarding the Health Care Task Force. The collection contains memoranda, correspondence, briefing and meeting materials, government publications, newspaper articles, congressional testimony, emails, and fact sheets on the Clitnon Administration's health care reform efforts. View collection finding aid
- Segment 14: This collection has not been digitized. This collection includes publications and papers. View collection finding aid
Chris Jennings - Health Security Act Collection Series: This series contains material which provides a detailed analysis of the Health Security Act (HSA). A chronological subseries within this series focuses on legislative strategies to enact the HSA, as well as efforts on the part of the Clinton Administration and its supporters to counter intense opposition to the legislation from opponents in Congress and powerful interest groups. This series also contains material which examines in detail the alternatives to the Health Security Act, particularly single-payer plans and a compromise proposal from a bipartisan group of moderates in Congress called the Mainstream Coalition. This series contains memoranda, correspondence, reports, press releases, briefing papers, statistical data, graphs, legislative drafts, publications, and news clippings related to the Health Security Act. View digitized documents from this collection
Robert J. Blendon, Mollyanne Brodie, and John Benson, "What Happened to American’s Support for Clinton Health Plan," https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.14.2.7, last accessed 08/03/2020.
“Clinton’s Health Care Plan Laid to Rest,” CQ Almanac, https://library.cqpress.com/cqalmanac/document.php?id=cqal94-1103561, last accessed 08/03/2020.
Russell L. Riley, “Bill Clinton: Domestic Affairs,” https://millercenter.org/president/clinton/domestic-affairs, last accessed 08/03/2020.
James Fallows, “A Triumph of Misinformation,” The Atlantic, January 1995 Issue, https://www.theatlantic.com/magazine/archive/1995/01/a-triumph-of-misinformation/306231/, last accessed 08/03/2020.