In the fall of 1993, as then-first lady Hillary Clinton was pushing her health care reform package, she warned Democratic lawmakers that the individual mandate was a political loser, according to new documents released Friday.
The documents, made public for the first time by her husband’s presidential library and the National Archives and Records Administration, shed light on how Clinton approached the difficult task of overhauling the nation’s health care system, and where she differed from the approach President Obama would take on the same issue years later.
Hillary Clinton spearheaded the White House’s 1993 reform effort, which ultimately failed, and went to Capitol Hill in early September that year to brief Democratic House and Senate leaders and committee chairs and to try to convince them to support her plan. The White House proposal relied more heavily on an employer mandate to pay for health insurance, while the Republican alternative at the time proposed a mandate on individuals to purchase coverage.
“We have looked at that in every way we know how to,” Clinton told the lawmakers of the individual mandate. “That is politically and substantively a much harder sell than the one we’ve got — a much harder sell.”
“Not only will you be saying that the individual bears the full responsibility; you will be sending shock waves through the currently insured population that if there is no requirement that employers continue to insure, then they, too, may bear the individual responsibility,” Clinton added.
It’s an artifact of how much of a political ping-pong ball the individual mandate has become over the intervening two decades, bouncing back and forth between and inside the two parties. The mandate started at the conservative Heritage Foundation as an alternative to Clinton’s plan.
But in 2008, when she was running for president, Clinton had come to support the mandate — drawing the ire from her then-primary challenger Barack Obama, who warned Clinton would “force uninsured people to buy insurance, even if they can’t afford it.” He too, of course, switched positions on the mandate, making it a key part of his signature health care law once he came into office. His law also includes an employer mandate like Clinton’s 1993 plan.
Her lengthy exchange with the Democratic leaders, including difficult questions and complaints about lawmakers being kept in the dark, suggest Clinton had a deep command of the both policy and politics of health care reform, and clear-eyed view of the challenges she faced. That includes many of the same challenges Obama faced and currently faces with his own health plan.
“I think that there will be, very honestly, a period of adjustment, a period of setting, before any of you will feel comfortable with all the features of this, because we are really approaching the health care system in a different way,” she told the lawmakers.
For instance, she counseled Democrats to focus not on expanding coverage when speaking with constituents — though that was the central goal of the plan — since the message doesn’t sell as well. “It may be an unpleasant fact for some of us Democrats to face, but the argument is not going to be won on bringing in the uninsured. The argument is going to be won on keeping [coverage] for everybody, including those who are insured, but may not be next year or the year after,” she said.
It’s advice that rings as true in 2014 as it was in 1993. Of course, Clinton wasn’t successful then and Obama has yet to convince the country today.