Why Hillary Clinton Was Not a Fan of the Individual Mandate

As she pushed her health reform plan in 1993, the former first lady warned Democrats the mandate would send “shock waves” through insured America.

National Journal
Alex Seitz Wald
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Alex Seitz-Wald
Feb. 28, 2014, 9:43 a.m.

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. 

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