Why did Clinton Health Security Act of 1993 failed despite the opportunity to reform?

Marie M.

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Why did Clinton Health Security Act of 1993 failed despite the opportunity to reform?

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Reforming the US health care system was one of the top priorities of the presidential battle in 1992 and William Jefferson Clinton managed to appear as the most competent candidate to deliver a comprehensive plan to solve this problem. Since the late 1970's, the country was facing problems because of its health care system. Many Americans had no health insurance, and the first cause of individual bankruptcy was due to high medical expanses. American companies also faced competitive disadvantages because of high health care costs: from 1965 to 1989, business spending on health benefit climbed from 2.2 % to 8.3% of wages and salaries and from 8.4 % to 56% of pre-tax corporate profits. But those problems only came up at the national level after Wofford's 1991 victory in the senatorial election in Pennsylvania. Indeed, the latter used the health care issue to win those elections and as a result, paved the way for the national leader to utilise this topic in order to get elected. The Health Security Act (HSA) delivered by Clinton and his administration in 1993 pretended to be universal and of high quality. But, above all, it was a strategic tool which ultimate aim was to legitimate the Democrats within the US political sphere for decades to come.

Sommaire

Introduction.
The Health Security Act (HSA) delivered by Clinton.
Why President Clinton's proposal was not legislated.
1. Rapidly rising costs which began to affect both public and private sectors.
2. Problems for the employers.
3. What placed health care reform on the political agenda.
Clinton and his administration.
1. Clinton and his administration.
2. Attracting the middle class.
3. The employer mandate.
4. Mobilizing interest groups.
5. The legislative strategy.
Why did HSA fail despite the favourable context.
1. US political institutions - structurally biased against comprehensive reform.
2. Absence of complete control on his agenda.
3. Preoccupation with other issues.
4. The loss of intrest from big employers.
5. Clinton's overestimation of the Democrats and their capacity to get unified around the bill.
The Republican mobilization effort.
Conclusion.
Bibliography.

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Extraits

[...] First, Clinton did not act quickly enough and missed the window of opportunity, which lasted from spring to fall 1993. During his campaigning, he promised to have a healthcare bill ready within the first hundred days in office, but in reality, it took over ninth months to prepare the bill. Moreover, this text was very long (1342 pages) and very difficult to understand for ordinary citizens, since little was said about employer mandates, finance or regional health alliances. The President had no entire control on his agenda and was first preoccupied by the budget battle, the crisis in Somalia, Haiti, and Russia, and then by the NAFTA. [...]

[...] That was a signal to the national leaders, telling them that there was an opportunity to reform the insurance system. Similarly, others interests groups began to tackle this issue and came up with ideas of reforms. Under these circumstances, usual opponents of reform were divided and, for instance, the American Medical Association which used to be the interest group the ever more opposed to all governmentally sponsored health reform became more receptive to some versions of the reform.[5] The AMA also proposed its own plan to solve the health care problem in the United States with its “Health Access America” plan. [...]

[...] Missing Millions: Organized Labor, Business, and the Defeat of Clinton's Health Security Journal of Health Politics, Policy and Law (1999) 489-530. Klein, Jennifer. “Review of Cathie Jo Martin, Stuck in Neutral,” Journal of Health Politics, Policy and Law. (2002) 27 677-82. Martin, Cathie Jo. Stuck in Neutral, Princeton: Princeton University Press Peterson, Mark A. Politics of Health Care Policy: Over reaching in an Age of Polarization,” in Margaret Weir, ed., The Social Divide, New York: Brookings Institution Press 181-229. Skocpol, Theda. Boomerang: Health Care Reform and the Turn Against Government, New York: W.W. [...]

[...] In this context, Clinton and his administration did believe that there were responding to the needs of a vast majority of U.S. citizens. There was a large support of the public opinion which was very concerned about the problem, and which ranked the health reform right after the economy and the foreign affairs among the political priorities. HSA was a very ambitious measure, more ambitious than any previous proposition and when Clinton first announced the plan in September of the public favoured it while only 20% were opposed.[6] With his plan, Clinton wanted to recreate a New Deal that would establish a new long-term coalition of Democrats for generations to come. [...]

[...] At first, this bill was rejected by the fiscal elite but the legions which were acting at the local / state / and national level pressured the Government so that the bill could be passed.[18] In the same way, small business had deep social roots at all levels in the US and succeeded in being an important and unified source of opposition to the HSA. Finally, concerning the legislative strategy, Clinton overestimated the Democrats and their capacity to get unified around the bill. As a result, even in his own party, the President didn't manage to get a strong support coalition of the Democrats formally endorsed the president's plan supported it but withheld endorsement and 49% supported some features but opposed others. [...]

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