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Bill Clinton, the 42nd president, was in office 1992-2000. Like all presidents, he was charged with dealing with both domestic and foreign issues. As Johnson and Broder write, "four challenges emerge as the greatest the nation faces: war and the threats from foreign enemies' race and the dreadful heritage of slavery; economic instability and the ravages of periodic and often severe joblessness; and the social safety net, protecting the most vulnerable in their times of need" (Johnson and Broder 61). It is under this final category that health reform falls. Image File history File links Stop_hand. ... William Jefferson Bill Clinton (born August 19, 1946) was the 42nd President of the United States, serving from 1993 to 2001. ... (This article is about movements to improve health. ...

Clinton knew that the middle-class was the main addressee of his plan, saying his top priorities were for "those who do the work, pay the taxes, raise the kids, and play by the rules" (Blendon, Brodie, Benson 15). His health care reform plan was developed by some of the largest private insurers (Aetna, Prudential, and Travelers), who wanted to manage the delivery of health care along with paying for it. Large corporations, wanting to reduce cost through managed care and wanting also to shift some burden of cost to smaller companies, joined the interested parties. These corporations included General Electic Company, General Motors Corporation and Caterpillar (Terris: 16). Aetna (Aetna Inc. ... Prudential plc is a United Kingdom based financial services company. ... The St. ... GM redirects here. ... The striking caterpillar of the Emperor Gum Moth A caterpillar is the larval form of a lepidopteran (a member of the insect order comprising butterflies and moths). ...

The issue

Background

When Bill Clinton was elected as president, it seemed possible to achieve health reform with strong democratic political capital in Congress and rising public support. Clinton faced a Democratic majority in Congress. The Democratic Congress would have been in favor of an agenda pertaining to public welfare and equality. Clinton however, was unable to develop a clear and transparent national health insurance plan. Many Americans trusted that Clinton and the Democrats had a general plan working towards reform. After Clinton was elected, he relied on his speechwriting team to develop a comprehensive health care reform plan. However, Clinton rejected the plan just one day before his speech to a joint session of Congress on the future of health care. The final version of the speech briefly outlined how Clinton would implement national health insurance but left a lot of questions unanswered. Ambiguities of the plan, including the finance of such reform, limited the credibility and efficiency of such reform.

Clinton also could not make health care a top priority for Americans. During Clinton’s campaign, citizens ranked health care third behind the economy and the national deficit. In addition, Clinton failed to convince Americans to support his plan of managed competition. Opposition from powerful interest groups also hurt Clinton's chances of reforming the current healthcare system. Clinton's inability to gather public concern and interest on the current state of healthcare in America coupled with his ambiguous reform plan resulted in no progress towards universal health care.

How the issue got noticed

Until the early 1990s, the US health care system was dominated by traditional indemnity insurance, fee-for-service payment, free choice of doctors who were mainly in solo or small group practices, and third party payment. American's had become used to top quality care without having to pay the bill (Graig, p. 17). This set-up led to a large problem of moral hazard which increased the cost of health care tremendously. With no central government organization to moderate these costs, US companies began to complain that health care costs put them at a competitive disadvantage with regard to foreign competitors. Many large companies became more involved in overseeing employee health care costs by self-insuring or enrolling their employees in a managed care system (Graig, p. 19). However, the late 1980s and early 1990s saw the rise and fall of the idea of managed care. While in 1980 few employers viewed health care costs as a major problem, by the end of the decade, that was no longer the prevailing view.

Rising health care costs became an extremely serious issue in the 1990's (Johnson and Broder 61). During the 1980's, total health care costs grew by $1400 (Johnson and Broder 61). According to some estimates, $1 out of every $7 dollars of goods and services produced in America was being spent on health care(Johnson and Broder 61). Since only the wealthy could afford health care, thirty seven million people, or 15% of the population, did not have insurance (Johnson and Broder 62). In addition, government officals were worried that the rising costs would have a detrimental effect on the national debt and limit the amount of money available for other government programs (Johnson and Broder 62). Therefore, both Democrats and Republicans agreed that the health care system needed to be reformed in order to provide greater security to citizens. Although previous efforts to impose universal health insurance had failed, Americans were now "experiencing a troubling new sense of vulnerbility"(Johnson and Broder 62). During the 1990's, a large economic recession resulted in the loss of health benefits for many working Americans. In 1992, one million, two hundred thousand American families lost their insurance. Many other Americans believed that their current insurance would not be sufficient in the case of a severe illness or injury (Johnson and Broder 63). The loss of security felt by millions of Americans increased public attention on the health care system. While people did not want the government to run the health care system, they believed that the government had to institute some kind of reform (Johnson and Broder 63).

How the issue was framed

Clinton decided to frame the discussion of health care reform in an address to a joint session of Congress and the American people. On September 22, 1993, Clinton delivered a speech outlining a plan for universal health coverage. He made the case for reform, by citing rising health care costs, 37 million uninsured Americans, and a generally wasteful and inefficient system. He outlined the proposal within the context of six principles: security, simplicity, savings, choice, quality, and responsibility.

Much of the speech was devoted to the idea of prevention: the long term benefits of more preventative care, and cutting the financial burden of universal coverage. Clinton depicted the current system as barring doctors from working effectively, and individuals from the right care. He conceded that his plan would cost more for some, but stressed that everyone would save in the long term. He asserted that there should be no free rides in the US health care system, that everyone should pay. Clinton posited universal health care as his generation's moon landing, and as a step towards the equality of public welfare. A 1930 Soviet poster propagating breast care. ...

Full text of the address is available at [1]

The policy stream

Policy communities

First Lady Hillary Rodham Clinton played an important role in the formation of health policy. She took health policy to be her "crusade" and stood by Bill and testified at Congress, advocating the passage of new health care reform. On January 15, 1993, it was announced that Hilary would be in charge of a task force made to develop a plan for health care reform (Quadagno 185). Hillary was a force to be reckoned with. "Hillary on the Hill became one of those events charged with political symbolism, and unforeseen consequences. It was dramatic. It was triumphant. But its very success also triggered new and intense activity among opponents who saw in this formidable First lady a foe whose defeat would require their most determined efforts" (Johnson and Broder 182). In late 1993, Hillary's approval rating for her handling of health care reform was actually higher than the President's. The public gave President Clinton a 55% rating, while Hillary got a 60% (Schneider). In late February of 1993, three groups from the health care industry sued the reform task force, claiming that Hillary could not chair a task force since she was not a government employee. Hillary called the suit a "deft political move, designed to disrupt our work...and foster an impression with the public and the news media that we were conducting secret meetings" (Quadagno 186). The suit resulted in the release of 250 boxes of uninteresting task force memos and reports. The task force eventually formulated a plan for health care reform in late September, a few months past the "100 days" promise of Clinton; the plan became a 1,342 page long bill known as Clinton's Health Security plan (Quadagno 187). Hillary Rodham Clinton (born Hillary Diane Rodham on October 26, 1947) is the junior United States Senator from New York, serving her freshman term since January 3, 2001. ...

The Health Insurance Association of America immediately opposed the plan. The Association had hired Bill Gradison, a Republican on the House Ways and Means Committee, as its president and chief lobbyist. Gradison brought Charles Kahn, the leading health policy counsel on Ways and Means, on board as well. Gradison then initiated a $3 million dollar ad campaign against Clinton's plan with the general message "You will lose control" (Quadagno 189). The most famous ads featured a husband and wife, Harry and Louise, discussing the Clinton plan and using phrases such as "The government may force us to pick from a few health plans designed by government bureaucrats" and "government monopoly" (Quadagno 189). (The advertisements may have been particularly effective because they characterized Clinton's plan as being against middle class values.) The Health Insurance Association of America also used its own insurance agents to lobby their own communities and members of Congress (Quadagno 190). Harry and Louise was a television commercial aired by the health insurance industry in opposition to President Bill Clintons proposed health care plan in 1993. ...

This lack of support for a national health reform plan prompted Aetna, MetLife, Cigna, Prudential, and Travelers to resign from the Health Insurance Association of America in 1992. These five companies formed their own lobby group, the Alliance for Managed Competition, which supported Clinton's plan in some areas, but called for change in others. For example, they opposed the creation of a national health board which could cap health spending nationally (Quadagno 190).

Policy entrepreneurs

Senator Jay Rockefeller of West Virginia had a personal stake in the passage of health reform because his mother had died of Alzheimers. He took the issue so seriously in fact, that "he believed health care reform to be an issue that represented nothing less than the economic health and future of the United States" (Johnson and Broder 33).

Arnold Bennett, the Media Director of Families USA was another key play in the Clinton health reform initiative. Arnold Bennett is a political activist, Democratic consultant and documentary filmmaker. Bennett said, “is unfortunately not the only report that conveys the notion that the Clinton health reform plan will help the uninsured at the expense of the middle class, and that new taxes on us are needed to insure them”. Bennett did not want to convey that the poor are the winners and the middle class is footing the bill. The middle class only wanted security and did not want to foot the bill for the uninsured, Bennett understood this.

Another key player was Senator Ted Kennedy from Massachusetts. He strongly believed in health reform and supported Clinton whole-heartedly. He "believed this was a moment of historic opportunity, the most favorable in all his years in Congress" (Johnson and Broder 34).

The origin of the idea of national health insurance

The idea of National Health Insurance began in Germany in 1883 when Otto von Bismark devised the health insurance plan as a manifestation of his government's concerns for the health of its citizens. The German government was responding to new needs for social programs generated by industrialization, population growth, urbanization, increasing wage dependence, and the increasing political awareness of new industrial workers(Graig, Health of Nations, p.45).

The 1883 Sickness Insurance Act required all workers earning a certain income or below be insured by a sickness fund or mutual aid society. This form of insurance was to be financed by mandated employer-employee contributions and required a minimum level of benefits. These original benefits included physician's services, eyeglasses, and hospital treatment without charge at the point of service (Graig, p.46). By 1998, approximately 90% of the German population was covered by this statutory insurance model(Graig, p.48)

Compulsory Insurance in Germany, 1893, was the first study of the idea in the United States. Many attempts by previous presidents to introduce national health insurance all failed. Starting with the New Deal, the government sought to having an increasing role in the promotion of public welfare. The nationalization of healthcare was also observed in other countries, such as Canada and Great Britain. The equality of care observed in other countries and the observation of large healthcare inequities within the country sparked public appeal for national healthcare and universal coverage.

The political stream

The national mood

In the initial months of the Clinton Administration, the public had a limited amount of confidence in the new president. Following two failed attorney general nominations, a Republican filibuster of the first part of the Clinton economic plan, and a controversy over gays in the military, the nation was in a "skittish mood", but open to health reform (Johnson and Broder 17). Clinton may refer to a number of persons or places. ... President is a title held by many leaders of organizations, companies, universities, and countries. ... In a legislature or other decision making body, a filibuster is an attempt to extend debate upon a proposal in order to delay or completely prevent a vote on its passage. ...

In one of Clinton's initial polls on health care, most individuals were unhappy with their personal health coverage. Two-thirds of voters were dissatisfied with the overall health care system. Further based on the polling data, the administration concluded that the public wanted to see "Congress take its time" in making major changes. Thus, the administration worked to frame their reform as a deliberate, bi-partisan, and inclusive reform process (Johnson and Broder 18). At the time of Clinton's speech to present his plan in September of 1993, one Harris poll found that ninety-one percent of Americans agreed with the idea that "everybody should have the right to get the best possible care--as good as the treatment a millionaire gets," and a Gallup poll found that eighty percent of Americans believed that "government should be responsible for medical care for people who can't afford it" (Yankelovich 12). The only two groups who did not support Clinton's plan were Republicans and persons who earned more than $50,000 per year (Blendon, Brodie, Benson 9).

The No Name Coalition, started by the Conservative Christian Coalition and National Taxpayers Union placed negative editorials in The Wall Street Journal and used conservative media personals like Rush Limbaugh to wage an intensive war against Clinton’s Plan. In the end, the Coalition grew to include more than 30 organizations. Not including additional money by corporations and other associations, public records show that the Coalition spent over $100 million dollars against Clinton’s plan. Conservatism or political conservatism is any of several historically related political philosophies or political ideologies. ... As a noun, Christian is an appellation and moniker deriving from the appellation Christ, which many people associate exclusively with Jesus of Nazareth. ... The Wall Street Journal is an influential international daily newspaper published in New York City, New York with an average daily circulation of 1,800,607 (2002). ...

Just as Clinton was about to begin a series of speeches and events to generate attention and support for the Health Securtiy plan in late 1993, the crisis in Somalia erupted. Two Black Hawk helicopters were shot down; 18 Americans were killed and another 80 were injured. The nation's attention was captured by the events, causing Clinton to put his plan on hold for an entire month (Quadagno 187).

Organized political interests

Newt Gingrich was one of the most staunch opponents to Clinton and his healthcare plan. He believed the Clinton plan ruined his own desires to become Speaker of the House. "Only by controlling Congress with a new conservative Republican majority could the final goals of their "Republican Revolution" be achieved: to break the public dependency on Democratic tax-funded government programs; "defund the government," as they put it, and in so doing, destroy the liberal constitutency groups; and permit the flowering of an antigovernment, antitax, entreprenurial nations. All these aims were threatened by the Clinton plan" (Johnson and Broder 12). The term Speaker is usually the title given to the presiding officer of a countrys lower house of parliament or congress (ie: the House of Commons or House of Representatives). ...

Gingrich also felt that the Clinton plan was too pro-big-government. In June of 1994, Gingrich said that the bill would cause "bigger government, bigger bureaucracy and higher taxes for worse healthcare" (Clymer).

Medical lobby communities gave moderate support to the Clinton plan. For example, the AMA supported employer mandates and universal coverage, but did not support reductions in Medicare benefits, caps on spending, or criminal penalties for abuse by physicians. Similarly, the American Group Practice Association (AGPA) supported cost containment and universal coverage, but opposed premium caps and health alliances, fearing interference with group practice strategies (Langbert 642).

The AFL-CIO favored the Clinton plan initially; they supported employer-based solutions for the health care problem. (Johnson and Broder) This proved untimely however, as the prospects of an employer mandate option seemed to be unpopular with business. (Gottschalk) In 1993 and 1994, the AFL-CIO staged many grassroots efforts to generate support for reform. (Dark) The labor movement "played old politics" through local efforts, while the Republicans and opposers of reform used the media to reach the mass public. (Johnson and Broder) Organized labor opposed, most of all, taxation of health insurance benefits (Langbert 642). The AFL-CIO is the largest labor union federation in the United States. ... The AFL-CIO is the largest labor union federation in the United States. ... The Republican Party is one of the two major political parties in the United States, the other being the Democratic Party. ...

However, strong opposition forces from interest groups and the business class existed. The Health Insurance Association of American spent over $20 million on advertisements to oppose a universal health reform plan. Their efforts included the notorious "Harry and Louise" television commercials. Other techniques such as mailing campaigns and phoning were used by coalitions. Rush Limbaugh also spread daily messages exaggerating the total cost of the program and stated that people who currently had insurance would now receive lower quality care. Advocacy is an umbrella term for organized activism related to a particular set of issues. ... This article does not cite its references or sources. ...

Moreover, small businesses, who feared financial burdens, organized oppositions with mailings and town meetings (Reynolds). The National Federation for Independent Business (NFIB) fiercely opposed employer-mandates -- a crucial component to the Clinton Plan. (Starr:1995) Small business pledged to oppose any legislation with an employer mandate; Clinton's plan had a mandate requiring all employers to pay 80% of insurance premiums. In a 1995 survey, only 28% of companies supported an employer mandate (Martin 899, 904).

On the other hand, big business generally supported employer mandates. According to Michael Becker, vice presient of benefits for McDonnell Douglas Corporation, claimed in 1995 that companies with generous benefit programs would experience cost reductions as a result of universal coverage (Langbert 642).

The Republican Party was whipped by some of its most conservative members and advisors into opposing the health care plan, led by Bill Kristol, conservative opinionmaker and president of the Project for the Republican Future think tank. In his first of what would become legendary strategy memos circulated among Republican policymakers, Kristol said the party should "kill," not amend or compromise on, the Clinton health care plan. He reasoned that allowing any plan to pass under a Democratic president and Congress would give that party control of the middle-class vote. Ideologically, this would encourage and strengthen New Deal liberal ideas of government support, at the cost of gains from limited government. He wrote: William Bill Kristol (born December 23, 1952 in New York City) is an American neoconservative lobbyist. ... Project for the Republican Future was founded in 1993 by Thomas L. Dusty Rhodes. ...

It will re-legitimize middle-class dependence for 'security' on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government. (Johnson and Broder 234)

Thus, Kristol presented the first public document uniting Republicans behind total opposition to the reform plan, a position already (privately) advocated by Speaker of the House Newt Gingrich and other strategists. A later memo advocated the phrase There is no health care crisis, which Senate Majority Leader Bob Dole used in his response to the State of the Union address. (Johnson and Broder 270) Unfortunately, this resulted in an avalanche of phone calls from citizens seeking to demonstrate the reality of their health care problems, and played into the image of Republicans as aloof and uncaring. (Johnson and Broder 363) Image File history File links Quotation marks File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Image File history File links Quotation marks File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Newt Gingrich Newton Leroy Gingrich, Ph. ... Robert Joseph Dole (born July 22, 1923) is best known as a former Republican United States Senate Majority Leader and Senator from Kansas from 1969-1996. ...

Kristol was so set on total opposition to any health reform under a Democratic Congress that he urged the defeat of liberal Republican Senator John Chafee's compromise bill in another memo. He wrote: John Lester Hubbard Chafee (October 22, 1922 – October 24, 1999) was an American politician. ...

The Chafee-led rump group runs the serious risk of snatching defeat out of the jaws of victory. We're going to defeat Clinton on health care, win seats in November, and pass our own health bill next year. (Johnson and Broder 446)

By now, Republican policymakers were so overwhelmed by these weekly memos that they felt they had no choice but to follow in total opposition to reform, not compromise. (Johnson and Broder 385) After the death of the plan, Kristol went into the midterm election proclaiming, "I think we can continue to wrap the Clinton plan around the necks of the Democratic candidates." (Johnson and Broder 531) Image File history File links Quotation marks File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Image File history File links Quotation marks File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ...

The policy window for health reform

Why the window of opportunity for health reform opened

In part, public opinion helped open up a new opportunity for health reform during the Clinton era. Beginning in 1973, Americans have felt that they have been spending “too little rather than too much on protecting the nation’s health” (Blendon & Benson 38). By 1993, national health spending had reached a record high of $888 billion as health insurance premiums rose rapidly (CMS). Public confidence in institutional leaders of medicine reached a record low (44%), and a majority of Americans felt that the nation was spending too little on improving healthcare (Blendon & Benson 38-39). In the 1992 election, voters ranked health care ranked as the third most important issue in their presidential choice, behind only the economy and the federal budget deficit (Blendon, Brodie, Benson 12).

After the hard fought 1992 election, Clinton stepped into office with fresh optimism and confidence in his abilities. With the American public and an experienced, Democrat-dominated Congress supporting him, President Clinton seemed like the right man in taking on the task of health care reform. As Clinton began formulation a national health care plan, public opinion polls showed a two to one margin a approval for the plan; fifty-seven percent of Americans approved of the plan that Clinton was promising (Yankelovich 11). Even as the nation's trust in the presidency and government was falling, Americans became noticeably more supportive of government involvement in health care (Hacker 658). Paul Starr, a sociologist from Princeton and author of "The Middle Class and National Health Reform," claimed that, due to pressures from the middle class, the pressure for national health care reform was stronger in the 1990's than it had been for decades (Hacker 657).

Why the window of opportunity for health reform closed

President Clinton’s failure started with isolating important players, Congressional leaders and administration officers, whose support would be critical in shepherding reforms through Congress. The Clinton Administration tried to tie the health reform plan to the budget reconciliation bill, but key senators refused to allow such. Instead of compromising and reaching out to moderate Congressmen, President Clinton continued to push his own plan. In his 1994 State of the Union address, he promised to veto any bill that did not provide universal coverage (Reynolds). Additionally, Clinton's "closed door policy" surrounding the generation of a healtcare reform plan angered both Democrats and Republicans on Capitol Hill. By leaving key decisions to relative outsiders, Hillary Rodham Clinton and Ira Magaziner, President Clinton turned his back on the legislators whose votes he eventually needed. 1994 (MCMXCIV) was a common year starting on Saturday of the Gregorian calendar, and was designated the International year of the Family. ...

Clinton chose to develop a reform plan through a special White House task force directed by his wife, Hillary Clinton and top aid, Ira Magaziner. Instead of fostering relationships with important players, President Clinton, Ira Magaziner, and Hillary Clinton left out important players whose support would have been critical in shepherding reforms through Congress. These included Congressional leaders and administration officials (Reynolds).

Moreover, Clinton's leadership style was a hindrance to the passage of health legislation. He was optimistic almost to a fault. "Related to Clinton's energy, enthusiasm, intelligence and devotion to policy is a cluster of more problematic traits -- absence of self-discipline; hubristic confidence in his own views and abilities; and difficulty in narrowing his goals, ordering his efforts and devising strategies for advancing and communicating the ends he seeks to achieve" (Greenstein 594). In addition, Clinton took on many responsibilities, impeding his ability to focus soley on healthcare. Arrogant, and perhaps hard headed, President Clinton continued to back his own plan. The further alienated support by pledging to veto any bill that did not provide universal coverage (alternative plans) in his 1994 Sate of the Union Address. This delay played a crucial part in the demise of the reform. It allowed opposition time to organize and mobilize public opinion against the plan (Reynolds).

Clinton was slow to pass health reform. During his campaigning, he promised to have a healthcare bill ready within the first 100 days in office, but in reality, it took over 9 months to prepare the bill. Clinton's failure to mobilize during the "honeymoon period" impeded his ability to get the bill passed. By the time Clinton presented a plan to Congress, more than 500 lobby groups had bombarded the administration on the topic of health reform (Langbert 641).

His delay, itself, was not all his fault. The administration’s health reform plan was halted for nine months because of concerns about getting the budget reconciliation bill passed. Clinton thought he had enough votes to pass the budget bill, but key senators back out. The bill was tied to the health reform and thus, nothing went through. Instead of reaching out to moderate Democrats and Senate Republics, Clinton refused to compromise with his health care reform.

When the bill was finally made public, only twenty-one percent of Americans said they knew a lot about Clinton's plan. One month later, only seventeen percent of Americans felt they knew what Clinton's plan was about. That number fell to thirteen percent one month later (Yankelovich 14). He lacked a concrete plan as well as considering the financial costs of such health care reform. The lack of a definitive plan limited the credibility and therefore the efficacy of the Clinton plan.

The future of healthcare reform

One interesting duo has paired up to work on health care reform in the recent months: Hillary Rodham Clinton and Newt Gingrich. "As it turns out, Gingrich and Clinton have a lot more in common now that they have left behind the politics of the 1990s, when she was seen as a symbol of the liberal excesses of the Clinton White House and he was a fiery spokesman for a resurgent conservative movement in Washington" (Hernandez). Although the pairing surprised many people, both Clinton and Gingrich were confident. Clinton stated that "I find he and I have a lot in common in the way we see the problems that we're going to have to deal with in order to have a 21st-century health care system." Gingrich also expressed confidence in the bipartisan nature of their effort, saying that "I'm confident there are things like votes in the Senate and judges where there would be dramatic difference, but I think we're both mature enough as adults that we separate this argument" (Washington Post).

While Clinton was not successful with his national health insurance initiative, there were several programs enacted during the Clinton administration that expanded Medicaid coverage for select groups, especially low-income children.

Specifically, the Balanced Budget Act of 1997 established both the State Children's Health Insurance Program (SCHIP) and an additional Medicaid coverage group for low-income children parallel to the group of children eligible for SCHIP. The two provisions allowed states to choose to extend Medicaid for targeted low-income children, create a new SCHIP program for those children, or coordinate both programs to cover the target population. Targeted low-income children are those who are not otherwise eligible for Medicaid, not covered under a group health plan or other insurance, and are living in families with income that is either: (1) above the state's Medicaid financial eligibility standard but less than 200% of the federal poverty level; or (2) in states with Medicaid income levels for children already at or above 200% of the poverty level. As of August 2004, 33 states cover targeted low-income children under Medicaid. 1997 (MCMXCVII) is a common year starting on Wednesday of the Gregorian calendar. ... The State Children’s Health Insurance Program (SCHIP) is a national program in the United States designed for families who earn too much money to qualify for Medicaid, yet cannot afford to buy private insurance. ... Medicaid in the United States is a program managed by the states and funded jointly by the states and federal government to provide health insurance for individuals and families with low incomes and resources. ...

A Legal Advocate named Gordon Bonnyman has also used the legal system to try to expand health care access. Bonnyman is the executive director of the Tennessee Justice Center, an organization which sues Tennessee to force expansion of the state’s Medicaid plan (TennCare). The program has successfully helped 400,000 people receive insurance. Bonnyman still believes however that the best solution to the health care problems facing this country is to promote universal health care coverage. While he does not think that a single-payer system could work in this country, he suggests an incremental approach which would force both parties to compromise and to stop waiting to find the "perfect" universal health care plan. He also believes that a universal health care plan would eventually save costs.

Jonathan Overland, of Health Affairs, lists some political obstacles to health reform. One is institutional fragmentation. "The structure of U.S. political institutions creates a number of barriers to the passage of any legislation, let alone a reform as controversial, ideologically devisive and threatening to powerful interests as national health insurance" (Overland 3). He also cites the fact that political parties are weaker in the US than anywhere else in the democratic world. The structure of Congress also establishes an "institutional bias in U.S. politics favoring the status quo: traditionally reformerss have had to jump over every legislative hurdle, while opponents have only had to trip them up once to win" (Overlander 3). An unbalanced political areana and the general political culture are also obstacles. He writes that "the three most overlooked lessons from US health politifcs are these: (1) Getting reform onto the national agenda does not mean that it is going to pass; (2) Consensus that a problem exists implies no agreement whatsoever on solutions; and (3) Favorable public opinion does not guarantee legislative victory" (Overland 8).

Yet there still is hope for the United States in passing universal coverage. Current attention and public opinion has been put on national defense and the war on terror. The nation has also expressed high concern for the economic status of the country. As time goes on, America will start to pull out troops form Iraq, and domestic concerns will get more of the spotlight. Fears of the current economic status combined with the inevitable bankruptcy of Social Security, Medicare, and Medicaid, will give great support for health care reform. Also, the examination of the healthcare efforts of Hurricane Katrina has shown the great necessity for reform. Reforms in such a large government expenditure as health care will produce significant effects on the economy, and if done correctly, can help to pull the nation out of its current budget deficit crisis.

References

-- "Gingrich, Clinton Collaborate on Health Care Bill." Washington Post, May 12, 2005.

Blendon, Robert and Benson, John. “Americans' Views On Health Policy: A Fifty-Year Historical Perspective.” Health Affairs 20 (March-April 2001) 2: 33-46

Blendon, Robert J., Mollyann Brodie, and John Benson. "What Happened to Americans' Support For the Clinton Health Plan?" Health Affairs, Summer 1995, pp. 7-23.

Johnson, Fard. 2004. Politics, Propaganda and Public Opinion: The Influence of Race and Class on the 1993 - 1994 Health Care Reform Debate. Master's Thesis, Gallatin School of Individualized Study, New York University, New York.

Johnson, Haynes and David S. Broder. "The System: The American Way of Politics at the Breaking Point," Link, Brown and Company: New York (1997).

Clymer, Adam. "G.O.P. in the House is Trying to Block Health Care Bill." New York Times, A.1, June 17, 1994.

Dark, Taylor E. "The Unions and the Democrats." Cornell University Press, 1999.

Greg, Laurene A. "Health of Nations: Third Edition - An International Perspective on U.S. Health Care Reform." Washington, DC: Congressional Quarterly, Inc., 1999.

Greenstein, Fred, "The Presidential Leadership Style of Bill Clinton: An Early Apprasial," Political Science Quarterly, 108.4, Winter 93-94, p589-601.

Gottschalk, Marie. "The Shadow of the Welfare State: Labor, Business, and the Politics of Health Care in the United States." Cornell University Press, 2000.

Hacker, Jacob S. "National Health Care Reform: An Idea Whose Time Came and Went." Journal of Health Politics, Policy, and Law. Vol. 21, No. 4, pp. 647-690.

Hernandez, Raymond. "New Odd Couple: Hillary Clinton and Newt Gingrich." The New York Times. May 14, 2005.

Langbert, Mitchell and Frederick Murphy. "Health Reform and the Legal-Economic Nexus." Journal of Economic Issues. Vol. 29, No. 2, pp. 639-650.

Martin, Cathy Jo. "Nature or Nurture? Sources of Firm Preference for National Health Reform." The American Political Science Review. Vol. 89, Issue 4, pp. 898-913.

Overlander, Jonathan. "The Politics of Health Reform: Why Do Bad Things Happen to Good Plans?" Health Affairs, Aug 27, 2003. Quadagno, Jill. "One Nation, Uninsured." Oxford University Press, 2005.

Reynolds, William A, FACP. “Health Care Reform: How Bright Prospects Plummeted.” <http://www.acponline.org/journals/news/may97/plummet.htm>

Schneider, William. "Political Pulse--Health Care Reform: What Went Right." National Journal. Oct. 2, 1993.

Starr, Paul. "What Happened to Health Care Reform?" The American Prospect, No. 20, Winter 1995.

Milton Terris. “National Health Insurance in the United States: A Drama in Too Many Acts" Journal of Public Health Policy 20 (1): 13-35.

Yankelovich, Daniel. "The Debate That Wasn't: The Public and the Clinton Plan." Health Affairs. Spring 1995, pp. 7-23. Daniel Yankelovich, born 1924, is a public opinion analyst and social researcher. ...

See also

• Healthcare reform
• U.S. health reform 1912-1920
• U.S. health reform under FDR
• U.S. health reform under Truman
• U.S. health reform under Nixon
• U.S. health reform under Carter
• U.S. health reform under Clinton