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Health Reform Ideas in the Primeval Soup
Unformatted Document Text:  9 proposals did not find majority coalitions to support them at either the committee or the floor of the House and Senate. Forceful champions, such as Kennedy, were unhappy with the scale and phase in features of the program. This was a factor in pushing Kennedy to seek the 1980 Presidential nomination by running against Carter in the Democratic primaries. 14 The long delayed Carter proposal came too late in the legislative cycle for enactment during the Carter term. By 1979 the national mood was more skeptical of large government programs, and economic and foreign policy problems pushed health insurance out of a preferred place on the legislative agenda. Plus, there was no real consensus around either the Carter plan or any of several alternatives. 15 It is possible that Congress might have enacted a significant health insurance reform bill in 1977 had one been proposed immediately during the honeymoon period most new Presidents enjoy. Many advocates had been waiting for this opportunity for a decade. The window of opportunity closed more quickly than anyone might have anticipated, and the possibility for health insurance reform legislation vanished for more than a decade. 1993-94- A Presidential Window Opening Conventional wisdom among health policy experts identifies the 1991 Senate campaign of Harris Woffard as the push to bring health reform onto the agenda of the 1992 Presidential race, and led to the Clinton plan of 1994. He came from far behind to win a surprising special election victory in 1991. His TV ads advocating health insurance reform were credited as making the difference. 16 More than decade after the last window of opportunity for major health insurance reform, the landscape had changed. Medicare cost containment legislation had passed and was working. 17 A series of Medicaid amendments had passed that increased coverage for pregnant women and children. But, in the world of employment based insurance managed care coverage denials and the fear of job loss was creating dissatisfaction and the growing public view that government ought to do something about health insurance. 18 After a contentious Health Task Force process led by Hillary Clinton, the Clinton health plan was unveiled in a Presidential speech to the joint session of Congress in September 1993. At the heart of the plan was the idea of managed competition promoted by 14 Quadagno, pp.. 129-31. 15 Robert Finbow, “Presidential Leadership or Structural Constraints? The failure of President Carter’s Health Insurance Proposals, Presidential Studies Quarterly, (Winter 1998); Kingdon, op.cit, p 160 and 171. 16 Theda Skocpol, Boomerang: Clinton’s Health Security Effort and the Turn Against Government in US Politics, (NewYork: WW Norton, 1996)pp26-29; Jacob Hacker, The Road to Nowhere: The Genesis of President Clinton’s Plan for Health Security, (Princeton: Princeton University Press, 1997), Chap. 1; Haynes Johnson and David Broder, The System: The American Way of Politics at the Breaking Point, (Boston: Little Brown and Co, 1996), Chap 5 17 David G. Smith, Paying for Medicare: The Politics of Reform, (New York: Aldine, 1992) 18 Jacob Hacker, National Health Care Reform: An Idea Whose Time Came and Went, Journal of Health Politics, Policy and Law (Winter 1996), pp 647-696.

Authors: Brasfield, James.
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9
proposals did not find majority coalitions to support them at either the committee or the
floor of the House and Senate. Forceful champions, such as Kennedy, were unhappy
with the scale and phase in features of the program. This was a factor in pushing
Kennedy to seek the 1980 Presidential nomination by running against Carter in the
Democratic primaries.
14
The long delayed Carter proposal came too late in the legislative cycle for enactment
during the Carter term. By 1979 the national mood was more skeptical of large
government programs, and economic and foreign policy problems pushed health
insurance out of a preferred place on the legislative agenda. Plus, there was no real
consensus around either the Carter plan or any of several alternatives.
15
It is possible that Congress might have enacted a significant health insurance reform bill
in 1977 had one been proposed immediately during the honeymoon period most new
Presidents enjoy. Many advocates had been waiting for this opportunity for a decade.
The window of opportunity closed more quickly than anyone might have anticipated, and
the possibility for health insurance reform legislation vanished for more than a decade.
1993-94- A Presidential Window Opening
Conventional wisdom among health policy experts identifies the 1991 Senate campaign
of Harris Woffard as the push to bring health reform onto the agenda of the 1992
Presidential race, and led to the Clinton plan of 1994. He came from far behind to win a
surprising special election victory in 1991. His TV ads advocating health insurance
reform were credited as making the difference.
16
More than decade after the last window of opportunity for major health insurance reform,
the landscape had changed. Medicare cost containment legislation had passed and was
working.
17
A series of Medicaid amendments had passed that increased coverage for
pregnant women and children. But, in the world of employment based insurance
managed care coverage denials and the fear of job loss was creating dissatisfaction and
the growing public view that government ought to do something about health insurance.
18
After a contentious Health Task Force process led by Hillary Clinton, the Clinton health
plan was unveiled in a Presidential speech to the joint session of Congress in September
1993. At the heart of the plan was the idea of managed competition promoted by
14
Quadagno, pp.. 129-31.
15
Robert Finbow, “Presidential Leadership or Structural Constraints? The failure of President Carter’s
Health Insurance Proposals, Presidential Studies Quarterly, (Winter 1998); Kingdon, op.cit, p 160 and 171.
16
Theda Skocpol, Boomerang: Clinton’s Health Security Effort and the Turn Against Government in US
Politics, (NewYork: WW Norton, 1996)pp26-29; Jacob Hacker, The Road to Nowhere: The Genesis of
President Clinton’s Plan for Health Security, (Princeton: Princeton University Press, 1997), Chap. 1;
Haynes Johnson and David Broder, The System: The American Way of Politics at the Breaking Point,
(Boston: Little Brown and Co, 1996), Chap 5
17
David G. Smith, Paying for Medicare: The Politics of Reform, (New York: Aldine, 1992)
18
Jacob Hacker, National Health Care Reform: An Idea Whose Time Came and Went, Journal of Health
Politics, Policy and Law (Winter 1996), pp 647-696.


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