Is Ronald Reagan Responsible For 1,990 Page Health Bill?

Republicans responded to the release of the House health bill by criticizing the sheer size of the legislation. House Minority Leader John Boehner (R-OH) began the Republican press conference by carrying out the 1,990 page bill and positioning the stack between the two microphones on the podium, in full view of the cameras.

“Now tell me how we’re going to fix the health care system with 1,990 pages of government bureaucracy. Now this is what the American people have been saying over the last few months, ‘enough is enough,'” he said.

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The original Medicare legislation was a mere 15 pages. Today, Congress regularly produces legislation that that is thousands of pages long. So what happened? It’s the result of the “polarization of American politics,” Congressional historian Ross Baker told the Wonk Room. In the last 50 years, “the total number of pages of legislation has gone up from slightly more than 2,000 pages in 1948 to more than 7,000 pages in 2006.”

The trend started during the 1980s, once the Regan administration began padding various committees with industry cronies and taking full advantage of the vagueness of the legislative language. Congress began writing longer bills to ensure that its intent would be properly enforced. Lesley Russell, currently a visiting Fellow at the Center of American Progress, but at the time a member of the professional staff of the House Energy and Commerce Committee, recalls how in 1987, her committee, along with Ways and Means, produced an unusually large bill governing nursing home regulations.

The Reagan administration had sought to “repeal the federal rules that governed nursing homes,” including “basic requirements that nursing homes maintain a safe and sanitary environment and respect the privacy and dignity of residents.” Congress enacted moratorium prohibiting the repeal and the Institute of Medicine was commissioned to study the conditions of nursing homes.

The report concluded that “individuals who are admitted receive very inadequate — sometimes shockingly deficient — care that is likely to hasten the deterioration of their physical, mental, and emotional health,” and Congress responded by writing “broad reform legislation, commonly referred to as the Nursing Home Reform Act.” For the first time, “the law placed a new focus on resident rights. It gave nursing home residents the right to choose a personal attending physician, to participate in planning their own care and treatment, and to be free from physical and mental abuse, corporal punishment, involuntary seclusion, and “any physical or chemical restraints imposed for purposes of discipline or convenience.”

“We knew, when we were writing this needed legislation, that it was intrinsically opposed by the administration and so we were very conscious of the need to insure that all the provisions were fully enacted as Congress intended,” Russell said. “This is my earliest recollection of Congress deliberately putting a lot of detail into legislative language,” Russell said.

Baker explained that large multi-paget bills allow Congress to hide controversial provisions, but dismissed the oft-cited argument that smaller bills would help the public better digest legislation and enhance the Democratic process. “It’s a quaint thought to think that the public would read smaller bills,” but there is really no correlation between the size of the bill and the willingness of Americans to read it, he insisted.