The recent release of Clinton administration papers by the Clinton Presidential Library has raised speculation that then-First Lady Hillary Clinton opposed a central tenet of the Affordable Care Act while trying to sell Bill Clinton’s health care reform bill.
In a speech to Democrats in 1993, Hillary Clinton characterized the individual mandate to purchase coverage — then a centerpiece of the GOP’s counter-proposal — as a “much harder sell” than her husband’s requirement for employers to provide coverage to their employees. “That is politically and substantively a much harder sell than the one we’ve got,” Clinton said. “Because 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.”
Critics, eager to highlight Clinton’s disapproval of a provision in President Obama’s health care law and create a rift between Clinton’s own 2007 campaign proposal — which included the individual requirement — pounced. The RNC blared, “HILLARY CLINTON DISPARAGED THE INDIVIDUAL MANDATE BEFORE SHE ADOPTED IT IN 2008 AND IN OBAMACARE.” Politico headlined, “Hillary Clinton dissed individual mandate, docs show.” “Clinton criticized individual mandate,” The Hill reported.
But that’s just not true — not by a long shot. The administration’s 1993 health care proposal, Health Security Act, relied heavily on an employer mandate, but it also included an individual responsibility component. “In accordance with this Act, each eligible individual (other than a Medicare-eligible individual) must enroll in an applicable health plan for the individual, and must pay any premium required, consistent with this Act, with respect to such enrollment,” section 1002 (a) states. Individuals who did not enroll in a plan would have been auto-enrolled in insurance once they sought health care services and paid twice the back premium in penalty.
“[T]he individual will be responsible for making a contribution, but the employer will also be supporting that contribution,” Clinton explained during testimony before the Senate Finance Committee in 1993. “Every individual will have to take responsibility and pay something, and that is where two-thirds of the financing for premiums will come from.” In a back-and-forth with former Sen. John Chafee (R-RI) — the architect of the Republican alternative — Clinton conceded that the administration’s proposal includes the individual requirement:
SEN. JOHN H. CHAFEE (R-RI): Your plan does have an individual mandate to the extent of the 20 percent.
MRS. CLINTON: Yes, sir.
SEN. CHAFEE: In other words, the individual is responsible for paying a portion of his or her — the employee — insurance. Whereas ours makes the individual 100 percent, yours makes him 20 percent. So it’s a difference of degree more than the total difference.
MRS. CLINTON: That’s right.
Former Clinton administration officials who worked closely with administration in drafting the proposal explained that the Clintons strongly disagreed with the GOP’ push to require individuals to pay for all of their health care costs and sought to build on the existing health care system and bolster the role of the employer in providing coverage. As Hillary Clinton explained before the Committee, the administration feared that without a companion employer requirement, “the numbers of people who currently are insured through their employment will decrease, because there will no longer be any reason for many employers who have struggled to ensure their workers.”
“People remember the employer mandate in the Clinton plan, but it had both,” Judy Feder, a Georgetown professor who helped craft the Clinton plan, told ThinkProgress. “Hillary Clinton has been on this for years.”
The former first lady was also prescient about the politics of the individual requirement. Public opinion polls from the time showed that most Americans believed that employers should contribute to their employees’ health care coverage, leading Republican leadership to quickly sour on their own alternative. As Sen. Bob Dole admitted on Meet The Press, the “individual mandates aren’t going to pass.” “I see about three votes for individual mandates on the Finance Committee.”