In 1994, the then First Lady, Hillary Rodham Clinton with Ira Magaziner as her top healthcare guru at her side introduced the Health Security Act. Hillary’s first round with healthcare reform failed and the Health Security Act, which never made it to either house of Congress for debate, went down with not a bang, but a whimper. But did it?
Most political and healthcare analysts agreed this effort had failed because of a total lack of any attempt to establish any grass-roots political organization. Simply, put. Nobody counted the votes. As a result, the opposition (Republicans) took advantage to mobilize unions and labor to oppose the bill. They pounced on Mrs. Clinton’s attempt to force universal health coverage on a nation that socially, at least in elements, agreed, but was not prepared to accept in totality the political ramifications of socialized medicine.
In 2008, in his run to his parties’ nomination for president, Mr. Obama, a neophyte in healthcare policy at the time found himself at a podium debating Mrs. Clinton on a subject matter she knew extremely well, both in policy and politics. The two debated 21 times. Obama offered as one of his staunch change in America agenda planks, universal health coverage for all. Mrs. Clinton dissected this postulate and literally beat him up intellectually as well as in the polls early on in the debates running up to the democratic convention. This forced Obama to study healthcare, he assembled most of her 1994 team to gain perspective, weigh his oratory. And as the debates advanced so did his ability to score points with Mrs. Clinton on healthcare. She, in turn, gained respect for his ability debate and command subject matter. He, as well, commented to his political team that, “Hillary had been right in 1994.”
During the drafting of the Patient Protection Affordable Care Act which was authored in the White House, not Congress, Obama’s team drew heavily upon mistakes made in 1993 and 1994 and set in motion a political machine led by Nancy Pelosi, then Speaker of the House, to get the votes needed in the House as well as a unilateral effort to gain the 60 votes needed in the Senate to pass the ACA. Something, again, Mrs. Clinton failed to do.
Now, on the day that Mrs. Clinton has announced her second presidential bid, make no mistake, she has assembled most of Mr. Obama’s ACA team to enable her to now take it to the next level learning, one could argue, directly from President Obama on his failure to implement the law. Giving two years before enacting the tenets of his legislation has, once again, allowed the GOP to attempt to repeal the act in its entirety. The House of Representatives has already voted over 40 times to do just that. And now the Supreme Court is deliberating to announce its opinion on King v. Burwell which tests the constitutionality of the ACA on subsidies, which according to the plaintiffs limit federal subsidizes to only states that established health insurance exchanges, of which there are only 15. Having paid any to federally run exchanges would therefore, according to their claim, be against the law.
So, we have come full-circle. Obama learning from Clinton, adapting and evolving the Health Security Act basics to propose the Patient Protection Affordable Care Act. And now, Mrs. Clinton inheriting Mr. Obama’s ACA and having to fix its political baggage and implementation struggles.
Today’s New York Times, on the front page, offers a headline that suggests just the opposite. “Clinton Working to Separate Herself from Obama.” That may work for Twitter, in 140 character tweets, but in healthcare Mrs. Clinton and Mr. Obama will be chronicled as co-conspirators or co-defendants. The next shoe to drop will come from Chief Justice John Roberts in June. So, the question I pose is this. Who really establishes healthcare policy in America today? The Executive branch or the Judicial branch of government?