The biggest obstacle back then was not Republican opposition, though that was strong. It was convincing Democrats to unite around a bill—which Democrats finally were able to do 17 years later. A bloc of about three dozen conservative House Democrats led by Tennessee congressman Jim Cooper was the biggest hurdle for the Clintons. Most pundits and journalists today forget that.
White House aide Chris Jennings, in a memo to Hillary Clinton, urged that special attention should be paid to Cooper, who wanted to expand insurance coverage without a mandate on employers to provide coverage. “As the intellectual father of the … managed competition plan, he is becoming increasingly concerned that his viewpoints are being ignored,” Jennings wrote. “He could be a problem, particularly in the press, if we don't get him to at least feel we are considering his opinions.”
But as one indicator that the political environment was less hostile in 1993-94 than it was in 2009-2010, Jennings wrote that some Republicans were open to working with the White House on passing reform.
“The Republicans are finding themselves in a dilemma,” he wrote in a May 1993 memo to Hillary Clinton. “Many do not particularly want to help the President, but many also believe they cannot be perceived to be standing in the way of health reform. In addition, there is a significant number of Republicans who sincerely want to participate in shaping the response to the health care crisis.”
Another problem is that the Clintons were trying to sell a complicated, market-based plan when many Democrats really wanted some form of a government single-payer model funded by taxes. “It would be a lot simpler if we thought a payroll tax was an alternative and would be politically more acceptable to people than the premium system. But it is not,” Hillary Clinton told the Democratic leaders, according to the transcript.
In prescient comments, Hillary argued that the individual mandate model proposed by moderate Republicans led by Sen. John Chafee of Rhode Island would be politically and administratively more complicated than the employer-mandate model the administration proposed. She called the individual mandate—later to become the controversial centerpiece of Obamacare—a “much harder sell,” she told congressional Democrats.
“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,” she said.
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