With her solid victory over Vermont Sen. Bernie Sanders in the New York presidential primary Tuesday, Hillary Clinton took a big step toward clinching the Democratic Party nomination and taking her ambitious healthcare agenda into the November general election.
But Sanders and many of his supporters continue to debunk her commitment to progressive healthcare and social change and belittle her claims of past achievements. They point to her failure in the mid-1990s as field marshal for the Clinton administration's healthcare reform effort to win passage of universal coverage legislation as proof of her ineffectiveness and timidity in confronting powerful special interest groups.
“What Secretary Clinton is saying is that the United States should continue to be the only major country on earth that doesn't guarantee healthcare to all of our people,” Sanders said during a debate last month.
“I do believe in universal coverage,” Clinton shot back. “Remember, I fought for it 25 years ago.”
Millennial voters, who have skewed heavily toward Sanders in the Democratic primaries and tend to scoff at Clinton's record, are too young to know her history. Even Baby Boomers are prone to forgetting it. It seems like a good time to revisit Hillary Clinton's healthcare story.
Two people with first-hand knowledge of that story are Neera Tanden, CEO of the Center for American Progress, a liberal research and policy group based in Washington, and Fran Visco, executive director of the National Breast Cancer Coalition. Both say the Hillary Clinton they know is nothing like the self-serving politician described by her critics.
Tanden—who served as a senior policy adviser to Clinton when she was first lady, legislative director when Clinton was in the Senate, and policy director when she ran for president in 2008—emphasizes Clinton's tireless work as first lady in helping pass and implement the State Children's Health Insurance Program, which now covers 8 million kids. It's widely acknowledged that Clinton played a pivotal role in building congressional and White House support for the 1997 passage of that legislation.
She pushed her reluctant husband to support $24 billion in funding for the new program in the Senate bill, rather than the $16 billion approved by the House. "The children's health program wouldn't be in existence today if we didn't have Hillary pushing for it from the other end of Pennsylvania Avenue," Democratic Sen. Ted Kennedy, who co-authored the CHIP bill with Republican Sen. Orrin Hatch, told the Associated Press in 2007.
Tanden's account of Clinton's CHIP implementation efforts squares with her sometimes-mocked image as a detail-oriented policy wonk. Hillary was the person in the Clinton administration most focused on outreach and enrollment for the new children's insurance program, bringing together private-sector officials from the Ad Council and AT&T to organize advertising and a toll-free line to get information out to the public, Tanden said.
“She recognized this legislation would stand or fall on whether people knew about it and signed up kids,” Tanden says. “She rolled up her sleeves and figured out how to get a high take-up rate. The amount of free advertising we got for CHIP was monumental given that we had no resources.”
Even when she was running for Senate in 2000, Clinton still checked up regularly on the CHIP enrollment rate, just as she closely monitored the progress of the Affordable Care Act legislation—and lobbied Democratic lawmakers to support it—in 2009 when she was secretary of state, Tanden says.
“After the CHIP bill passed, she didn't just rest, she kept at it,” Tanden said. “Healthcare is very close to her heart.”
The CHIP legislation was just one of several ambitious healthcare initiatives Clinton worked on. In the Senate, she developed comprehensive healthcare quality legislation, which included precursors of accountable care organizations and other payment reform models, though it did not pass. “Very early on, she was talking about the problem that we have a sick care system rather than a system of keeping people healthy,” Tanden said. “She was a leading thinker on a lot of these issues.”
Clinton also was ahead of the curve on health information technology. In 2003, she introduced the Health Information for Quality Improvement Act, which called for a new office to create a national health information infrastructure including patient safety, privacy, and interoperability initiatives. The following year, the Bush administration established the Office of the National Coordinator for Health Information Technology.
The breast cancer coalition's Visco recalls first meeting Clinton just before her husband was elected president in October 1992. She was struck by how much Clinton cared about the issue of breast cancer and how much she knew about policy relating to the disease. With the first lady's support, the coalition succeeded in persuading Congress to increase federal funding for breast cancer research from $100 million a year to more than $400 million, with some of that funding going to the Defense Department.
But the Pentagon didn't want to spend money on the breast cancer research program. “So we went to Hillary Clinton, and she went to the president and made it happen,” Visco said. “She was our ally from Day 1. I've never known her to be cautious when it came to doing the right thing.”
Tanden particularly debunks the criticism from Sanders and his supporters that Clinton has kowtowed to powerful industry groups. “I find that so ridiculous,” she says, pointing to Clinton's losing battle with the health insurance industry in 1993-1994 to pass comprehensive healthcare reform. “She wasn't worried about sacred cows in insurance. They spent a ton of money against her.”
“She always tries to think about what's best for families,” Tanden continues. “She's been a fearless advocate for taking on special interests (when they are) in direct conflict with families. She thinks about these things in terms of the difference it makes in someone's life.”
It remains to be seen if Clinton can make her case to voters as compellingly as Tanden and Visco make it. The candidate herself is painfully aware of her shortcomings as a communicator. “I am not a natural politician, in case you haven't noticed, like my husband or President Obama,” she said in the March debate. “I just have to do the best I can” and “hope that people see that I am fighting for them.”