Clinton on Health Care, Take 2: Plan Mandates Coverage for All By LAURA MECKLER
September 15, 2007; Page A1 [Wall Street Journal] Thirteen years after Hillary Rodham Clinton's plan for health care went down to disastrous defeat, she is back with a new proposal that again seeks to cover all Americans but reflects some lessons learned. The Democratic presidential candidate is set to unveil her new approach in Iowa Monday, and she will include a requirement that everyone get health insurance. A big difference from last time: She's proposing to build on the existing system of insuring Americans -- a mix of private coverage and government-subsidized care -- not remake it altogether. Still, Mrs. Clinton's plan, described by people familiar with it, would involve sweeping change. It would create new federal subsidies to aid those who couldn't afford the required health coverage. And it would impose new mandates on large employers to provide health coverage or help pay for it. That will surely trigger sharp criticism from conservatives branding her plan government-dictated "HillaryCare" and comparing it to the unwieldy overhaul she proposed 13 years ago during her husband's presidency. Yet she may find Americans more receptive to an expanded federal role in health care, as the national mood has changed since the 1990s and states have experimented with universal-coverage plans. The number of people without insurance has risen to 47 million from 39.7 million in 1993, and insurance premiums have doubled for those with coverage. Mrs. Clinton's two principal rivals for the Democratic nomination, John Edwards and Barack Obama, both have comprehensive plans that, like Sen. Clinton's, build on action in the states and place mandates on employers. Republicans Mitt Romney and Rudy Giuliani also have detailed their more market-oriented approaches. Mr. Romney would rely on the states to lead change; Mr. Giuliani wants changes to the federal tax code that would make it easier to buy coverage on the open market. But no candidate has been as closely watched on the issue as Mrs. Clinton. Health care and Iraq are likely to be the two central issues that define how the New York senator's candidacy is perceived by voters and key constituencies from labor to business. On the presidential campaign trail, Sen. Clinton regularly mentions her scars from the 1993 effort, saying it gave her the experience to get the job done this time. Aides say she is diligently implementing battle lessons. Chief among them: Assure people who already like their coverage that they can keep it, and that her plan still offers something for them. To that end, she first offered detailed proposals on reducing health-care costs and improving quality, before moving on to address how she would expand coverage to those who don't have it. Officials at the Clinton campaign declined to discuss details of the proposal Sen. Clinton is scheduled to release Monday. While people familiar with it said the outline is in place, details could change over the weekend. Sen. Clinton has telegraphed that, unlike last time, she would be willing to compromise to get a deal. She regularly cites the importance of developing consensus. In recent months, she has met with dozens of executives at large corporations to talk about health care, hoping to forestall a backlash during her campaign and, if she wins, her presidency. Robert Galvin, director of global health care for General Electric Co., met with her in a small group a few months ago. He says she hit a "home run" in understanding business and its concerns. "I saw in there someone who came out of a tough experience in the '90s wiser, more patient, and with a real understanding of the complexities and how every stakeholder had to have some win," says Mr. Galvin. The Clinton 2007 health plan is likely to be less threatening to the insurance industry, which helped kill her earlier plan. Mrs. Clinton's rhetoric denouncing the industry remains sharp -- but her plan is less so. Last time, she proposed caps on premiums to hold down costs and a system under which insurance companies would be required to bid for regional business. This time, insurance companies would be required to sell a policy to anyone who applied and would be barred from charging sick people more. But they wouldn't face limits on how much they could charge for premiums generally. The most significant element of the Clinton plan is expected to be a new requirement for all Americans to have insurance. That disturbs some liberals, who worry that low-income families won't be able to afford it, as well as some conservatives, who object to such a sweeping government mandate. But many health-policy experts say it's essential that everyone be in the insurance system so that healthy people with low medical costs can balance out the sick. Sen. Edwards, too, has proposed an individual mandate; Sen. Obama has not. Gov. Romney supported the mandate when he was governor of Massachusetts but has not endorsed it nationally. To help people get insurance, Sen. Clinton would establish federal subsidies for lower-income Americans and create new pools where individuals and small businesses could shop for private health plans. She is also likely to require that some employers, likely large ones, either cover their workers or help pay the cost of their coverage elsewhere. That will be controversial with employers that don't provide insurance, though likely welcomed by those that do. Exempting small business could eliminate opposition from small-business owners, who helped lead the effort to kill the 1993 plan. Sen. Clinton also supports expansion of the joint federal-state Children's Health Insurance Program. Conservatives led by President Bush oppose that, saying it's a step toward government-run insurance for all, in what has become something of a proxy for the larger health-coverage debate. Politically, analysts say the health issue cuts both ways for Sen. Clinton. Polls suggest Americans trust her more than any presidential candidate of either party when it comes to health. A July Gallup poll found that 65% of all voters had a great deal or a fair amount of confidence that she would do the "right thing" for the health-care system. Among Democrats, the figure was 91%. "People see her as very committed to health care and making sure people in this country have coverage," says Bill McInturff, a Republican pollster who worked for opponents of the original Clinton plan and now works for Republican presidential candidate John McCain. Still, he said, Mrs. Clinton is vulnerable among swing voters and Republicans, particularly if she produces a health plan that is seen as too complicated or too government-driven. In certain circles, her name is synonymous with big, government-run health. Republicans regularly deride health care proposals they don't like as "HillaryCare." A summary of Mr. Romney's health care plan, posted on his Web site, contains the word "Hillary" 23 times, attacks her 1993 plan as "socialized medicine" and is headlined, "The Romney Vision: Conservative, Market-Based Health Care Vs. Hillarycare." Sen. Clinton says she has learned her lessons. For one, in 1993 the White House got too mired in the details, delivering to Congress a 1,342-page bill for consideration. By giving so many specifics, the Clintons gave opponents with special interests easy fodder to kill the plan, while the public was bewildered. By contrast, her aides speak admiringly of President Bush's approach on many domestic issues: put out general principles, negotiate the details with Congress and, more often that not, declare victory when a bill reaches his desk. At one stage, Mrs. Clinton's aides considered not presenting a specific plan for covering the uninsured, noting that many Americans thought she had one already. But pressure from other candidates and from the powerful Service Employers International Union persuaded her to come forward. Messrs. Obama and Edwards had criticized her for sticking to generalities even as they offered specifics. Aides say Sen. Clinton knows that the White House erred last time in failing to woo Congress, meaning her plan had few champions on Capitol Hill. In her later White House years, Mrs. Clinton learned to work more effectively with Congress and saw some successes, such as bipartisan passage of the Children's Health Insurance Program. Since winning election to the Senate in 2000, Mrs. Clinton has worked with Republicans on a range of health issues. She allied with Republican Sen. Lindsey Graham of South Carolina on health benefits for veterans, although he had served as a manager of the effort to impeach her husband. She has even exchanged warm words on health with former House Speaker Newt Gingrich, who helped lead the effort to torpedo her 1993 plan. -- Jim Devine / "Segui il tuo corso, e lascia dir le genti." (Go your own way and let people talk.) -- Karl, paraphrasing Dante.
