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Clintons’ 1993 Health-Care Strategy Show Obama Pitfalls

Hillary Clinton sought to improve the chances of passing health care legislation in 1993 by letting Congress fill in the details, according to documents made public today by the Clinton presidential library.

The legislative strategy from the first weeks of Bill Clinton’s presidency relied on the first lady making lawmakers and major stakeholders feel included in the development of legislation. By proposing broad outlines and ideas for a bill, while letting lawmakers know what the White House considered “off limits,” the administration foresaw a winning process.

Instead, the Clinton health care proposal withered. Members of Congress held it up in the committee process and interest groups complained of being excluded anyway.

The experience informed President Barack Obama’s strategy when he rolled out his health care plan upon taking office in 2009 and framed her advice to the administration as the process got under way. Obama won passage with no Republican support and by pushing his version even as members of his party worried about the consequences for their re-election and the rest of the president’s agenda.

“If the administration drafts a detailed bill and sends it to the Congress with a ’here’s the bill, there’s not much time, take it to the floor quick’ approach” the bill might fail because of lawmakers feeling excluded, according to notes among the documents released today titled “Discussion with Hillary Clinton” and dated Jan. 28, 1993, written the White House’s top health care official, Ira Magaziner.

Including Congress

Trying to dictate details of the legislation would mean “many Members would feel excluded from playing a role in the refinement of the bill [and] interest groups will object that their concerns, even those that are small or reasonable, have been excluded,” he wrote.

Today’s document release, the second of its kind this year, provides new insight into how then-first lady Hillary Clinton and top White House aides approached their attempt to pass a health care law, one that ultimately failed.

If she runs for president in 2016, Republicans are certain to use Hillary Clinton’s health care effort two decades ago to reinforce her ties to Obama’s Affordable Care Act, which has been the centerpiece of Republican attacks on Democrats.

Last month, the Republican National Committee released a memo arguing that “Hillarycare is Obamacare on steroids.”

For her part, Clinton, 66, who lost the 2008 Democratic nomination to Obama and then became his first secretary of state, has been trying to put a little daylight between herself and Obama’s law.

Making Changes

“I would be the first to say if things aren’t working, then we need people of good faith to come together and make evidence-based changes,” she said in remarks to the Healthcare Information and Management Systems Society in Orlando, Florida, last month, according to CNN.

The political strategy for advancing the 1993 bill is evident throughout many of the documents. That includes a March 1993 memo to Hillary Clinton about a two-day White House hearing designed to show that the health care task force she headed was considering outside viewpoints.

“As we discussed, the primary goal for this two day hearing would be to inoculate ourselves from charges that we are refusing to listen to all those groups out there that want input,” Alexis Herman and Mike Lux, top officials in the White House office of public liaison, wrote. “It’s important to understand that even with two long days of testimony, we will not be able to schedule everyone we want to schedule.”

Rating Members

The memos also include White House officials’ view of leading Democratic members of Congress. Then-Representative Fortney “Pete” Stark of California was characterized as a force who had been given wide latitude by the House Ways and Means Chairman Dan Rostenkowski of Illinois. Stark’s abrasive style had made him “probably one of the most disliked” members of Congress, according to a memo written by Chris Jennings, who until recently was a top health care adviser to Obama.

Representative Henry Waxman of California is described by Jennings as “likely to be less concerned with how it is achieved -- be it a managed competition framework or some other approach -- as long as the system provides universal access and enforceable cost measures.” He was likely to be an administration ally if “handled right.”

The original framework for what became known derisively as “Hillarycare” was laid out in bullet points in Magaziner’s notes on his discussion with Hillary Clinton.

“If the Administration proposes major principles and works with the committees on the details, the process will go smoother and faster than any other approach,” Magaziner concluded.

President Clinton had no illusions about the minefield he was sending his wife into when he tapped her to head his health care overhaul effort.

“I am grateful that Hillary has agreed to chair this task force and not only because it means she’ll be sharing some of the heat I expect to generate,” he said in public remarks to reporters on Jan. 25, 1993.

The Clinton library, in Little Rock, Arkansas, has said it will release two more sets of documents in the coming weeks.

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