By Bob Cusack - 01/24/10 05:27 PM EST
Democrats have taken great pains to avoid the healthcare missteps Bill Clinton made, but this year is looking more and more like a rerun of 1994.
Healthcare reform in the 111th Congress is a long way from dead, but it’s closer than it ever has been to being six feet under.
Following that devastating blow to the White House, some Democrats on Capitol Hill pronounced the House- and Senate-passed bills as dead.
Obama quickly floated an idea of focusing on the “core elements” of healthcare reform. Some House Democrats quickly embraced the idea, saying they want to pass health reform on a piecemeal basis.
No final decisions have been made, but a scaled-back bill is a leading option.
Similarly, in 1994, after comprehensive reform was deemed off the table, President Clinton urged the Democratic-led Congress to pass a streamlined measure.
Talks lingered for months. In August of 1994, then Senate Majority Leader George Mitchell (D-Maine) said, “[Healthcare reform] clearly will not be a bill as comprehensive as I would prefer, but there’s much that can be done that would represent progress.”
Days earlier, then House Speaker Thomas Foley (D-Wash.) said he was interested in pursuing a bill that made steps toward insurance reform, cost controls and universal coverage.
It didn’t work. On Sept. 26, 1994, Mitchell acknowledged that health reform was dead. The demise of healthcare legislation was especially stunning because Clinton, like Obama, worked with a Congress with strong Democratic majorities in both chambers.
Marilyn Moon, vice president and director of the health program at the American Institutes for Research, said there is a clear reason why incremental reform didn’t work then and why she is dubious of its chances in 2010.
“In 1993, [the bill] was a house of cards. I think that’s pretty much true today,” Moon said, explaining that it is difficult to pass a limited measure without having it negatively affect another part of the healthcare system.
Healthcare experts like Moon note that insurance reforms could very well backfire without an individual or employer mandate. If healthy individuals aren’t in the so-called risk pool, premiums for many Americans will increase, experts say.
Moon said there are similarities between 1994 and 2010, citing finger pointing and accusations of Republican obstructionism as well as the Democrats mulling a Plan B of playing small ball on healthcare.
Joe Antos, a former Congressional Budget Office employee who works at the American Enterprise Institute, believes healthcare reform is dead.
“Obama blew his historical opportunity,” Antos said, adding it’s possible comprehensive health reform could pass years from now if Obama is reelected.
Asked about parallels between 1994 and this year, Antos laughed, saying, “It’s human nature and politics. Of course we’re repeating history. Human nature and politics don’t change.”
Like Moon, Antos sees policy hurdles in a scaled-back bill, calling its chances of enactment “highly iffy.”
Obama this week made it clear that he is far from throwing in the towel. But gone is some of the bravado of last year, when he said, “Failure is not an option,” and “Don’t bet against us.”
Unlike 1994, the healthcare reform debate is unlikely to drag into the fall. Healthcare experts believe any major push has to come soon after Obama’s State of the Union address on Wednesday, citing widespread healthcare fatigue on Capitol Hill.
Lawmakers agree. On Thursday, Sen. Charles Schumer (D-N.Y.) said, “I don’t think we want to do healthcare the next three months.”
Moon pointed out that a difference between 1994 and 2010 is that Obama realized that he needed industry partners on health reform. Industry opposition helped defeat the 1994 legislation.
Another difference is that Clinton proposed a specific healthcare plan while Obama left the details up to Congress. Even though Democrats this Congress have attracted criticism for a lack of transparency on healthcare, the process has been far more open than it was under Clinton, Moon said.
“Damned if you do, damned if you don’t,” Moon said.
Three days after Mitchell said Congress would not pass health reform in 1994, Hillary Rodham Clinton – tapped by her husband to lead the overhaul – refused to give up.
At the time, she said, “This journey is far from over.”
But the GOP takeover of Congress a month later ended the Democrats’ plan for universal coverage. Bill Clinton later worked the Republican-controlled Congress to pass health bills, including the Health Insurance Portability and Accountability Act of 1996.