The Attempt at “Health Care Security”

Pressures for reform began simmering again in the early 1990s as more and more Americans found themselves uninsured or otherwise unable to pay their health care bills. These problems led U.S. President William J. Clinton to propose his Health Care Security Act (HCSA) in 1993. The HCSA represented a liberal approach to health care reform. If adopted, the act would have broadened access to care without seriously threatening the basically entrepreneurial nature of the U.S. health care system or the power of the “big players” in health care. Under the HCSA, Americans still would have received health insurance from many different insurers, retaining the complexity and costs of the current system. Wealthier Americans would have retained the right to purchase health care options unavailable to others, so health care would have remained a two-class system. And the proposal included no oversight mechanisms to restrain the costs (and profits) of hospital, drug, or medical care.

Nevertheless, opposition to the plan was fierce, especially from the insurance industry, which poured millions into fighting the bill. Moreover, the sheer complexity of the bill made it easier for opponents to raise fears among the American public, which since the 1980s had increasingly distrusted “big government”. In the end, Congress rejected the bill. However, Congress did approve passage of the State Children’s Health Insurance Program (SCHIP). That program has extended coverage (primarily through Medicaid) to many children under age 18 whose families earned too much to qualify for Medicaid but too little to pay for health care on their own. Still, millions of Americans were left without access to health care.

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