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First lady Hillary Rodham Clinton greets delegates at the American Medical Association's annual meeting in Chicago on June 13, 1993, to discuss health care reform. First lady Hillary Rodham Clinton greets delegates at the American Medical Association's annual meeting in Chicago on June 13, 1993, to discuss health care reform.

First lady Hillary Rodham Clinton greets delegates at the American Medical Association's annual meeting in Chicago on June 13, 1993, to discuss health care reform.

Steve Contorno
By Steve Contorno May 21, 2014

Was Hillary Clinton against the individual mandate during the 1990s?

Louisiana Republican Gov. Bobby Jindal still thinks the Affordable Care Act is unworkable and he found an unlikely ally to help him criticize the law: Hillary Clinton.

Before you stop the presses or get Wolf Blitzer ready in the Situation Room, there’s an important twist: Jindal was quoting Clinton from 1993.

In an op-ed for Politico, Jindal rehashed his opposition to the individual mandate that requires most Americans to purchase health insurance, a key tenant of President Barack Obama’s health care law. And he noted that Clinton was once against it, too.

"It is a well-known fact that Clinton came to strenuously support an individual health insurance mandate in her 2008 primary campaign against Barack Obama," Jindal wrote. "Less well-remembered, however, is that Clinton considered an employer mandate — not an individual mandate — the best way to achieve ‘universal coverage’ in her health care task force’s ill-fated 1993 proposal, put forth while she was first lady."

Twenty years have passed since the Clintons’ unsuccessful attempt at health care reform, but hey, we live in the days when hologram Michael Jackson performs on stage. So maybe what’s old is new again, and a trip to the ’90s is just what we need.

The Clintons go to Washington

In 1993, Hillary Clinton led a task force created by her husband, President Bill Clinton, with the goal of reforming the health industry and providing care for most of the population.

On Sept. 22, 1993, President Clinton gave a speech where he laid out his proposal based off the task force’s findings. Universal coverage, he said, could be achieved by requiring all employers to provide insurance to workers.

First Lady Clinton then testified on the Hill for several days to explain and defend the plan before a handful of congressional committees. Clinton said that the administration settled on an employer mandate, rather than instituting a broad-based tax similar to Medicare, or an individual mandate, which a handful of Republicans had offered as a means of achieving universal coverage.

We listened to several hours of Clinton’s testimony and read many news accounts from 1993. We can say with confidence that Jindal is right: Clinton opposed delivering universal coverage entirely through an individual mandate and supported an employer mandate instead.

But Jindal also picks out a couple of Clinton’s concerns and tries to tie them to current events, as though her comments in 1993 foreshadowed Obamacare’s impact on the health care industry. Perhaps Clinton’s misgivings are relevant to today’s debate, but not how Jindal portrayed them.

For example, as Jindal notes, Clinton testified she thought employers may see the individual mandate as an opportunity to forgo providing their employees insurance and push them instead to the new individual market.

Jindal tries to link this comment to the millions of individuals who had their policies canceled last year due to minimum requirements in Obamacare (which, he notes, contributed to PolitiFact’s Lie of the Year). Clinton’s concerns, though, have nothing to do with what happened to those people. The millions who had their policies canceled or changed last year bought plans from an independent provider, not through their employer.

Clinton also thought employers might feel pressure under an individual mandate to keep wages low so employees would qualify for government-paid subsidies to purchase insurance on the private market. Jindal wrote, "That sounds a lot like what the Congressional Budget Office concluded in February: that Obamacare will reduce the labor force by the equivalent of 2.3 million workers, because employers will not raise wages and individuals will choose not to work in order to retain access to government insurance subsidies."

That’s not what exactly what the CBO said, as we’ve noted on multiple occasions. People aren’t leaving jobs as part of a ploy to make themselves eligible for subsidies. Rather, the CBO said that the availability of affordable insurance would make it possible for individuals to voluntarily cut back hours or quit jobs they stayed in only for the health insurance (like someone with a pre-existing condition who previously could not get coverage on the private market and was working just for the insurance).

It’s worth noting, too, those weren’t Clinton’s only concerns. She also said that the existing private insurance system was heavily reliant on employer-provided coverage and an employer mandate would be the "least disruptive" and most familiar to people.

Over the last two decades, though, fewer individuals are receiving health care benefits from their employer. It’s still a plurality of Americans, but it has dropped steadily. In 1997, nearly 65 percent of individuals bought their insurance through their employer; in 2010 it was 56.5 percent, the U.S. Census said, and continues to decline. Kaiser Family Foundation, the non-partisan health experts, estimates it’s down to 48 percent of the population.

Clinton also worried that government couldn’t create a system to pull off the individual mandate. She had "great concerns about how the administrative structure to track the individual contribution, to collect it and to then connect it with health insurance would be set up." Such a system, she said, would be "extremely complicated and bureaucratic."

The technology the Obama administration utilized (eventually) to create a new market for buying and selling private health insurance is inconceivable to anything Clinton could have imagined back when the World Wide Web was an infant. That may have assuaged some of her concerns about the bureaucratic and logistical hurdles. Though, as Obama can attest, even with the technology, it hasn’t been easy.

Finally, we noticed Clinton wasn’t all that down on the individual mandate, an idea promoted by moderate Republicans like Sen. John Chafee, R-R.I. She said it was "in the same ballpark" as her plan because it was a means to universal coverage. It just wasn’t her prefered pathway. She was more critical of alternatives offered by conservative Democrats that did not include any mandates at all.

Our ruling

Jindal said that in supporting an employer health insurance mandate in 1993, Clinton opposed an individual mandate. We think readers would be wise to review the red flags we raised surrounding Jindal’s characterization of Clinton’s comments and how they apply to the current state of affairs. But when it comes to reciting history, Jindal is largely accurate. Clinton had serious misgivings about an individual mandate to buy health insurance, and strongly preferred an employer-based model.

On that point, we give Jindal a Mostly True.


Our Sources

Politico Magazine, "What Hillary Knew — In 1993," May 13, 2014

C-SPAN, Hillary Clinton testifies before Senate Finance Committee, Sept. 30, 1993

C-SPAN, Hillary Clinton testifies before House Committee on Energy and Commerce, Sept. 28, 1993

Email interview with Mike Reed, spokesman for Gov. Bobby Jindal, May 16, 2014

Email interview with Paul Starr, Professor of Sociology and Public Affairs at Princeton University, May 19, 2014

Email interview with Gail Wilensky, economist and senior fellow at Project HOPE and form director for Center for Medicare and Medicaid Services under President George H.W. Bush, May 19, 2014

Phone interview with Henry Aaron, senior fellow at the Brookings Institute, May 19, 2014

PolitiFact, "John Boehner says Obamacare is ‘expected to destroy 2.3 million jobs,’ Feb. 5, 2014

PolitiFact, "NRCC says Congressional Budget Office predicts Obamacare will cost economy 2.5 million jobs," Feb. 14, 2014

PolitiFact, "Facebook post says Republicans embraced individual mandate in 1993," April 19, 2012

Kaiser Health News, Summary Of A 1993 Republican Health Reform Plan, Feb. 23, 2010

Kaiser Health News, The Democrats' 2010 Health Reform Plan Evokes 1993 Republican Bill, Feb. 23, 2010

Library of Congress, S. 1757 Health Security Act, accessed May 19, 2014

University of Dayton School of Law, Description of Health Security Act, Accessed May 19, 2014

Center for the Study of the Presidency and Congress, President Clinton’s Health Care Reform  Proposals of 1994, accessed May 19, 2014

Harvard University Center for Business and Government and John F. Kennedy School of Government, "Health Policy in the Clinton Era: Once Bitten, Twice Shy," May 2001

U.S. Census, Employment-Based Health Insurance: 2010, February 2013

Gallup, "Fewer Americans Getting Health Insurance From Employer," Feb. 22, 2013

New York Times, Transcript of President's Address to Congress on Health Care, Sept. 23, 1993

New York Times, "Hillary Clinton Attacks Health Plans Offered by Conservative Democrats," Nov. 9, 1993; accessed via Nexis search May 19, 2014

Los Angeles Times, "Clinton proposes sweeping coverage in health care plan," Sept. 11, 1993; accessed via Nexis search May 19, 2014

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