By John E. McDonough
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Additional resources for Inside National Health Reform
His signature legislation to contain hospital costs passed the Senate and was defeated in the House. 7 Universal coverage reemerged as a compelling political issue in 1993, when Bill Clinton staked his young presidency on achieving national health reform, placing Hillary Rodham Clinton in charge of the cause and a ﬁve-hundred-person White House task force. That effort, begun with high hopes and optimism, foundered in Congress, and the backlash from the failed effort along with a lackluster economy and other political setbacks in the early Clinton administration helped Republicans reclaim control of the Senate and House of Representatives in the November 1994 midterm elections.
Massachusetts put a ﬁnancial gun to its head that made passage of universal coverage legislation a policy, political, and ﬁnancial necessity and the Bush administration provided the bullets. Still, the road to legislative 40 / Preludes and Process enactment was contentious, with policy differences dividing the governor, the Senate, and the House. Romney proposed an individual mandate for all residents to purchase health insurance and the creation of an “insurance exchange” (suggested by Heritage).
The Service Employees International Union supported the new law, while the state and national AFL-CIO blasted the law for its lack of a tough employer mandate and the inclusion of an individual mandate. Shortly after the signing, all the major constituencies joined in a statewide campaign, including paid TV advertising, to educate the public about the new law. The new law became known as Chapter 58, the ﬁfty-eighth bill signed in 2006. It was not designed as comprehensive health reform; it was crafted to respond to the threat and opportunity provided by the Bush administration’s determination to withdraw more than $1 billion that the state had assumed would continue to ﬂow into its health care system.