In 1994, Hillary Clinton suffered the worst setback in her political career when a Democratic-controlled Congress rejected a massive overhaul of the nation’s health insurance system that she and her advisor Ira Magaziner had devised.
Clinton’s goal in 1994: mandated medical insurance for every American from birth until death. Her plan was scuttled, partly because its design was too complex for the public to fathom.
Now, 11 years later, Clinton has found an alternative way of getting the taxpayer to help pay for coverage of thousands of uninsured workers.
Instead of pushing an all-encompassing plan, she is moving incrementally. And unlike Clinton’s 1994 plan, to be eligible for this one, you must be wearing a uniform or a family member of someone who is wearing one.
Clinton and Sen. Lindsey Graham, R-S.C., want to spend $3.8 billion over five years so that more members of the National Guard and Reserve can be covered by the Defense Department’s TRICARE medical insurance plan.
Graham, who as a House member in 1998 took a leading role in the House impeachment proceedings against her husband, lavished praise on Sen. Clinton on the Senate floor last month. “Without her, I don't think we would be as far as we are. She has been terrific,” said Graham, who served in the Air Force and as a member of the South Carolina Air National Guard.
By coincidence, the chief Democratic sponsor of a parallel measure in the House, Rep. Gene Taylor, D-Miss., was one of only a handful of House Democrats to vote for Bill Clinton’s impeachment in 1998.
In October 2004, Graham and Clinton co-sponsored legislation which provided an extension of one additional year of TRICARE eligibility to Guard and Reserve members for every 90 days the Reservist or Guardsman served. That law took effect in April.
Their current proposal, approved by the Senate last month, offers TRICARE coverage to reservists and guard members as long as they serve in deployable status and they pay premiums of $75 a month for an individual and $233 a month for family coverage. There are also deductibles and co-payments.
Up to 830,000 Guard and Reserve members would be eligible.
The proposal “would offer health care stability to families who lose coverage under employers' plans when a family member is called to active duty, or to families — and we have so many of them in the Guard and Reserve — who do not have health insurance to begin with,” Clinton explained in a speech on the Senate floor last month, just before the Senate passed the proposal as part of the defense authorization bill.
“I heard throughout New York about the hardship being imposed on Guard and Reserve members and their families, not because they didn't want to serve their country — indeed, they were eager to go and do whatever they could to protect and defend our interests — but because they didn't have health insurance,” Clinton said.
'Entice people to join'
Rep. Taylor explained in a face-off with Defense Secretary Donald Rumsfeld last June, “We know we have a recruiting and retention problem with the Guard and reserve. I happen to believe that one of the ways we can entice people to join, one of the ways we can entice people to stay in, is to address the problem that over 20 percent of our guardsmen and reservists don't have health insurance.”
House Armed Service Committee chairman Duncan Hunter, R-Calif., deleted Taylor’s proposal from the House defense authorization bill in June, citing concerns about its cost.
Now Clinton and Graham must persuade a House-Senate conference committee to not cut their proposal from the final defense spending bill.
Even though the Graham-Clinton plan isn’t as colossal and complex as the 1994 ‘Hillary-care’ proposal, it would add a new fiscal burden to the Defense Department at a time when it is already struggling to replace worn-out equipment, fund research on new weapons systems, and maintain troops in Iraq and Afghanistan.
When Taylor pressed Defense Secretary Rumsfeld to support the idea of covering Guard members and reservists under TRICARE at a House Armed Services Committee hearing last June, Rumsfeld said he worried about doing anything to make TRICARE a more appealing option than it already is.
“It's acted as a magnet, because it is considerably more attractive than most other (health insurance) programs,” Rumsfeld told Taylor. “And as a result, the numbers have gone up substantially.”
A better deal for second careerists
Since military personnel can retire at age 45 or younger, many of them pursue a second career in the private sector. The enrollment fees and the co-payments TRICARE requires of beneficiaries haven’t increased in a decade, even though the co-payments imposed by private-sector insurers such as Blue Cross have increased significantly.
TRICARE is a better deal for many military retirees who are working for private firms than is the insurance offered by their private-sector employers. “This has persuaded a growing number of our beneficiaries to drop their private coverage and to fully rely upon TRICARE,” Assistant Secretary of Defense for Health Affairs William Winkenwerder, Jr. told the Senate Armed Services Committee last spring.
“If current trends continue, the Defense Department risks becoming the primary insurer for all of its beneficiaries, picking up an even higher share of costs that would otherwise be covered by employer health plans,” economist Susan Hosek, the co-director of the Center for Military Health Policy Research at the RAND Corporation, told the committee.
The TRICARE program covers 9 million beneficiaries. That will cost the Military Health System this year $36 billion, about eight percent of overall national defense outlays. Defense Department spending on health care has doubled in the past four years.
It’s hard to imagine that someone would join the military primarily for the health insurance benefits. But the Graham-Clinton proposal underscores the fact that just as Ford’s viability as a car company is increasingly determined by its role as an employee health insurer, so too the Defense Department is struggling to reconcile its job as a war-fighting agency with its growing role as a health care provider.