In the fall of 1994, the Clinton Administration’s much debated comprehensive, and complicated, health-insurance bill—known derisively as Hillarycare—died quietly on Capitol Hill. It was a moment that, the Princeton sociologist Paul Starr later argued, would “go down as one of the great lost political opportunities in American history.” But, before the end, talk of another approach kept bubbling up: to allow those Americans who couldn’t get insurance elsewhere to buy a policy that was just as good, and inexpensive, as what members of Congress got. When Senator Edward M. Kennedy, of Massachusetts, said that Americans should get “exactly what we have,” he meant the Federal Employees Health Benefits Program.
The F.E.H.B.P., as it’s known, was started in 1959, a few years before Medicare, and was meant to cover some nine million government employees—civil-service workers, the courts, the Post Office, members of Congress, and more. It wasn’t a single plan but, rather, as a Times story put it, “a supermarket offering 300 private health plans.” (Even the right-learning Heritage Foundation called it “a showcase of consumer choice and free-market competition.”) One may get a sense of its scope and inclusiveness—its supermarket-ness—in the way that the Office of Personnel Management, which administers the program, explains it to federal employees. Much of the program—for instance, the idea that no one can be refused, or charged more, for a preëxisting condition, or that dependents under twenty-six are covered—will sound familiar to anyone conversant with the most attractive parts of the Affordable Care Act.
In the summer of 1994, when the Clinton Administration struggled to win approval for its proposal, there were some signs of actual good will in Congress, along with the predictable determination to dynamite the whole idea. Senator Daniel Patrick Moynihan, a New York Democrat, wanted any insurer who sold policies to federal workers to offer the same thing to “civilians,” at a reasonable price. Bob Dole, a Kansas Republican and the Minority Leader, favored a scheme in which self-employed individuals and small businesses (employers of up to fifty workers) could buy the federal policy “at the same premium price.” There were several variations of this approach.
Then it all went bad, as it had gone bad since the days of the New Deal. Newt Gingrich, who was then the deputy Minority Leader of the House, warned President Clinton that he was endangering his entire agenda in the pursuit of health-care reform—in particular, Gingrich insisted that Clinton was risking a global trade agreement that was probably never in danger. (Someone probably can still explain that era’s excitement over the General Agreement on Tariffs and Trade, or GATT.) Dole by then had given up, and so had Congressman John Dingell, of Michigan, a Democrat, who had been pushing health-care reform since 1955 but eventually said that it was “time to give health-care reform a decent burial and provide for its rebirth.” Two months later, in the midterm elections, Democrats, although they managed to cling to the Senate, lost the House by the widest margin since the midterms of 1946; Gingrich was elected Speaker on the strength of his “Contract with America,” which made a number of promises that were impossible to keep, and in the process launched an era of rabid partisanship. The failure of health-care reform showed mostly that Democrats were a pushover party, with few sounding like Senator Bob Kerrey, of Nebraska, who said, “I’m not elected to read the polls and say the public wants me to give up.” The “rebirth” for which Dingell hoped would only come a decade and a half later, with the passage, in 2010, of the Affordable Care Act. For all its flaws, bumbled launch, and absence of Republican support, the A.C.A. has provided health insurance to some twenty million Americans who didn’t have it before. Republicans have been venomously eager to dismantle it ever since. Late last week, the Senate took a big step in that direction by passing a budget “blueprint” that will make it easy for Congress, controlled by Republicans, to repeal the act.
If it’s sometimes hard to understand what makes Republican legislators so angry, here is a theory: their fury may not stem from some ungraspable principle, or hatred of President Obama’s historic victory (or of Obama himself), but, rather, from something personal, and selfish. Under the A.C.A., members of Congress, and congressional staff, among other Capitol Hill employees, were no longer eligible for the F.E.H.B.P. In the chilly language of government directives, the Office of Personnel Management Web site said that “Section 1312 of the Affordable Care Act requires that Members of Congress and their official staff obtain coverage by health plans created under the Affordable Care Act or coverage offered via an Affordable Insurance Exchange.”
Ouch! In other words, the comfortable choices that were available for more than fifty years were suddenly transferred to the slightly murky passageways of Obamacare. And it follows that, if the Affordable Care Act is repealed, members of Congress would be able to return to the federal plan that they, like millions of federal employees, were so fond of. Twenty million other Americans won’t.
A better idea, though, might be to find a path (it won’t be easy, but it’s certainly easier than anything else that might be effective and that hundreds of legislators could ever agree upon) to finally offer the beloved, and by most accounts well-administered, federal plan to the rest of the uninsured nation. We can almost hear America demanding, “We want what they’re having.” If Congress is serious about repealing, and replacing, the act, then that’s the sort of replacement that almost anyone could live with.
