With Republican senators’ Affordable Care Act replacement, the Better Care Reconciliation Act drawing as little as 12 percent approval nationwide—and even majorities of Republicans disapproving of their assault on Medicaid—it is understandable that the plan’s defenders would be looking far and wide for political cover. But arguing that the approach is “borrowed from a nearly identical 1995 proposal by President Bill Clinton,” as Avik Roy recently did in The New York Times, distorts Clinton’s efforts to protect Medicaid from then-Speaker of the House Newt Gingrich beyond recognition.
Clinton’s singular goal in this period was to defend Medicaid from the exact same Republican attack we see today: an effort to finance tax relief for the top 1 percent of Americans (and, in this case, pharmaceutical companies and health insurers as well) under the guise of thwarting allegedly out of control Medicaid cost growth. Clinton’s tactical measures, and ultimate commitment to holding the line on the defense of Medicaid, can only be used as historical support for standing firm on Medicaid—not as cover to fundamentally undermine the program—as is sought by defenders of Trumpcare today.
There is no question that defending Medicaid was a harder battle in 1995. The program was far less popular, perhaps because fewer people understood its critical role in helping children get coverage or Americans in nursing homes and with disabilities get the care they need. And while Medicaid today is extremely efficient—with lower per-person cost growth than the private sector—in the mid-1990s it was far more vulnerable to arguments that its growth needed to be reduced.