U.S. National Library of Medicine

Introduction to Health Services Research : A Self-Study Course

Module 2: Brief History of Health Services Research (Page 28 of 40)

Legacy of the 1990s: Health Care Reform Legislation

Clinton Administration Reform Efforts

In the 1990s, health care reform legislation was a major effort under the early Clinton Administration. He promoted access to health for all in the Health Security Plan of 1993. It assured citizens of comprehensive benefits, cost savings, quality care, freedom of choice in selecting a physician, simplicity (paperwork reduction), and personal responsiblity. It was rejected.

Corporations Suffer from High Costs of Health Insurance

Some of the largest backers of reform were the giant auto manufacturers. Chrysler Corporation complained that they paid $5300 per employee for health insurance (Cronin, 1986), adding $700 on each car they produced to cover the cost ( Consumer Reports, 1990; De Lew, 1992).

Large corporations were sick of paying these insurance fees; many of them supported tax-based universal coverage.

Many large corporations supported tax-based universal coverage in the 1990s.

Taxing Employees

Taxing employees for health care was preferable to financing it out of potential earnings. Employers also remained wary of severe cost cutting measures as most of the labor strikes during the 1980s resulted from attempts to reduce health benefits (De Lew, 1992).

Small Business Worries

Smaller businesses worried that employer mandated plans would impoverish them. Under this proposal, the government would require all employers to provide health insurance to full-time workers. The small businesses balked and organized against this while others worried that the employer mandate could increase the pool of part-time workers without satisfying their health care needs.

View Key Projects and Milestones in Health Services Research.

Discussion Questions

1. Why did the Clinton health plan fail? Why is it important to know why health plans often fail in the United States? Who wants a health plan to pass? Who wants it to fail?
2. Why did large corporations support tax-based universal coverage? Should librarians and researchers care what large corporations think? Why?
3. Several of the major American car manufacturers are still complaining that they are not competitive in producing cars for the world market. What is causing this lack of competitiveness? What should be done to ensure that American car manufacturers become competitive again? Will research help in the effort?
4. Are small businesses still worried that employer mandated plans will impoverish them? How are small businesses coping with insuring their employees? Is anyone doing research on small businesses? What are the policy and societal implications to us for those who work in businesses that supply few or no health plans?