The passage of Senate Bill 27 in 1989 created the Oregon Health Plan (OHP). Because it reflected a significant departure from the current Medicaid program it required federal waivers in order to be implemented. In August 1989, Oregon Senator Bob Packwood, who chaired the Senate Finance Committee, proposed an amendment to the 1989 budget reconciliation bill that would have summarily and statutorily granted Oregon its waiver. This sparked a firestorm of opposition to the Oregon Health Plan
The opposition was led by the Children’s Defense Fund (whose Board Chair at the time was Hillary Rodham Clinton), and was joined by the Catholic Health Association, Families USA, the Gray Panthers and the National Council of Senior Citizens. Both Senators Ted Kennedy and Al Gore, as well as Congressman Henry Waxman, were also outspoken opponents. This strident and persistent opposition lead the Bush Administration to deny Oregon’s waiver in August 1992.
A year earlier, in the spring of 1991, the Oregon Senate President’s office received a phone call from the office of the Governor of Arkansas, in Little Rock. Apparently, Governor Bill Clinton was going to be in Oregon that summer to meet with Governor Roberts, and he wanted to visit me to get a briefing on the Oregon Health Plan. Clinton obviously knew about it because it been on the national news for almost two years. It never occurred to me that Clinton was head of the Democratic Leadership Council, and getting ready run for president.
The governor arrived in Oregon sometime that summer in August. I gave him my OHP 101 lecture, with all the slides. It was a warm afternoon and all I can remember about the meeting is that the Governor of Arkansas seemed to be having considerable trouble staying awake. Maybe he knew how to sleep with his eyes open, I don’t know, but apparently, he retained something from my briefing.
The next month, I was invited to speak on a panel at the hundredth anniversary of Stanford University in Palo Alto. As it turned out, Governor Clinton was on a different panel at the same event and we happened to run into each other as we were both leaving the hotel for an early morning run. Clinton said he’d like to talk to me briefly after the forum and went on to tell me he was planning to run for president, was very interested in health policy and that there might be a place for me in his administration. Sure enough, on October 3, 1991, he announced his candidacy for President of the United States.
Fast-forward a year. The Health Services Commission (now the Health Evidence Review Commission) has completed the prioritized list and legislature has funded it, we have re-submitted our waiver application and it is denied on August 3, 1992. A month later, on October 11, the first presidential debate takes place in the Field House, on the campus of Washington University, in Saint Louis, Missouri. President Bush, Bill Clinton and Ross Perot were the participants. I remember watching that debate from a restaurant in Boston, where I was attending a conference.
During a discussion of the rising cost of health care, one of the panelists, Sander Vanocur, asked Clinton, “Is not the Oregon plan applied to Medicaid rationing the proper way to go even though the federal government last August ruled that it violated the Americans with Disabilities Act of 1990?” To which Clinton responded, “I thought the Oregon plan should at least have been allowed to be tried because at least the people in Oregon were trying to do something. But keep in mind that we are spending thirty percent more on health care than any country in the world, any country, and yet we have thirty-five million people uninsured, we have no prevention and primary care. The Oregon plan is a good start if the federal government is going to continue to abandon its responsibilities.”
I will never know whether Bill Clinton was truly convinced that the Oregon Health Plan had merit in its own right, or whether just he needed something to turn to in a “political moment.” Perhaps it was a combination of the two. In any event, and for whatever reason, he put himself on the national record to grant Oregon its waiver. A month later, on November 3, 1992, William Jefferson Clinton was elected the 42nd President of the United States.
Fast-forward again to 1993. Clinton has been sworn in, Al Gore, still a staunch opponent of the OHP, is now Vice President of the United States. Hillary Clinton, former chairperson of the Children’s Defense Fund and another committed foe of the OHP, is now the First Lady, and another former board member of the CDF, Donna Shelala, is Secretary of HHS. I’m thinking, “We’re screwed.” I am not in office, because I didn’t run again in 1992, and nothing seems to be happening in Washington, D.C. No word about the waiver.
Then, on March 17, the New York Times reported that the OHP had run into a wall of opposition within the administration. “As a candidate,” the article said, “Mr. Clinton promised to give Oregon swift approval. But his position was at odds with an influential children’s advocacy group whose board members included, until three months ago, Hillary Rodham Clinton, the President’s health policy chief.” And then, of course, we had Vice President Al Gore—not to mention Donna Shelala over at HHS, who would make the decision on the waiver.
While the national media had been focused on the First Lady’s national tour to promote her own health care reform agenda, another focused, yet quiet, lobbying effort had been under way to deny Oregon its waiver. “This may be the most important decision made by the Clinton Administration because it will send a message about which way they are going to go on health care,” said Robert Griss, a health policy analyst for the United Cerebral Palsy Associations, one of the groups opposing the Oregon plan. “There’s a war raging in the White House over this.” The next day, a letter signed by seventy national advocacy groups was delivered to the White House urging Clinton to reject the Oregon waiver request. Once again, I’m thinking, “We’re screwed.”
But then, out of nowhere, a spokeswoman for Vice President Al Gore, noting that there had been important changes in the Oregon Health Plan since the waiver was denied [there had, in fact, been no changes] said: “The Vice President will support whatever decision is made by the Administration.” With that, on Friday March 19, 1993, the Clinton Administration granted Oregon its waiver. I can only imagine the conversations that might have gone on inside the White House as the fate of our effort was being determined. But I remain convinced that the presentation made to Governor Clinton back in Oregon in August of 1991, and his subsequent remarks in the first presidential debate five months later, played at least some role in clearing the way for the implementation of the work we had labored on for so long.
I was in San Diego giving a speech at the Del Coronado Hotel when the waiver was granted. I had just come down from my room and saw the news in a paper while I was buying a cup of coffee. I walked slowly outside into a lovely soft morning, sat down on a bench facing the ocean and, for a long time, just let the feeling sink in. It had been just over five years since I nervously called the E-Board to order in January 1988 to lead a debate over transplants and the equitable allocation of public resources for health care—a debate that led to the creation of the Oregon Health Plan. It was a bittersweet feeling to some extent. Not only was I out of office when the waivers were finally secured, I was not even in Oregon. But the overwhelming feeling was one of great relief, a sense of accomplishment and deep gratitude to all the people who had believed in the vision and invested their time and energy to get us to this moment in time.
