In November 1992, a relative newcomer on the national political scene, Bill Clinton, was elected President of the United States. Arriving on the tail end of a significant economic downturn (so much so that one of his campaign themes was “It’s the economy, stupid”), Clinton was embraced by younger and more liberal voters, and seemed to embody a new wave of optimism in America. He joined a Democratic House and Senate in bringing about the first period of unified party governance in over a decade, promising policy change after too much gridlock. While a wide range of policy items dominated his agenda, President Clinton made it well-known early into his administration that he sought dramatic changes to health care in the United States.

To institute these changes, Clinton formed a health care task force early in 1993, comprised of a wide range of health care specialists from within and outside of government and headed by then-First Lady Hillary Rodham Clinton. After holding a series of behind-closed-doors meetings for the better part of a year, the task force completed its deliberations by the end of 1993 and released its policy proposal to the public. As originally conceived, health care (meaning some form of health insurance coverage) would be made available to all Americans through a combination of Medicare, employer-based insurance, and government provisions for the unemployed and low-income workers. The costs of maintaining such a system would purportedly be covered through efficiencies that were expected to be gained from competition among insurance companies and providers, and from a broader insurance pool that included all Americans. Furthermore, revenues generated from several new taxes (such as those on alcohol and cigarettes) would be directed toward covering the program’s costs. And large employers would face a mandate to provide affordable health insurance to their employees.