8
There were multiple proposals. The liberal wing of the Democratic party favored a
universal publically finance approach. More conservative Democrats on the Senate
Finance Committee were united around a proposal for catastrophic coverage combined
with federalizing Medicaid. The Nixon-Ford plan and Mills-Kennedy proposals retained
the existing employer based system with an expanded public program to cover those not
part of the employer system. Senator Long, Chairman of the Finance Committee, still
favored catastrophic coverage first, but had indicated a willingness to compromise.
In August 1974 the Ways and Means Committee with Wilbur Mills as Chairman
approved a modified version of Mills-Kennedy by a 13-12 vote. But, Mills was reluctant
to bring a bill to the floor with such slim committee margin.
12
Fall elections were looming
with the prospects high for a significant gain in Democratic seats.
When the new Congress convened in January 1975 there were significantly greater
Democratic margins, but President Ford was now threatening to veto any new major
spending legislation. The 1976 Presidential election campaign had begun. Liberal
Democrats believed they would elect one of their own as President in 1976, and the
prospects for comprehensive reform would be much better in 1977. Legislation did not
move forward in the 94
th
Congress.
1978-79 An Unexpectedly Brief Window
When Jimmy Carter took the oath of office in January 1977, NHI advocates had high
expectations for the long sought comprehensive legislation. President Carter had
advocated this in his campaign, and there was a solid Democratic majority in both the
House and Senate. However, Carter’s HEW Department undertook to study various
models, and did not project to announce a plan until 1978. Labor, Senator Kennedy, and
other advocates became impatient and began to formulate and propose various policy
ideas.
In June of 1979 Carter finally proposed a health insurance plan that was both a specific
proposal and a roadmap to later achieve the goal of comprehensive universal coverage.
At the center of the Carter plan was an employer mandate for catastrophic coverage for
all expenses above $2500 per year for a family. Medicare recipients were also included
for catastrophic coverage. There were a number of other provisions including full
comprehensive coverage for those below 55% of poverty, cost containment provisions,
and incentives for enrollment in HMOs.
13
The plan was to be the first step in moving toward the goal of a universal and
comprehensive health insurance program with the next steps pursued during a second
term in the early 1980s. Of course there was no second term, and the initial Carter
12
Flint Wainess, “The Ways and Means of National Health Care Reform, 1974 and Beyond”, Journal of
Health Politics, Policy and Law (April, 1999), p.326.
13
Jimmy Carter, “National Health Plan Message to the Congress on Proposed Legislation,” June 12, 1979,
accessed from The American Presidency Project, University of California at Santa Barbara.
Convention