242 The making of American domestic policy
was a threat by the Republican minority to mount a filibuster in the Senate if
an attempt was made by the Democratic leadership to put a Bill through, and
there was no prospect of finding the necessary votes to end such a filibuster.
The health care reform legislation, which had absorbed so much time and
effort by the Clinton administration, simply expired.
The failure of the Clinton Plan was the result of a combination of factors:
the decision by the Clintons to attempt a root-and-branch reform in a coun-
try where such exercises are viewed with suspicion; the weakness of a presi-
dent unable to depend upon the loyalty of his party in Congress; the power
of well-financed pressure groups; and the increasing resistance of the public
to ‘big government’. Following the victory of the Republicans in the congres-
sional elections of November 1994, the incremental approach to reform was
pursued in a bipartisan fashion. An Act was passed in 1996 as the result
of the collaboration of Republican Senator Nancy Kassebaum and Demo-
cratic Senator Edward Kennedy. The Kassebaum–Kennedy Act introduced a
number of changes that enabled the automatic transfer of health care insur-
ance from one job to another, and prevented the exclusion of the insured
person from health care coverage on the grounds of a pre-existing medical
condition. This was followed by an Act that extended state health care to
children in working families whose employers did not provide health care
for dependents. Thus the alternative programme which had been advocated
by Senator Dole was enacted after the defeat of the president’s grand plan.
These incremental changes did little, however, for the millions of people not
covered by the health care system at all, the original objective of the Clinton
reform proposals.
President Clinton had to abandon his attempt to provide inclusive health
care, and since the election of George W. Bush in 2000 the picture has got
worse. By 2004 the number of American citizens not covered by any kind of
medical plan had risen to 45.8 million, 15.7 per cent of the population, drawn
from all sections of the public.
Welfare reform and divided government
As in other Western democracies the decade of the 1990s began with in-
creasing concern about the rising costs of the welfare system, and with a
desire to reform it. The emphasis was to end the dependency of the poor on
welfare payments, and to get them back to work. Although it was the Repub-
licans who were most insistent on the need for reform, the demand was by
no means limited to them. During his 1992 campaign for the presidency Bill
Clinton had pledged ‘to end welfare as we know it’, but for his first two years
in office the president’s concern with health care reform precluded any seri-
ous attempt to fulfil this campaign promise. The victory of the Republicans
in the congressional elections of 1994, however, gave them the initiative and
put the president on the defensive, both in the case of welfare reform itself