By Lauren Guerdat
March 30, 2010

Bipartisanship helped determined the outcome of health care reform debates in both the Johnson and Clinton administrations. During the debate about Medicare and Medicaid, President Johnson managed to win 70 Republican votes in the House and 13 in the Senate in support of the Social Security Act of 1965. In contrast, President Bill Clinton failed to enact his health care agenda partially due to a legislative atmosphere poisoned by partisanship, which stalled negotiations on Clinton’s signature issue.

Republicans and Democrats overcame divisions on Medicare and Medicaid in the mid-1960s, in several respects. Johnson supported Medicare, while the American Medical Association endorsed means-testing for a new program. Meantime, Republican Representative John Byrnes called for voluntary participation of citizens in Medicare. While most Democrats favored Johnson’s approach, Republicans tended to favor Byrnes’. Because there was a division between what each party favored, the Democratic Chairman of the Ways and Means Committee Wilbur Mills negotiated a compromise that incorporated virtually each of these proposals into the final legislation.

Thus, Democrats won Medicare, and Republicans and the AMA were more enthusiastic about Medicaid because it was a voluntary program run by individual states. Democrats and Republicans set aside partisan tendencies; realizing that reform needed to be passed, partisans reached across the aisle and found a legislative solution.

Much the opposite occurred during Clinton's first White House term. There was very little interaction between the two parties when it came to drafting health care legislation. Clinton created a task force that was extremely secretive and isolated from many members of Congress. Naturally, the Republican response to Clinton’s task force was to create its own task force. Senator Chafee was the head of the Republican task force, and he also tried to establish another group, the mainstream coalition, in order to get moderate Democrats and Republicans to meet and discuss possible health care reform. Chafee was one of sixteen Republicans at the time who were considered moderate—a substantial bloc. Yet, Clinton’s closed-door meetings effectively shut out the moderates from the negotiating process.

As Johnson demonstrated, when the parties work together, bipartisan compromise on health care reform isn’t impossible. Clinton’s case, in contrast, shows the pitfalls of partisan action on health care. Both parties would do well to recall that bipartisanship has had a vital role in shaping the politics of health care reform, as they begin the work of implementing President Obama’s legislation and amending it in the years ahead.