The death of former Sen. Orrin Hatch (R-Utah) marks the loss of another congressional champion of health care legislation. Following the death late last year of former Sen. Bob Dole (R-Kansas), we have lost two leaders who helped shape health policy in the 1980s and 1990s.
Hatch was first elected to the Senate in 1976, upsetting long-time incumbent Frank Moss. It was his first run for public office. In 1981, he became chairman of the Senate Labor and Human Resources Committee (the predecessor to today’s Committee on Health, Education, Labor and Pensions or HELP), following the GOP takeover of the Senate as part of Reagan’s landslide election. He would serve as chairman until 1987. (Years later, he served as Chairman of the Senate Finance Committee from 2015 to 2019.)
As part of his sweeping package of reforms, President Reagan in 1981 proposed repealing Title X family planning program and replacing it with a state-run block grant. As chairman of the key health committee, Hatch was tasked with getting his committee to approve the section of the Omnibus Budget Reconciliation Act of 1981 covering the public health act. While much of the Reagan agenda sailed through Congress, changes to health care programs had a much tougher road to traverse.
Hatch had two moderate-to-liberal Republicans on his side of the committee – Lowell Weicker (R-Conn.) and Robert Stafford (R-Vermont), and on many key votes they voted with Kennedy to block the Reagan health care agenda. When Hatch tried to exclude both men from the House-Senate conference committee negotiations over a final bill, Stafford balked based on his seniority. Hatch had to back down and add Stafford to the Republican side of the conference committee. With Stafford siding with Kennedy and the other Democrats, the committee was soon stalemated.
Congressional Republicans and the Reagan White House were anxious to wrap up the spending cut package. But before he would agree to a compromise that would leave family planning a federally-administered grant program, Hatch demanded a letter from the President absolving him of responsibility for the failure to repeal Title X. Reagan sent a letter that, in part, said, “all things considered” he would prefer the legislation be passed and sent to him for his signature. The eventual compromise kept Title X as its own program, run by the federal government. As a sort of consolation prize to Hatch and other conservatives, the final agreement included the Adolescent Family Life Act, authored by Sen. Jeremiah Denton (R-AL), to fund facilities aimed at encouraging young people to abstain from sex until marriage. At the time, Representative Toby Moffett (D-Conn.) derisively referred to them as “storefront chastity centers.”
Moving Toward The Center
Based on his experience of 1981-82, Hatch moved to finding common ground with Kennedy and other Democrats, including Henry Waxman (D-Calif.), the chair of the House Commerce Committee’s Health Subcommittee. The new approach yielded a string of victories that have become part of Hatch’s legacy. Three stand out:
The “Drug Price Competition and Patent Term Restoration Act of 1984,” also known as the Hatch-Waxman Act, was the product of a classic political bargain. Hatch wanted to extend the patents for drug makers to restore the time lost during FDA’s approval process. Waxman wanted to speed FDA approval of generic drugs. The final product did both. Drug makers were granted an extension of their patents for the amount of time the drug was under regulatory review by the FDA. In return, generic manufacturers can file for an Abbreviated New Drug Approval when the patent on a drug is expiring to prove their products are bioequivalent to the brand name product. The impact has been enormous. In 1984, only 19 percent of prescriptions were filled with generics; by 2013 that market share rose to 86 percent.
Ryan White And ADAP
Hatch worked with both Kennedy and Waxman to enact the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, the nation’s first comprehensive response to the HIV/AIDS epidemic. The three lawmakers waded into one of the toughest issues of the day. The legislation was named for Ryan White, an Indiana teenager who was living with HIV/AIDS and later died shortly before the legislation was enacted. The law authorized billions of dollars in federal help to states and cities on the front lines of the epidemic, helping to fund nongovernmental care organizations across the country. The law also created the AIDS Drug Assistance Program (ADAP), which provides billions to states to help pay for drugs that help extend the lives of those living with the virus.
Facing conservative opposition, Hatch told a committee hearing, “This is not a gay disease, an inner-city disease, or a disease of the poor. AIDS does not play favorites. It affects rich and poor, children and adults, men and women, rural communities and the inner city.” Hatch and Kennedy recruited 64 colleagues to cosponsor the bill, enough to defeat any attempt at a filibuster. While the final vote of 95-4 was overwhelmingly bipartisan the sponsors had to beat back efforts by Sen. Jesse Helms (R-N.C.) and others to add unpalatable restrictions to the bill. Waxman fought a similar battle in the House before it approved the law
The State Children’s Health Insurance Program (CHIP) of 1997 was part of the Balanced Budget Act of 1997. It created a federal-state partnership program that provides health coverage options for children whose families earn too much to qualify for Medicaid but too little to afford private insurance. At the time, there were 10 million uninsured kids in America and the law’s sponsors set a goal of reducing that number by 50% in three years. Enacted a few years after President Clinton’s far more ambitious attempt at health reform crashed and burned in 1994, CHIP’s passage charted a much more incremental approach to reform.
At Hatch’s insistence, the law did not use Medicaid to expand coverage of kids and left it to the states to decide how to shape their programs. In the 25 years since it was enacted, CHIP has helped to reduce the number of uninsured children and remains popular in both political parties. To pay for the program, Hatch, a non-smoking Mormon, proposed increasing the federal excise tax on cigarettes and other tobacco products. Kennedy quickly said yes, and the bill became law.
Working Across The Aisle
In no way did Senator Hatch become a moderate member of his party, but he did see the benefits of pairing up with the opposite party to help shape the laws that were being written.
Today, few members of Congress see much value in working across the aisle, but bipartisanship does erupt every once in awhile resulting in legislation signed into law. For members of Congress looking to leave their mark, Orrin Hatch provided an excellent template.