The Clinton campaign released an ad on June 15 that discusses Clinton's efforts to increase health care coverage for children. (Hillary Clinton)

“It’s always been about kids. And when millions could not get health care, this first lady worked with Democrats and Republicans to fix it, creating the Children’s Health Insurance Program ‘so that every child gets the health care they deserve.’ Now 8 million kids are covered. That’s the kind of leader she is — and the kind of president she will be.”
— Voiceover in Hillary Clinton campaign ad, released June 15

This new ad features a 1998 clip of Hillary Clinton speaking about the Children’s Health Insurance Program (CHIP) signed into law by her husband, then-President Bill Clinton. The ad is an interesting example of how images and words can be assembled to present an image of leadership, while giving a misleading impression about what exactly happened.

Clinton herself has echoed the narrative in the ad. “Even when I was first lady, you know after we were not successful in health care, I teamed up with Republicans and Democrats to create the Children’s Health Insurance Program,” she told Newsday in April.

Given the facts about CHIP and the reporting at the time, you could assemble a somewhat less favorable account about Clinton’s role in creating CHIP. The ad is correct that about 8 million low-income children receive health care through the program. But it’s questionable that she played a key leadership role to creating CHIP.

The Facts

After Bill Clinton was elected president in 1992, he assigned his wife to spearhead a bold plan to enact national health-care insurance — which failed spectacularly. Hillary Clinton then retreated more into the role of a traditional first lady, without an overt policy portfolio.

The operative phrasing in the ad is that Clinton, as first lady, “worked with Democrats and Republicans to fix it, creating the Children’s Health Insurance Program.” At this point in the ad, the 1998 clip appears of Clinton speaking about the program.

CHIP was actually passed in 1997, as part of a balanced-budget deal sign by the president. In 1998, the Clintons were urging states to sign up for the program, and Hillary Clinton took a more overt public role in promoting it. But the campaign would have been unable to find a clip from 1997, because Hillary Clinton’s role was more hidden — and in dispute.

By all accounts, the prime mover behind CHIP was the late Sen. Edward Kennedy (D-Mass.). He was inspired by a similar Massachusetts program and then enlisted Sen. Orrin Hatch (R-Utah) as his partner in the effort. The idea was to fund children’s health care with money raised from taxes on tobacco products. Bill Clinton endorsed the idea in his 1997 State of the Union address but then backed off when it appeared that the concept would imperil budget talks with Republicans. With urging from the president, a Senate vote in May doomed the plan.

Hillary Clinton is on record having defended her husband for pulling the plug on the initial Kennedy-Hatch effort: ”He had to safeguard the overall budget proposal,” Hillary Clinton said at a luncheon, according to a May 1997 New York Times article. ”He will look for ways to demand full coverage for minors’ health.”

But Kennedy would not give up and within weeks was trying again to pass a revised version of CHIP. An August 1997 New York Times article on final passage of the bill reported that “participants in the campaign for the health bill both on and off Capitol Hill said the First Lady had played a crucial behind-the-scenes role in lining up White House support. But Mr. Clinton did not appear to move on the issue until a meeting at the White House on July 22 with an agitated Mr. Kennedy.”

This behind-the-scenes role is why Hillary Clinton’s actual impact on the legislation is fuzzy. When she first ran for president in 2008, various fact checks and news reports came to contradictory conclusions. (Note: The program was originally called SCHIP.) The positive accounts were cited by the Clinton campaign in defense of the ad.

The Associated Press, Oct. 5, 2007

The effort was revived, with Kennedy, Hatch and a coalition of advocacy groups ranging from the Children’s Defense Fund to the Girl Scouts lobbying hard. Kennedy made a special appeal to the first lady, who added her pressure anew.
“The children’s health program wouldn’t be in existence today if we didn’t have Hillary pushing for it from the other end of Pennsylvania Avenue,” Kennedy told The Associated Press.
President Clinton signed the bill in August 1997.
While Kennedy is widely viewed as the driving force behind the program, by all accounts the former first lady’s pressure was crucial.
“She wasn’t a legislator, she didn’t write the law, and she wasn’t the president, so she didn’t make the decisions,” says Nick Littlefield, then a senior health adviser to Kennedy. “But we relied on her, worked with her and she was pivotal in encouraging the White House to do it.”

The Boston Globe, March 14, 2008

Hillary Clinton, who has frequently described herself on the campaign trail as playing a pivotal role in forging a children’s health insurance plan, had little to do with crafting the landmark legislation or ushering it through Congress, according to several lawmakers, staffers, and healthcare advocates involved in the issue….
The Clinton White House, while supportive of the idea of expanding children’s health, fought the first SCHIP effort, spearheaded by Senators Edward M. Kennedy, Democrat of Massachusetts, and Orrin G. Hatch, Republican of Utah, because of fears that it would derail a bigger budget bill. And several current and former lawmakers and staff said Hillary Clinton had no role in helping to write the congressional legislation, which grew out of a similar program approved in Massachusetts in 1996.
“The White House wasn’t for it. We really roughed them up” in trying to get it approved over the Clinton administration’s objections, Hatch said in an interview. “She may have done some advocacy [privately] over at the White House, but I’m not aware of it.”

FactCheck.org, March 18, 2008

We review the record and conclude that she deserves plenty of credit, both for the passage of the SCHIP legislation and for pushing outreach efforts to translate the law into reality.
Adam Clymer, former chief Washington correspondent for the New York Times, covered the legislative maneuvering and also wrote about it in a 1999 book, “Edward M. Kennedy: A Biography.” Clymer wrote that Kennedy “worked with” Hillary Clinton to get White House support for a Senate measure to grant $24 billion for the new program, rather than the $16 billion approved by the House. “With strong administration support, the $24 billion stayed in,” he wrote. Then, when the bill finally passed, Kennedy “credited the President, the First Lady, [Senate Democratic Leader Tom] Daschle, Marian Wright Edelman, head of the Children’s Defense Fund, and Hatch.”

The Washington Post, March 24, 2008

During months of SCHIP negotiations in 1997, her name rarely surfaced in news accounts. Clinton never testified before Congress or held a news conference on the bill.
When Sen. Orrin G. Hatch (Utah), the lead GOP negotiator of the children’s health bill, heard reports that Clinton was depicting herself as SCHIP’s main advocate, “I had to blink a few times,” he said. Hatch said he doesn’t recall a single conversation with Clinton about SCHIP, even a mention of her name. “If she was involved, I didn’t know about it,” he said.
“You know how she says, ‘I started SCHIP’? Well, so did I,” joked Sen. John D. Rockefeller IV (D-W.Va.), one of the Democrats who pushed the bill across the finish line along with Kennedy. Both have endorsed Obama.
Some Clinton insiders also are uncomfortable with some of her assertions. “I don’t really like the way she talks about her role in SCHIP,” conceded one former Clinton administration official, who supports the first lady’s candidacy, speaking on the condition of anonymity in order to express his views candidly. “She doesn’t say it right. What she should say is ‘I was the driving force in the administration.’ That’s pretty big, and it’s all true.”…
Last fall, Kennedy said SCHIP “wouldn’t be in existence” without Clinton’s support inside the White House. But when her rhetoric on the campaign trail started to filter back to the Capitol, the veteran legislator became stingier with his praise.
“At the last hour, the administration supported it, and she was part of the administration, so I suppose she could say she supported it at the time,” Kennedy said.

Finally, we have Kennedy’s remarks in an oral history interview in 2008. Kennedy detailed at length his collaboration with Hatch and noted that Clinton administration had to be dragged into it a second time. He makes one reference to Hillary Clinton, who at the time of the interview was a U.S. senator. (At the time of the interview, Kennedy had endorsed Barack Obama for president.)
Sen. Edward Kennedy, oral history interview, March 28, 2008

“The Clinton Administration opposed it because it had budget implications. President Clinton had made an agreement with the Republicans — Trent Lott — on the Budget, and Trent Lott wasn’t going to support the alterations and change, so they resisted and resisted and resisted it. It was effectively defeated once, and then we were able to save it at the very end. At the very end we had everyone pulling for it, including Senator Clinton.”

The Post article quoted one White House aide as explaining that Clinton deliberately kept her role low-key because she knew she was a political lightning rod.

Chris Jennings, health policy coordinator in the Clinton White House, offers a different account.
He recalled discussing an SCHIP-like program with the first lady even as her universal plan was unraveling. Jennings said Clinton pressed her husband to include children’s health coverage in the 1997 State of the Union address and fiscal 1998 budget request.
But context is key, Jennings added. Barely two years had passed since the collapse of the universal health-care idea, and Clinton was still nursing deep political wounds. “She low-keyed her exposure, but that was on purpose,” Jennings said. “Her feeling was ‘I know my role, I’m going to be quiet, but I’m not going to go away.’ “

The Clinton campaign pointed to a 1999 White House news release of Clinton participating in an event with Republican governors to promote the law after it was enacted, as evidence that she worked in a bipartisan fashion.

Update, Oct. 3, 2016: Laurie Rubiner, a top aide to Sen. John Chafee (R-R.I.) at the time and later an aide to Clinton after she became a senator, requested that we add this statement to this fact check.

There were two approaches to creating legislation to covering low-income children – one was the Kennedy-Hatch bill that was a grant program and the other was the Chafee-Rockefeller bill that expanded the Medicaid program. The final bill was a compromise between the two bills. At that time, the Republican Leadership in the House and Senate were opposed to additional funding for children’s health care —  had it not been for the strong support of the White House and First Lady for funding children’s health, the SCHIP bill would never have been included in the Balanced Budget Act of 1997.  The SCHIP bill was ultimately passed out of the Finance Committee under the leadership of Finance Committee members, Senators Chafee and Rockefeller, and there were many conversations behind the scenes with staff in the White House and the First Lady’s office on the path to achieving that goal.

The Pinocchio Test

The driving force behind this legislation were two lawmakers — Kennedy and Hatch. Behind the scenes, Hillary Clinton was apparently an advocate for their effort, including ensuring the budget for the health plan was as large as possible.

But in reviewing the contemporaneous news reporting and later fact checks, we can find no evidence that she “worked with Democrats and Republicans” to create the law. Instead, she worked internally with White House staff and with Kennedy’s office; by Hatch’s account, she had no dealings with him, even though he was the key Republican moving the bill. Moreover, Clinton was certainly not involved in the details of the crafting the legislative language. The bill was a bipartisan effort, but her role was limited to being a largely hidden cheerleader at the White House, rather than a public advocate who directly worked with lawmakers in both parties. She emerged more visibly as a promoter of the law after it was enacted.

The ad thus offers an image of presidential-level leadership that is not reflected in the real story behind the Kennedy-Hatch legislation. She played a role, to be sure, but it is not as front and center as suggested in the ad.

Two Pinocchios


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