ABSTRACT
WHEN CONGRESS FAILED TO PASS THE HEALTH SECURITY ACT OF 1993, it ushered in a period of disillusionment and concern about the nation’s willingness to reform the health care system and expand access to the uninsured. The Clinton administration’s proposal provided a momentous opportunity to transform the system and achieve universal coverage. The failure to seize this moment was “most devastating” (Altman et al., 1998), and advocates of reform felt that the nation’s “commitment . . . seemed to collapse . . . as if the problem of the uninsured had disappeared” (p. 1). In actuality, the number of people without insurance was growing and was projected to reach 60 million by 2007 (Health Insurance Association of America, 1999). The passage of the Affordable Care Act (ACA) 17 years later during the Obama administration once again renewed hope that the U.S. would pursue both expansion of access to health care and a significant reduction in the number of uninsured in the U.S.
