Presidential Transition and
Public Policy: The Repeal of Medicare
Carolyn Rinkus Thompson
In 1988, Vice President George Bush encouraged President Ronald Reagan to sign the Medicare Catastrophic Coverage Act (MCCA), which provided the most significant expansion of Medicare since its inception in 1965 and was expected to be extraordinarily popular among senior citizens. However, within fifteen months Medicare Catastrophic Coverage was repealed. This chapter examines the factors that were instrumental to repeal, with particular attention to the effect of the presidential transition in 1988 from the administration of Ronald Reagan to George Bush.
In his 1986 State of the Union message, President Ronald Reagan called for a study of the catastrophic health needs of the nation. The next year, following a bitter internal political and ideological debate, the president endorsed a plan proposed by Secretary of Health and Human Services Otis Ray Bowen, M.D., to extend Medicare to include acute catastrophic coverage. The irony of the proposal was not its substance as an incremental expansion of Medicare, but its contrast with the myriad attempts to privatize government functions, sell natural resources and landmarks, and decrease the involvement of government in all aspects of American lives that had characterized the “Reagan Revolution.” Other research conducted by this author argued that three factors were instrumental to the inclusion of Medicare Catastrophic Coverage in President Reagan’s agenda. They include the political acumen and policy entrepreneurship of Secretary Otis Bowen; the inability of ideological opponents within the Reagan administration to muster effective opposition to the Bowen plan; and political developments at the time, including