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Electoral history of Nancy Pelosi
The electoral history of Nancy Pelosi spans more than three decades, from the mid-1980s to the present. A member of the Democratic Party in the United States, Nancy Pelosi was first elected to the U.S. House of Representatives in a 1987 special election after the death of Congresswoman Sala Burton that February. In the Democratic primary, Pelosi defeated San Francisco Supervisor Harry Britt, considered the more progressive candidate, with 36 percent of the vote to his 32 percent.  In the subsequent runoff she defeated Republican Harriet Ross, her closest competitor, by more than a 2–1 margin. 
Now in her 17th two-year term, Pelosi has enjoyed overwhelming voter support throughout her congressional career. Since 2013 she has represented California's 12th congressional district , which consists of four-fifths of the city and county of San Francisco. She initially represented the 5th district (1987–1993), and then, when district boundaries were redrawn after the 1990 Census, the 8th district (1993–2013). As the House Democratic Party leader since 2003, she has sought election to the office of Speaker of the United States House of Representatives every two years since that time.
State government trifectas
State government triplexes
State legislative chambers that changed party control
Pivot Counties in the 2020 presidential election
Congressional elections decided by 10 percentage points or fewer
United States Senate runoff elections in Georgia (January 5, 2021)
DOCUMENTING AMERICA’S PATH TO RECOVERY
Daily coverage of the Coronavirus Pandemic
Vermont ends statewide face-covering requirement
Texas Supreme Court Justice Eva Guzman resigns, creates midterm vacancy
Register for our briefing June 30 looking back at the Supreme Court's 2018 Janus v. AFSCME decision
Two Georgia state legislative special elections advance to July 13 runoffs
Decade-high number of incumbents defeated in New Jersey, Virginia legislative primaries
U.S. Supreme Court decides three cases in two rulings on June 14
Oregon House of Representatives votes to expel state Rep. Mike Nearman
Colorado governor signs transportation bill removing 2021 bond issue from ballot
Sports betting initiative qualifies for 2022 ballot in California
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|8/3||Washington primary election|
|11/2||U.S. general election|
|4/5/22||Wisconsin spring general election|
|5/17/22||Idaho statewide primary|
|5/24/22||Arkansas statewide primary|
|Source: Rasmussen Reports (June 13-15, 2021), Margin of error: +/-2.5, Sample size: 1,500|
|Source: Economist/YouGov (June 13-15, 2021), Margin of error: +/-3, Sample size: 1,305|
|Source: Politico/Morning Consult (June 11-13, 2021), Margin of error: +/-2, Sample size: 1,994|
|Source: Monmouth University (June 9-14, 2021), Margin of error: +/-3.5, Sample size: 758|
|Direction of country||39%|
|Source: Average of recent polls as of June 21, 2021|
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February Facts and Birthdays
The Many Names of February!
- In Old English terms, the Anglo-Saxons named February as ‘Solmonath’, which means month of cakes, mud-month, as the Gods were offered cakes in the February season.
- It was also called ‘Kale-monath’ or ‘sprout-kale’ by the Saxons, which is the name for cabbage and its sprouting.
- In Welsh, February is known as ‘y mis bach’, which translates to ‘the little month’.
- The second month is called ‘helmikuu’ in Finnish, which means ‘the month of pearl’, inspired from the snow falling on tree branches and the droplets freezing on them, metaphorical with the pearls of ice.
- About 400 years ago, during the Shakespearean time, this month was known as ‘Feverell’.
- In Newton’s time, which is like 300 years ago, it had changed to ‘Frbrueer’, which is where February has its latest derivation.
Results of the Washington Primary February 8th 2004 - History
DATES OF U.S. PRESIDENTIAL ELECTION "EVENTS":
1789 to the present
* (asterisk) indicates the earliest date Presidential Electors could be "appointed" in a State (whether by Popular Vote or not) in these Presidential Elections, the latest date such Electors could be chosen (presumably, by methods other than Popular Election, such as- for example- choice by the Legislature) was, of course, the date Electors were scheduled to cast their votes in any event.
A date in italics indicates that a date other than the statutorily-defined date was utilized due to special circumstances (as explained below this table).
Four times in American History a Tabulation Joint Session of Congress itself did not declare a person to be elected either President or Vice-President (or both) on the date on which it met: a list of these circumstances follows:
- Election No. 4 (1800) A tie in the Electoral Vote for President (at the time, each Elector voted for two persons for President) resulted in the U.S. House of Representatives (voting by State- and not as individual Congressmen)- after 36 ballots held over several days- electing Thomas Jefferson President (the other candidate in the Electoral Vote tie, Aaron Burr, became Vice President under the constitutional provisions of the time).
- Election No. 10 (1824) No candidate having received a majority of the Electoral Vote for President (by now, under terms of the 12th Amendment to the U.S. Constitution, Electors voted separately for President and Vice-President: John Calhoun had already received a majority of the Electoral Vote for Vice-President), the U.S. House of Representatives, voting (by State- and not as individual Congressmen) on a single ballot, elected- as President- John Quincy Adams, who had finished second to Andrew Jackson in the Electoral Vote for President.
- Election No. 13 (1836) No candidate having received a majority of the Electoral Vote for Vice-President (Martin Van Buren had already received a majority of the Electoral Vote for President), the U.S. Senate (voting as individual Senators- not by State) elected, as Vice-President, Richard Mentor Johnson.
- Election No. 23 (1876) As described more fully below this table, disputed Electoral Votes coming out of several States made it impossible for Congress- via the ordinary constitutional machinery- to determine just who had been elected both President and Vice-President.
Election No. [for (N)th Administration]:
As is the case with Congresses of two years' duration each, Presidential Administrations of four years' duration- likewise- can be numbered (in fact, the number of a given four year "Administration" is half of the number of the later of the two Congresses in office during that Administration: for example, because it was the 110th Congress that was meeting during the last two years of President George W. Bush's second term, those four years of that term make up the 55th Administration [110/2 = 55]).
Although it is altogether unofficial, Presidential Elections can be numbered according to the number of the Administration of the President that has been elected therein (thus, the 2004 Presidential Election- which resulted in President George W. Bush being elected to a second term [again, the aforementioned 55th Adminstration]- was Presidential Election No. 55).
Date Presidential Electors "appointed" [Presidential Election]:
Each State shall appoint, in such manner as the legislature thereof may direct, a number of Electors, equal to the whole number of Senators and Representatives to which the State may be entitled in the Congress.
from Article II, Section 1, clause 2 of the CONSTITUTION OF THE UNITED STATES
The "appointment" (to use the proper constitutional language, as seen above) of Presidential Electors is what ordinary Americans mean when we say 'Presidential Election' - even though many Americans are most unaware that they are really choosing a slate of Electors rather than, as they would describe what they are doing, "voting for President" (and- obviously, at the very same time- Vice President).
The Congress may determine the time of choosing the Electors.
from Article II, Section 1, clause 4 of the CONSTITUTION OF THE UNITED STATES
Nowadays, this is the day United States citizens resident in the 50 constituent States of the Union and the District of Columbia who wish to vote in said Presidential Election (and are, indeed, eligible [and have registered] to do so) go to their respective polling places and cast their votes (although several States now permit Early Voting and, even apart from this, many Americans will vote by Absentee Ballot- in each case, actually casting votes well before this date [but their votes will not be counted until this date])- but, in the earliest days of the Federal Republic, it was merely the date- or dates- on which each State formally chose its Presidential Electors (whether such choice was by Popular Vote of the State citizenry or not-- not until 1836 did all but one State allow for Popular Vote for President [in reality, the People of the States "appointing"- to use the language found in the U.S. Constitution itself- their State's Presidential Electors thereby]).
What follows is the actual text of the regulations for said Presidential Election (again, this being the date Presidential Electors are to be "appointed") and the election years in which a given regulation was actually in effect:
. [T]he first Wednesday in January next be the day for appointing Electors in the several States.
from Resolution of 13 September 1788 by the Confederation [=Continental] Congress
. [E]lectors shall be appointed in each State for the election of a President and Vice-President of the United States, withint thirty-four days preceding the first Wednesday in December, one thousand seven hundred and ninety-two, and within thirty-four days preceding the first Wednesday in December in every fourth year succeeding the last election, which Electors shall be equal to the number of Senators and Representatives, to which the several States may by Law be entitled at the time.
from 1 Stat. 239, Section 1
. [T]he Electors of President and Vice-President shall be appointed in each State on the Tuesday next after the first Monday in the month of November of the year in which they are to be appointed.
from 5 Stat. 721
although the date of the Presidential Election itself was not at all changed, the verbiage in the relevant statute was later tweaked as follows:
The Electors of President and Vice President shall be appointed, in each State, on the Tuesday next after the first Monday in November, in every fourth year succeeding every election of a President and Vice President.
from 62 Stat. 672, now codified as United States Code: Title 3, section 1 [3 USC 1]
Date Electors cast their votes in the several States:
The Electors shall meet in their respective States and vote by ballot.
from Article II, Section 1, clause 3 of the CONSTITUTION OF THE UNITED STATES (language retained in the 12th AMENDMENT to the U.S. Constitution)
The Presidential Electors so "appointed"- nowadays, however indirectly, by vote of the People in each of the several States of the Union (and D.C.)- must later meet in each jurisdiction (note that- despite prevalent use of the term- there is no such thing as a single "Electoral College" all meeting together rather, the Electors from each State [and D.C.] meet separately- thus, there are really 51 separate "electoral colleges") and cast their votes for President and Vice-President.
[The Congress may determine]. the day on which [the Electors] shall give their votes, which day shall be the same throughout the United States.
from Article II, Section 1, clause 4 of the CONSTITUTION OF THE UNITED STATES
Even though they do meet separately, the Electors must meet on the very same day and the actual text of the regulations governing just which day is to be the date of these separate "electoral colleges"- along with the election years in which said regulations were in force- follow:
. [T]he first Wednesday in February next be the day for the Electors to assemble in their respective States and vote for a President.
from Resolution of 13 September 1788 by the Confederation [=Continental] Congress
. [T]he Electors shall meet and give their votes on the. first Wednesday in December.
from 1 Stat. 239, Section 2
. [T]he Electors of each State shall meet and give their votes on the second Monday in January next following their appointment.
from 24 Stat. 373, Section 1
The Electors of President and Vice President of each State shall meet and give their votes on the first Monday after the second Wednesday in December next following their appointment
from 62 Stat. 673, now codified as United States Code: Title 3, Section 7 [3 USC 7]
Date Electoral Vote tabulated by a Joint Session of Congress:
. The President of the Senate shall, in the presence of the Senate and House of Representatives, open all the certificates [containing the Electoral Vote from each jurisdiction], and the votes shall then be counted.
from Article II, Section 1, clause 3 of the CONSTITUTION OF THE UNITED STATES (language retained in the 12th AMENDMENT to the U.S. Constitution)
Even with the Presidential Electors having met and fufilled their constitutional obligations, a President (or, for that matter, Vice President) of the United States is not officially elected unless and until the Congress of the United States says he or she is. In this regard (and despite the oft-heard claim that the U.S. Supreme Court "really" elected George W. Bush President back in 2000), Congress is- more or less- the "umpire" or "referee" in any and all Presidential Elections.
A Joint Session of Congress counts and tabulates the Electoral Vote sent to it by the "electoral colleges" in the several States and the District of Columbia (thus, this meeting of the Federal legislature is colloquially referred to as the "Tabulation Joint Session") and then- assuming, of course, that a candidate has received a majority of the total Electoral Vote- officially declares just who has been elected President (and Vice President).
As with the dates of the Presidential Election (that is, "appointing" of the Electors) and the several "electoral colleges" themselves, the date on which Congress holds this Tabulation Joint Session is also regulated by statute. What follows is the actual text of such regulations (and, again, the elections for which they were in effect):
. [T]he first Wednesday in March be the time. for commencing proceedings under the. Constitution.
from Resolution of 13 September 1788 by the Confederation [=Continental] Congress
(NOTE: Thus, 4 March 1789 was the earliest date on which the Electoral Vote could be formally counted by Congress as things turned out, the First Congress did not achieve a quorum in both houses [necessary in order to hold a Joint Session of the entire Congress] until 6 April 1789 and, so, the Electoral Vote coming out of the first Presidential Election was not counted and tabulated by Congress until that date)
1792 through 1872 1880 through 1932:
. Congress shall be in session on the second Wednesday in February, one thousand seven hundred and ninety-three, and on the second Wednesday in February succeeding every meeting of the Electors, and the certificates [containing the Electoral Vote from each jurisdiction]. shall then be opened, the votes counted, and the persons who shall fill the offices of President and Vice-President ascertained and declared, agreeably to the Constitution.
from 1 Stat. 239, Section 5
[NOTE: The Election of 1876 (the [in?]famous 'Disputed Election' between Democrat Samuel Tilden and Republican Rutherford B. Hayes) was a special case-- please see what immediately follows]
. [T]he Senate and House of Representatives shall meet. on the first Thursday in February, anno Domini eighteen hundred and seventy-seven.
from 19 Stat. 227, Section 1
It became apparent, well before the Tabulation Joint Session of Congress following this Presidential Election (that is, the "appointing" of Electors by the People of the several States via the ballot) was scheduled to meet on 14 February 1877, that something was terribly wrong with the Electoral Vote coming out of the meetings of more than a few "electoral colleges" held on 6 December 1876: not only would the Electoral Vote be altogether close (as could be easily discerned from the reports of the Popular Returns in each State as already published in newspapers around the Nation) but at least three States in the South (this still being the era of post-Civil War Reconstruction) were sending two sets of Electoral Votes- one in favor of each Major Party presidential candidate- to Congress. To make matters worse, one of these Major Parties controlled one house of the (in those days, it was the outgoing ["lame duck"]) Congress, while the other Party controlled the other (so there was no possibility of a mere Party line vote in Congress electing one Party's candidate President in any event).
To this end, Congress quickly passed legislation (it was signed into law by outgoing President Ulysses S. Grant on 29 January 1877) completely bypassing the whole, more usual, process of Electoral Vote counting, instead requiring Congress to hold what would otherwise be the normal Tabulation Joint Session early- in this case, on 1 February 1877- to discern just which States were in dispute and then formally handing such disputes over to a so-called "Electoral Commission" consisting of Senators, Congressmen and U.S. Supreme Court Justices appointed to the task by Congress itself (the earlier-than-usual meeting of Congress in Tabulation Joint Session was intended to buy the Electoral Commission more time [an extra fortnight] in which to resolve these disputes, for there was ever a looming deadline of 4 March 1877, on which date a new President- whoever it turned out to be- would have to take office [if only because, by a combination of constitutional fiat and Federal statute, President Grant's term ended- no matter what!- on that very date]).
. [after the Electoral Commission has determined which Electors' vote shall be officially counted in each of the disputed States] the two houses shall again meet, and such decision [of the Electoral Commission] shall be read and entered in the journal of each House, and the counting of the [Electoral] votes shall proceed in conformity therewith.
from 19 Stat. 227, Section 2
Congress, thus, would have to hold a "follow-up" Joint Session after the Electoral Commission had reported its decision as regarded each State re: which its Electoral Vote was in dispute and the last such Joint Session to count and tabulate a disputed State's Electoral Vote as decided by the Electoral Commission was held on 2 March 1877, just two days before the new President thereby elected [Rutherford B. Hayes] would constitutionally take office (interestingly, Hayes was not publicly inaugurated until 5 March 1877 because 4 March- the date on which, at the time, a newly-elected Congress as well as a newly-elected President took office- happened to fall on a Sunday that year however, because the 1876 Presidential Election dispute had been so politically charged [the vote of the Electoral Commission itself had been along Party lines, 8-7 in favor of the Republican Electors, in all disputed cases], there were actual fears of a coup d'etat instigated by supporters of Tilden! Thus, Hayes was first sworn in privately, at the White House on the invitation of outgoing President Grant, on the evening of Saturday 3 March [it also didn't help that neither Constitution nor statute made clear just when, on 4 March, the President actually took office inaugurating the President during the day was traditional but there was an argument to be made that his Term of Office, as well as those of Congressmen and newly elected or re-elected U.S. Senators- had actually begun at Midnight Local Mean Time in Washington (Standard Time was still a decade away in 1877): to this end, an outgoing Congress- never all that sure it had any authority to act early on a given 4 March- always adjourned sine die no later than 3 March. it is for this very reason that the 20th Amendment to the U.S. Constitution- which moved up the beginnings of terms of members of Congress to 3 January and the term of a President to 20 January- purposely makes clear that terms of office begin- and end- at Noon in the Nation's Capital (now on Eastern Standard Time, of course)]).
Congress shall be in session on the sixth day of January succeeding every meeting of the Electors. [and] all the certificates and papers purporting to be certificates of the electoral votes. shall be opened, presented, and acted upon.
from 62 Stat. 675, now codified as United States Code: Title 3, section 15 [3 USC 15]
There have been, since the 1936 Presidential Election, six exceptions to 6 January being the date for the Tabulation Joint Session: two of these were merely because 6 January happened to fall on a Sunday- in 1957 and 1985- and, in each such case, the Tabulation Joint Session was held on the following day (thus, these do not appear in italics in the table above).
Four other cases, however, were expressly permitted by statute:
[I]n carrying out the procedure set forth in section 15 of Title 3, United States Code, for 1989, `the fourth day of January' shall be substituted for `the sixth day of January' in the first sentence of such section.
102 Stat. 3341 (adopted 9 November 1988)--
thereby, the Tabulation Joint Session of Congress resulting from the 1988 Presidential Election was held two days early relative to the statutory date- on 4 January 1989
The meeting of the Senate and House of Representatives to be held in January 1997 pursuant to section 15 of Title 3, United States Code, to count the electoral votes for President and Vice President cast by the electors in December 1996 shall be held on January 9, 1997 (rather than on the date specified in the first sentence of that section).
110 Stat. 3558 (adopted 11 October 1996)--
thereby, the Tabulation Joint Session of Congress resulting from the 1996 Presidential Election was held three days late relative to the statutory date- on 9 January 1997 (this last was necessitated by the newly-elected 105th Congress not even first convening for its First Session until 7 January of that year)
The meeting of the Senate and House of Representatives to be held in January 2009 pursuant to section 15 of title 3, United States Code, to count the electoral votes for President and Vice President cast by the electors in December 2008 shall be held on January 8, 2009 (rather than on the date specified in the first sentence of that section).
122 Stat. 4846 (adopted 15 October 2008)--
thereby, the Tabulation Joint Session of Congress resulting from the 2008 Presidential Election was to be held two days late relative to the statutory date- on 8 January 2009 (this last necessitated by the newly-elected 111th Congress not even first convening for its First Session until 6 January of that year)
The meeting of the Senate and House of Representatives to be held in January 2013 pursuant to section 15 of title 3, United States Code, to count the electoral votes for President and Vice President cast by the electors in December 2012 shall be held on January 4, 2013 (rather than on the date specified in the first sentence of that section). 126 Stat. 1610 (adopted 28 December 2012)--
thereby, the Tabulation Joint Session of Congress resulting from the 2012 Presidential Election was to be held two days early relative to the statutory date- on 4 January 2013 (this last necessitated by the fact that 6 January happened to fall on a Sunday that year).
In these four cases immediately above, the date of the Tabulation Joint Session does appear in italics in the table.
Patterns in Policymaking and Their Consequences for Medicare Prescription Drug Coverage
Next we look at how, over time, policymakers have handled the issue of improving prescription drug coverage in Medicare. We draw on theories of the policy process to analyze when and how opportunities for policy change arise, what options for drug benefits are favored, and what factors lead to the success or failure of initiatives. We also examine how the current handling of this issue is influenced by many “legacies” of earlier decisions. These patterns, we argue, are critical to understanding the conditions that finally allowed the establishment of a Medicare drug benefit in 2003.
Major Policy Change Requires Political Opportunities and Leadership
The need to cover outpatient prescription drugs was evident soon after Medicare was implemented. It was not inevitable that nearly four decades later, beneficiaries would still lack adequate coverage for this crucial component of modern medical care. Rather, the history we outlined earlier includes a number of missed opportunities for creating a Medicare drug benefit. That history illustrates how policy changes depend on shifts in political priorities, leadership, fiscal conditions, and the element of chance. It also demonstrates that Medicare prescription drug coverage has seldom been debated as an independent issue rather, in nearly every debate, its fate has rested on the success or failure of other proposed changes to Medicare or the broader health insurance system.
John Kingdon (1995) argued that issues rise to the top of the policy agenda when two conditions are met. First, an abrupt shift in how a problem is perceived or in who controls the levers of governmental power opens a “window of opportunity” for policy innovation. Second, three relatively independent “streams” in the policy process—problems, policies, and politics—must converge. If advocates are able to couple their preferred policy alternative with the prevailing definition of the problem and the priorities of political leaders, organized interests, and public opinion, then the resulting alternative is likely to rise on the policy agenda and may lead to significant action within a short period of time.
The first major opportunity for improving Medicare coverage came in 1967 when President Johnson appointed HEW's Task Force on Prescription Drugs. In its final report in 1969, the task force recommended adding such coverage to Medicare. The timing of the report could not have been worse, however. Amid social unrest and political battering over the Vietnam War and his Great Society programs, President Johnson unexpectedly chose not to run for reelection in 1968.
When Vice President Hubert Humphrey (D) narrowly lost the presidential election to Richard Nixon, it became much more difficult to sustain the Johnson administration's initiatives. A review of the task force's recommendations for the incoming Nixon administration endorsed prescription drug coverage for Medicare, but neither HEW secretary Finch nor any of his successors drew up a formal proposal. A major window of opportunity thus closed with the change of administration. Over the next few years, rising costs in Medicare and Medicaid diverted what might have been the natural course of action, to expand eligibility and benefits, and cost containment became the chief priority for President Nixon and every succeeding president.
A combination of circumstances—the Reagan administration's desire to turn attention away from the Iran/contra scandal, the Democrats’ desire for action on domestic issues after recapturing control of the Senate in 1986, and the unusual personal interest of HHS secretary Bowen in strengthening financial protection of Medicare beneficiaries𠅎nabled the development of the MCCA and its universal but limited prescription drug benefit. Like many innovations in public policy, the MCCA required an extended period of what Kingdon calls “softening up,” during which policy entrepreneurs develop the basic idea for reform and test the feasibility of different approaches (Kingdon 1995, 127). For the MCCA, this began with the 1984 report of the Social Security Advisory Council. President Reagan solicited action on catastrophic coverage for Medicare in his 1986 State of the Union address, which opened a political window of opportunity for legislative initiatives.
From 1986 to mid-1988, congressional committees wrestled with different versions of the catastrophic coverage bill, driven by the first opportunity in a generation to “improve” Medicare by adding a variety of new benefits but constrained by Reagan's insistence that the bill not add to the federal budget deficit. Budget neutrality was the key factor in undermining the MCCA, since it forced seniors to shoulder the entire cost of the new coverage and effectively required well-off Medicare beneficiaries to subsidize lower-income beneficiaries.
Another window of opportunity opened in 1993 when the Clinton administration presented its plan for comprehensive health care reform. Given the guarantee of comprehensive benefits for the population under age 65, it was appropriate and politically necessary to add prescription drugs and other benefits to make the scope of Medicare benefits comparable. When the Clinton plan failed, enrollment in managed care rose rapidly throughout the U.S. health care system, including Medicare. Many plans offered additional benefits such as prescription drugs and also significantly reduced or eliminated most out-of-pocket costs. This may have helped convince many policymakers that moving most or all beneficiaries into managed care plans would be politically feasible and that universal prescription drug coverage would emerge automatically as a result of the private sector's practices, thereby eliminating the need for governmental mandates and explicit sources of financing. As the first step in that direction, Congress created the Medicare+Choice program in the Balanced Budget Act of 1997.
Not surprisingly, then, when Congress created the National Bipartisan Commission on the Future of Medicare, there was no mention of prescription drug coverage in its charge. The main proposals in 1999 called for the broad restructuring and privatization of the program, thus building on the Medicare+Choice approach. Only when several members expressed serious reservations about the commission's final proposals did the idea of adding drug benefits surface as a “sweetener” to win the number of votes needed to recommend a reform package to Congress.
The other significant development was the unexpected emergence of federal budget surpluses beginning in 1998, which enabled policymakers to come forward with proposals to add a prescription drug benefit to Medicare independent of the program's broad restructuring. As Kingdon explained, 𠇊 proposal must be shown to have a tolerable cost, at least a tolerable cost to the federal budget” (Kingdon 1995, 138). The combination of sizable budget surpluses along with unexpectedly low growth in spending for the rest of the Medicare program made it much easier to advocate an expensive new prescription drug program.
After 1999, the combination of rising costs, unequal access to coverage, a sharp decline in the stock market and retirement funds, and partisan politics forced policymakers to reexamine the options for a Medicare drug benefit. When the Balanced Budget Act trimmed capitation payments to Medicare HMOs, many responded by reducing or eliminating coverage for prescription drugs and other supplemental benefits. Employer-sponsored coverage for retirees also was eroding. Nearly a quarter of Medicare beneficiaries had no prescription drug assistance, and existing sources of assistance were becoming less and less adequate with each passing year. In addition, the rising cost of prescription drugs had become an issue for all Americans (Freudenheim 2003b). Per capita spending on prescription drugs rose at an annual rate of 13 percent or more each year from 1998 to 2002, several times the general inflation rate or rate of growth in the nation's gross domestic product (Strunk and Ginsburg 2003). Both Kingdon (1995, 95𠄹) and Jack Walker (1981, 88) observed that indicators like these help define problems or “performance gaps” that create the demand for governmental action.
By 2002, the inadequacy of coverage for Medicare beneficiaries joined other issues such as automatic patent extensions and the reimportation of drugs from other countries. In clear violation of existing law, states and communities created programs to buy prescription drugs from Canada (Belluck 2003) and senior citizens were crossing the borders with Canada and Mexico to buy lower-cost medicine (Flaherty and Paul 2003). These controversies were mutually reinforcing and put the pharmaceutical industry on the defensive. The pressure for reform was now probably higher than ever before.
For several reasons, the time for a Medicare prescription drug program finally arrived in 2003. What favored governmental action was that as in Kingdon's conceptual model, the three “streams” in the agenda-setting process—problems, policies, and politics𠅌onverged at a moment when a “window of opportunity” for reform was open. As noted earlier, the problem of rising drug costs and the resulting decline in the ability of Medicare beneficiaries to secure and maintain supplemental coverage was serious and growing worse. In fact, this was the first time since 1969 that prescription drug coverage was the primary issue on the policy agenda and that its fate was not strongly bound to broader proposals for health care reform.
Even though the Bush administration and Republican congressional leaders tried to use the enhanced drug benefits as a way to induce beneficiaries to join private managed care plans, members of both parties in Congress bowed to political realities and public dissatisfaction with managed care and developed what is primarily a package of new subsidies for prescription drug assistance. Kingdon contended that in the “primeval soup” of the policy stream, 𠇌reative activity usually involves recombination of old elements more than fresh invention of new ones” (Kingdon 1995, 124). From 1999 onward, all the major issues in designing a Medicare prescription drug benefit had been identified, and all the major components had been examined by officials and experts alike (e.g., CBO 2002). Thus the task for House and Senate leaders was to fit a variety of components into a $400 billion package that would pass muster with their colleagues and key constituencies. The income-related financing, the 𠇍oughnut hole” in coverage, the discount cards, and the reliance on pharmacy benefit managers were all adapted from recent proposals. The option of having the private sector manage the pharmacy benefits was especially important, as it allowed Republicans and their allies in the drug industry to support new benefits without appearing to support an expansion of governmental authority and bureaucracy.
Finally, there was sufficient political capacity and will to address this problem. A new, extraordinary window of opportunity opened when Republicans regained majority control of the Senate and maintained control of the House after the 2002 elections. At that point, President Bush made Medicare reform one of his administration's highest domestic priorities. Two of his party's most powerful legislators, Senate Majority Leader Frist and House Ways and Means Chairman Thomas, considered Medicare reform to be a high priority and were in a position to shepherd it through the Congress. Republican leaders concluded that they could claim credit for a prescription drug benefit but also that since they controlled both the legislative and executive branches of government, they could face negative consequences at the polls in 2004 if they failed to deliver on President Bush's pledge in the 2000 campaign. In their view, Medicare reform could take a major issue away from the Democrats and help ensure President Bush's reelection and the Republicans’ domination of national politics. The chairman of the Senate Republican Conference, Rick Santorum (R-Pa.), pointed out that “if we can't pass it, that is a big problem for us. There's no question the responsibility falls on a Republican president and Senate and House Republicans, and that's why it won't fail” (Dewar 2003).
The president and other Republican leaders made numerous concessions by greatly increasing the amount of subsidies over those of previous proposals and by agreeing that beneficiaries could get generally equivalent benefits even if they remained in the fee-for-service program. The fact that President Bush and many conservatives in Congress were still willing to commit $400 billion to get legislation enacted in 2003, despite the mounting costs of the war in Iraq and an unprecedented budget deficit, testifies to the eagerness of Republicans to co-opt an issue that has traditionally favored Democrats. Sensing that the limited bipartisan cooperation in the Senate prevented a filibuster, President Bush invested his political capital to win over skeptical allies and enact legislation as soon as possible (California Healthline 2003d Goldstein 2003a).
Political support was also easier to obtain now than in the past because the “pay-as-you-go” requirements of the Budget Enforcement Act of 1990 expired in 2002. As a result, policymakers were not forced to create a costly prescription drug benefit within a zero-sum financial game, which would force them to pay for the new coverage by imposing the higher costs on seniors themselves, increasing taxes, or making cuts in other parts of Medicare or other domestic programs. The willingness to spend new federal revenues made it far less likely that policymakers would see a repeat of the revolt that led to repeal of the Medicare Catastrophic Coverage Act and its drug benefit in 1989. Nonetheless, the concerns held by both liberals and conservatives about specific provisions in the final conference report kept its fate uncertain until the very end.
Ultimately, it was the “sheer force” of the Republican leadership—House Speaker Hastert and Senate Majority Leader Frist, in concert with President Bush and HHS secretary Thompson𠅊nd perhaps the suppression of the administration's cost estimates, that maintained sufficient party discipline to nudge the reform package over the finish line in 2003 (Goldstein 2003b Koszczuk and Allen 2003 Schuler and Carey 2004). This particular episode, as well as those that preceded it, illustrate what political scholars regard as an inherent unpredictability in the policy process, in which ideas, individual leaders, and the context for debate are often as influential as conventional political interests in determining the scope and substance of the agenda and the translation of proposals into policy (Baumgartner and Jones 1993 Jones 1989 Kingdon 1995 Oliver 1996 Polsby 1984 Walker 1981).
The Core Values of Competing Advocacy Coalitions Can Produce Policy Deadlock
Whereas Kingdon highlights the potential instability of politics and policymaking, other analysts focus on the reasons why certain policies are so resistant to change. We explain next how the ideological conflict between those seeking to expand the traditional Medicare program and those preferring a greater role for private health care companies prevented political agreement on adding prescription drug coverage over the last decade and what forces narrowly broke the deadlock in 2003.
According to Paul Sabatier and Hank Jenkins-Smith (1993), long-term policy change depends on the competition among two or more vocacy coalitions” whose members monitor and actively try to influence specific policy issues. Like Kingdon, Sabatier and Jenkins-Smith do acknowledge some degree of punctuated equilibrium in policy development. In their view, most policy changes are the product of shifts in large-scale social, economic, or political conditions. These shifts roughly correspond to what Kingdon calls “windows of opportunity” in the policy process. As the history of Medicare and prescription drug coverage demonstrates, however, even with a major shift in political power or other external circumstances, it is often difficult for government to respond to even serious problems because an effective response would violate the core values of an advocacy coalition.
Sabatier and Jenkins-Smith argue that on many, if not most, policy issues, the competing coalitions are not temporary alliances—“strange bedfellows”𠅋ut, rather, individuals and organizations with the same values and beliefs concerning what constitutes appropriate and effective public policy. They hold p-core” normative beliefs and “near-core” policy beliefs that are highly resistant to change. In addition, they hold a variety of “secondary” beliefs that are more tactical than strategic and are more subject to change over time. Building on these beliefs, they develop long-standing relationships with other members of the advocacy coalition and exhibit a high degree of coordination on political strategy.
In the absence of changes in broader, contextual conditions, Sabatier and Jenkins-Smith believe that policy still can change if partisan positions are modified through a process of “policy learning.” Policy learning is a fairly subtle and gradual process. The members of an advocacy coalition almost never change their deep-core values and beliefs, which dictate their basic orientation to an issue and the role of government. But they may change their “near-core” policy-oriented beliefs and a variety of “secondary” beliefs when new information overcomes their claims about the nature of a problem or the effectiveness of a solution. Given a new understanding of the problem and potential remedies, current policies may become indefensible, and a coalition may accept new methods of government intervention.
For most of Medicare's history, the principal advocacy coalitions were organized around the interests of providers, beneficiaries, and government officials (Oliver 1993, 128). The core values centered on professional autonomy (and economic interest) for providers, the preservation of meaningful entitlements for beneficiaries, and the protection of the public purse for government officials. Within the government coalition there was considerable bipartisanship, which was useful when countering beneficiaries’ and providers’ shared interests in expanding services and when instituting regulatory regimes for cost containment (Oberlander 2003, 106, 133 Oliver 1993, 132).
The politics of the Clinton health plan drastically changed the politics of Medicare in the mid-1990s. Although President Clinton had seized on “managed competition” as a synthesis of liberal goals and conservative methods (Hacker 1997 Starr 1992), the health insurance industry, small business groups, pharmaceutical companies, and other opponents successfully attacked the reforms on the grounds that they represented heavy-handed intrusion into individual choice and created sizable bureaucracies to manage the system and constrain costs if competition failed to do so (Johnson and Broder 1996 Skocpol 1996).
Republicans helped kill the 𠇋ig government” Clinton plan and then moved to dismantle many existing government programs once they captured control of Congress in 1995. As Haynes Johnson and David Broder pointed out, “It was not consensus politics being practiced in Washington or even conservative politics as previously defined. This was ideological warfare, a battle to destroy the remnants of the liberal, progressive brand of politics that had governed America through most of the twentieth century” (Johnson and Broder 1996, 569). Since the mid-1990s, the advocacy coalitions regarding Medicare policy have fractured, dividing providers and government officials in particular. The new coalitions are much more aligned with the Democratic and Republican parties, and as a result, the debates over adding prescription drugs and other strategies to “modernize” Medicare are highly polarized.
In contemporary politics, conservative Republicans and liberal Democrats often hold fundamentally different deep-core beliefs about individual responsibility, the role of government, and the capacity of the private sector to meet social needs. They also have very different near-core beliefs that shape their policy preferences. Democrats tend to favor a government-financed system of national health insurance. They consider Medicare, along with Social Security, as the central components of a social insurance system that provides universal protection to all of the nation's senior citizens. Where health care is purchased privately, Democrats still favor a strong hand for federal and state regulation of providers, health plans, and the rest of the health care industry.
In contrast, Republicans advocate individual, not collective, responsibility for securing most goods and services. They accept a minimal role for the government in Medicaid, welfare, and other safety net programs for the poor and oppose the expansion of universal entitlements. Republicans stress the superiority of markets over government in the allocation of resources and thus want to preserve a major role for private business and health systems in the provision of health care services. Jacob Hacker and Theda Skocpol (1997) described what they perceived to be the threefold strategy adopted by the Republicans: (1) Reduce spending on existing programs and cut taxes to prevent future spending (2) transfer authority for federal-state programs to the states (e.g., welfare, Medicaid) and (3) replace public services with the public purchase of privately delivered services.
These distinct approaches are deeply entrenched, and the series of proposals that have emerged over the past decade indicate that they are unlikely to be modified by more research and analysis. Robin Toner noted how closely intertwined politics has become with policy prescriptions:
In fact, the divisions over health care—specifically, how much to trust private markets, how much to rely on government𠅊re among the most profound in politics today. Republicans and their allies say turning Medicare into more of a private health care market place, in which numerous health plans compete for the elderly's business, will give the program's beneficiaries more choices and modernize its bureaucratic structure before the baby boom generation hits.mocrats and their allies say Medicare was created because the private health insurance market failed to meet the needs of the elderly. They charge that what some Republicans are ultimately aiming for is replacing the guaranteed benefits of Medicare with a voucher. (2003a)
Ultimately, the different approaches of Republicans and Democrats depend on whether one views medical care as a market good or as a medically determined need. According to Sherry Glied, there are sharp contrasts between “marketist” and “medicalist” advocates of health care reform. “Marketists” see health care as just another good or service (Glied 1997, 26). They object to the government's financing of health care because it distorts the market (despite abundant evidence that the market does not function properly in health care). For “medicalists,” allocation should depend on a person's needs as determined by expert providers, whose diagnosis and treatment should be guided entirely by medical science and not cost (despite abundant evidence that practice patterns of health care providers often are unscientific and excessively expensive). Glied argued that ideological differences contribute to political deadlock and undermine even incremental reform, since 𠇎very such change increases the likelihood that either the marketist or medicalist view of health care will ultimately prevail” (Glied 1997, 34𠄵).
Between 1999 and 2003, initiatives to add prescription drug coverage to Medicare reached an impasse𠅎ven when it appeared that the coverage could easily be funded by federal budget surplusesuse of divided government and ideological conflict between the dominant advocacy coalitions in Medicare policy. More than anything else, the impasse was due to the seemingly irreconcilable core beliefs guiding public policy in general and Medicare in particular. Even when Republican leaders accepted the need for government subsidies of prescription drug costs, they almost exclusively favored the marketist approach to policy design, rejecting standard benefits and central administration. This was especially true for Representative Thomas and his colleagues in the House of Representatives. Most Democratic leaders strongly favored the medicalist approach (albeit with a heavy dose of government oversight). Similarly, the AARP focused on adequate benefits for all beneficiaries—ruling out a strictly marketist approach𠅊nd PhRMA vetoed any steps that could easily lead to price controls in what was by far its most lucrative market.
What happened to break the ideological and political impasse in 2003? The policies hammered out in the conference report did little to resolve the most controversial issues:
Negotiators were never able to bridge the gap between free-market Republicans, on one side, who are hellbent on bringing the private market into the senior health care business and New Deal Democrats on the other, who hold dearly to the belief that Medicare is a cornerstone of the federal government's social contract with senior citizens. How do you reach a compromise between those two intractable positions? In fact, there is more concession than compromise in this conference report. What it provides is a way to let each side think it has gotten a 𠇏oot in the door,” and thus an inroad to its larger objectives.
The critical changes were external to the ongoing legislative battles. First, the contextual conditions shifted when the Republicans took control of both houses of Congress and the White House and when President Bush decided to invest heavily in reaching a prescription drug program in order to take that issue away from Democrats in his 2004 reelection campaign. The president and the Republican leadership in Congress intensely lobbied legislators and the pharmaceutical industry to concede some of their market-oriented agenda on Medicare in order to strengthen their broader political agenda.
Second, a broadly constructed set of evidence and arguments emerged to challenge the practices of the pharmaceutical industry. Drug manufacturers were accused of charging Medicare beneficiaries prices that were many times higher than the prices for the identical drug in other countries, obtaining unwarranted extensions of patents to pad profits and delay the introduction of generic competitors, and investing millions of dollars in me-too drugs and direct-to-consumer advertising. Criticism of those practices, combined with the spectacular rise in drug spending per beneficiary and the consequent erosion of supplemental coverage through employers and Medicare+Choice, led Republicans to take responsibility for moving legislation that previously would never have been a high priority for them.
Third, the decision by the AARP to endorse H.R. 1 broke up the long-standing alignment of the competing coalitions and gave lawmakers political cover to vote for the reform package and, if necessary, disregard their ideological convictions. The unprecedented momentum for action forced members of both advocacy coalitions into concessions in policy design that challenged their core values. Conservatives won a heavy role for the private sector in providing drug coverage. But they were unable to dramatically strengthen the overall role of private health plans in Medicare and agreed to give those beneficiaries who choose to remain in the fee-for-service program benefits comparable to those for people enrolled in managed care. Many liberals supported the Senate bill, and a critical few ended up voting for the final version of H.R. 1, even though it introduced means testing of benefits and income-related premiums for the first time in Medicare's history. They may believe that helping the neediest beneficiaries—those with low incomes and those with extraordinary drug expenses—is their core priority. If so, it is preferable to waiting for a more favorable political climate in which to adopt a more universal and generous program. They may also believe that once the government is providing some prescription drug assistance, if that assistance proves inadequate for large numbers of beneficiaries, then policymakers will be forced to improve the program rather than neglect it.
Policy Legacies and Learning Heavily Influence the Evolution of Medicare
As the advocacy coalition model suggests, many shifts in Medicare policy are based on longitudinal analysis and action, what Richard Rose (1993) called “learning across time.” Simply put, there are several significant ways in which today's problems and possibilities are affected by actions in the past. Similarly, policy changes today will quite possibly have a significant impact on conditions, perceptions, and policy alternatives in the future. Mark Peterson warned of analysis that assumes that
specific policy-making events could be well understood without reference to anything beyond the immediate political, institutional, and interpersonal contexts in which they transpired. Identify the players in the game, their vantage points and institutional resources, as well as the vectors of interest-group influence and general electoral incentives, and one had a sufficient explanation of the process of policy deliberation and choice. (1997, 1079)
Peterson's model of social learning builds on the work of Paul Pierson (1993), who found that a change in public policy creates ks” or “legacies” in two ways. First, by altering existing institutions or creating new ones, it can have “structural effects” on the resources and incentives of participants in the policy process: social groups, governmental elites, or the mass public. Second, policy change can produce “learning effects” that alter the distribution of information and interpretation of social conditions and government actions.
The evolution of Medicare has produced a number of structural effects that influence the contemporary debate over prescription drug coverage. Perhaps the most powerful one is the incentive of Medicare beneficiaries to mobilize politically to defend their existing benefits in a program that, despite its defects, gives them greater access to care and greater overall satisfaction than nonelderly adults have with private insurance (Kaiser Family Foundation and Commonwealth Fund 1997). The skepticism of senior citizens about recent proposals to add prescription drug benefits, which were generally linked to proposals for restructuring other program benefits, proved to be a brake on reform efforts until the AARP made its dramatic endorsement of H.R. 1 as it came to a final vote in November 2003.
This policy legacy is tied closely to another one, namely, the problem of making a transition from separate Part A and Part B benefits to a more integrated set of benefits and program administration. The limited enrollment in Part C, the Medicare+Choice program (now Medicare Advantage), meant that policymakers were essentially forced to incorporate prescription drug benefits into Part B or create yet another administrative structure, an independent Part D.
Finally, Medicare's limited benefits—restrictions on institutional stays, no catastrophic coverage, no outpatient prescription drugs𠅌reated their own legacy. Part of the reason for creating Medicare was the lack of interest by private insurance companies in offering coverage to retirees. Not only was the coverage expensive, but it also was not regarded as classic insurance, since many seniors had chronic health conditions and a need for services. Yet Medicare beneficiaries demonstrated early on that they wanted comprehensive coverage and protection against catastrophic expenses, and when Medicare did not provide them, they found other sources of supplemental coverage. Today, 87 percent of all Medicare beneficiaries have supplemental coverage beyond Parts A and B, and 78 percent have some form of prescription drug coverage, whether bought by former employers or Medicaid or paid for out of their own pockets (Kaiser Family Foundation 2003b). It can be argued that over time, the expansion of supplemental coverage has stalled the development of broader benefits within the Medicare program proper (Oberlander 2003, 48). In particular, the repeal of the MCCA was in part a legacy of the incomplete benefits accepted by the architects of Medicare in 1965. Beneficiaries who found affordable drug coverage elsewhere were not inclined to support mandatory conversion to a new program (and perhaps pay more for the privilege), and private insurers who sold Medigap or employee retirement benefits were not inclined to give up those customers.
The history of Medicare also illustrates a number of learning effects on the current handling of the issue of prescription drug coverage. Peterson makes the important distinction between “substantive learning” about the need for new policies and the relative effectiveness of policy options, and “situational learning” about the political and social consequences of policies (Peterson 1997, 1085). Substantive learning tends to be dominated by experts, whereas situational learning tends to be dominated by politicians and organized interests. Substantive learning tends to promote reform, as evidence and arguments mount to support new policies. Conversely, situational learning can either promote or inhibit reform, depending on the lessons that participants learn from past policy initiatives. The evolution of Medicare has numerous examples of each form of policy learning.
The most obvious examples of substantive learning in Medicare are the development in the 1980s and 1990s of prospective payment systems for hospitals, physician services, home health, and other services. Each change in policy followed a prolonged period of what policymakers regarded as unacceptable growth in that area of Medicare spending, as well as research on and analysis of methods to control costs without jeopardizing access to services for beneficiaries (e.g., Oliver 1993 Smith 1992). The rapid increase in prescription drug costs relative to those for other health services over the past decade has led both public and private health plans to negotiate lower prices, restrict utilization, and promote generic substitution. Such regulation will almost inevitably become part of any prescription drug coverage for Medicare beneficiaries—if not immediately, then soon after its implementation (Oberlander and Jaffe 2003).
The repeal of the MCCA in 1989 is an enduring event in the minds of almost all experts in Medicare policy and a prominent source of situational learning. As Peter Hall (1993, 278, 293) and Peterson (1997, 1090) stated, nothing about either substantive or situational learning requires that the lessons learned by policymakers, interest groups, or the public be accurate rather, it is the political effect on future policy choices that matters. Rovner argued precisely this point:
The conventional wisdom on the ill-fated Medicare Catastrophic Coverage Act is that it was all a big mistake.…[F]inancially secure senior citizens rebelled when they realized they would have to pay for expanded benefits they felt they did not need. The real story of the rise and fall of the Medicare Catastrophic Coverage Act sends several ominous messages about the state of Congress and our political system, but the power of the senior citizens’ lobby is not one of them. Those who lived through this nightmare instead learned a lot more about the power of direct mail, the ease of manipulating the public with information that is simply wrong, the resistance recipients of federal entitlement programs feel toward change, and the lack of knowledge Americans have about programs that so directly affect their lives. (1995, 145𠄶)
There is an additional and, in our view, critical lesson: The MCCA threatened the social contract established in 1965 in two ways, by advancing the concepts that Medicare benefits were no longer universally rned” during one's working years and that the program would no longer treat all beneficiaries in a strictly equal manner. Thus, both the policy and process were important to sealing the fate of the MCCA.
The proposals advanced in 2003 reflected situational learning based on what Rovner called the 𠇌onventional wisdom” from the demise of the MCCA, whether accurate or not. Most significantly, none of the bills imposed the full costs of the new benefits on seniors themselves, as happened in 1988. Instead, the costs of the program were to be paid out of general revenues, enrollees’ premiums, and out-of-pocket expenses. Another lesson was that participation in the new prescription drug coverage had to be voluntary (Dallek 2003). In particular, it was crucial to avoid requiring Medicare beneficiaries to switch out of supplemental coverage that was heavily subsidized and with which they were satisfied (e.g., employee retirement programs). Policymakers also created upfront benefits in the form of a discount card and a lower deductible, whereas the benefits under the MCCA were scheduled to take effect after beneficiaries had begun paying premiums to build up financial reserves for the program (Himelfarb 1995, 86).
Many provisions in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, however, were not consistent with the lessons learned from the demise of the MCCA. The incompleteness and complexity of the Part D benefits ensured that beneficiaries will be confused and that many of them will not see any improvement in their coverage (Bettelheim 2003 Pear 2003b Stolberg 2003b). Indeed, many beneficiaries will be worse off if a large number of employers drop the prescription drug benefits that they currently offer to retirees. Beneficiaries may also react negatively when they learn that neither they nor their former employers may buy supplemental coverage for costs not covered by the Part D program (Pear 2003d). Finally, the law reintroduced the income-related premiums so detested in the MCCA as well as direct means testing for low-income subsidies. The law requires Medicare and private insurers to obtain information about beneficiaries’ income from the Internal Revenue Service or another source, something sure to raise concerns in many quarters (Bettelheim 2003). These are the logical outcomes of a process in which the price tag of reform is decided before the appropriate method of reform is settled on. Even if some of these outcomes are expected or easily explained, they may prove politically damaging for the proponents of this approach.
The proposals in 2003 also reflected the situational learning of the pharmaceutical manufacturers. Since the Nixon administration altered Medicaid's drug-purchasing practices, the industry has opposed most proposals to add prescription drug benefits to Medicare. The proposed rebates under the health security act only reinforced the industry's concerns. In recent years, the industry toned down its strident opposition and offered conditional support for adding Medicare drug benefits yet it still vehemently resisted a centrally administered drug benefit. The influence of the pharmaceutical industry is one reason that most proposals called for a stand-alone drug benefit administered by pharmacy benefit managers or for formally integrating drug coverage into Medicare managed care plans.
From 1965 to 1999, proposals to expand Medicare benefits always included prescription drugs with the rest of ambulatory medical services in the Part B program. The idea of a stand-alone drug benefit first surfaced in President Clinton's 1999 proposal and is an integral part of the legislation passed in 2003. In some ways, this form of administrative intermediary is no different from the original Medicare program in contracting out claims payments and other functions to private insurers for both Part A and Part B. The idea then, as now, was to make transactions between health care providers and the Medicare program mirror the transactions with private health plans or, more bluntly, to create a buffer between health care providers and the regulatory reach of the government (NASI 2002, 24 Oberlander 2003, 111𠄶). Even if pharmacy benefits managers use cost-saving mechanisms like formularies, volume discounts, and utilization review, they still are viewed as part of the “market” and are not as threatening to the pharmaceutical industry as a central governmental agency employing the same techniques would be. The industry believes it will have stronger negotiating power vis-à-vis private organizations and less regulatory oversight than it would if it had to deal directly with the federal government.
This sort of administrative fragmentation through benefit rve-outs” has a short history, however: Pharmacy benefits managers appeared only in the past decade as employer-sponsored health plans struggled to contain the spiraling costs of prescription drugs for their beneficiaries. Without this institutional development, policymakers ideologically inclined to rely on the private sector's administration would not have had any experience on which to judge the viability of this approach. As it is, there are few examples of stand-alone drug plans that bear financial risk (CBO 2002), great uncertainty that insurers will actually participate in a Medicare drug benefit program (Goldstein 2003a, d Health Policy Alternatives 2003a), and little evidence to date that they can control the costs of a major Medicare benefit (Lipton et al. 1999 Lipton et al. 2000). When serving as administrator of the Centers for Medicare & Medicaid Services, Thomas Scully contended in congressional testimony that stand-alone drug coverage 𠇍oes not exist in nature” and would probably not work in practice (Pear 2003e). Hence, the use of private pharmacy benefits programs is based more on situational learning than on substantive learning from experience. Given the uncertainty, the conditions for offering a fallback prescription drug program to Medicare's fee-for-service enrollees were among the most contentious provisions of the new law.
A final, powerful example of situational learning is based on the “managed care backlash” that began with rejection of the Clinton health plan in 1994 and culminated in the troubled experience of the Medicare+Choice program. Not only did the enrollment of Medicare beneficiaries in managed care plans drop from 6.3 million to 5.0 million between 2000 and 2002, but the reduction of prescription drug coverage in the remaining managed care plans added to the pressure for an explicit Medicare drug benefit program. Thus, despite Republican control across the federal government, both the House and Senate produced bills with relatively equivalent benefits available to Medicare beneficiaries, regardless of whether they enrolled in a managed care plan or remained in the government-administered fee-for-service program.
The withdrawals of Medicare+Choice plans from the Medicare program since 1998 persuaded policymakers that they could not rely on comprehensive private plans completely, especially in rural regions of the country, and that beneficiaries would strongly oppose efforts to make drug benefits contingent on joining a health plan that might limit their choice of providers or access to specialists. “Where is the line between financial incentives and economic coercion? Republicans are keenly aware that one of the most devastating accusations against President Bill Clinton's plan for universal health insurance was that it would force Americans into HMOs” (Pear and Toner 2003a). The heavy representation of rural states on the Senate Finance Committee ensured that it would adopt comparable benefits for the managed care and the fee-for-service programs (Toner 2003b), but in the end the House also agreed to adopt this approach in H.R. 1 to make the new program attractive to as many beneficiaries as possible.
The 2004 Tsunami Wiped Away Towns With 'Mind-Boggling' Destruction
It was 2004, the day after Christmas, and thousands of European and American tourists had flocked to the beaches of Thailand, Sri Lanka and Indonesia to escape the winter chill in a tropical paradise.
At 7:59 AM, a 9.1-magnitude earthquake—one of the largest ever recorded—ripped through an undersea fault in the Indian Ocean, propelling a massive column of water toward unsuspecting shores. The Boxing Day tsunami would be the deadliest in recorded history, taking a staggering 230,000 lives in a matter of hours.
The city of Banda Aceh on the northern tip of Sumatra was closest to the powerful earthquake’s epicenter and the first waves arrived in just 20 minutes. It’s nearly impossible to imagine the 100-foot roiling mountain of water that engulfed the coastal city of 320,000, instantly killing more than 100,000 men, women and children. Buildings folded like houses of cards, trees and cars were swept up in the oil-black rapids and virtually no one caught in the deluge survived.
Thailand was next. With waves traveling 500 mph across the Indian Ocean, the tsunami hit the coastal provinces of Phang Nga and Phuket an hour and a half later. Despite the time lapse, locals and tourists were caught completely unaware of the imminent destruction. Curious beachgoers even wandered out among the oddly receding waves, only to be chased down by a churning wall of water. The death toll in Thailand was nearly 5,400 including 2,000 foreign tourists.
An hour later, on the opposite side of the Indian Ocean, the waves struck the southeastern coast of India near the city of Chennai, pushing debris-choked water kilometers inland and killing more than 10,000 people, mostly women and children, since many of the men were out fishing. But some of the worst devastation was reserved for the island nation of Sri Lanka, where more than 30,000 people were swept away by the waves and hundreds of thousands left homeless.
As proof of the record-breaking strength of the tsunami, the last victims of the Boxing Day disaster perished nearly eight hours later when swelling seas and rogue waves caught swimmers by surprise in South Africa, 5,000 miles from the quake’s epicenter.
Vasily Titov is a tsunami researcher and forecaster with the National Oceanic and Atmospheric Administration Center for Tsunami Research. He credits the unsparing destructiveness of the 2004 Indian Ocean tsunami on the raw power of the earthquake that spawned it. The quake originated in a so-called megathrust fault, where heavy oceanic plates subduct beneath lighter continental plates.
“They are the largest faults in the world and they’re all underwater,” says Titov.
The 2004 quake ruptured a 900-mile stretch along the Indian and Australian plates 31 miles below the ocean floor. Rather than delivering one violent jolt, the quake lasted an unrelenting 10 minutes, releasing as much pent-up power as several thousand atomic bombs.
In the process, massive segments of the ocean floor were forced upward an estimated 30 or 40 meters (up to 130 feet). The effect was like dropping the world’s largest pebble in the Indian Ocean with ripples the size of mountains extending out in all directions.
Titov emphasizes that tsunamis look nothing like the giant surfing break-style waves that many of us imagine.
“It’s a wave, but from the observer’s standpoint, you wouldn’t recognize it as a wave,” Titov says. “It’s more like the ocean turns into a white water river and floods everything in its path.”
Once caught in the raging waters, if the currents don’t pull you under, the debris will finish the job.
“In earthquakes, a certain number of people die but many more are injured. It’s completely reversed with tsunamis,” says Titov. 𠇊lmost no injuries, because it’s such a difficult disaster to survive.”
An earthquake and tsunami of the magnitude that struck in 2004 is so rare that catastrophic tsunamis are all but unknown in the long cultural histories of India and Sri Lanka, explains Jose Borrero, a tsunami researcher with the University of Southern California and director of eCoast, a marine consultancy based in New Zealand.
“[The Indian Ocean tsunami] came ashore in these places that had no natural warning either, because they were far enough away that they didn’t feel any of the earthquake,” says Borrero. “So without a natural warning, without an official warning and with no history of tsunamis, hitting coastlines full of people, that’s the perfect combination to cause a lot of death and destruction.”
Both Borrero and Titov took part in U.S. Geological Survey expeditions in early 2005 to measure the full extent of the tsunami that struck Sumatra. It was during these expeditions that scientists confirmed maximum wave heights of more than 131 feet on the northwestern tip of the island. Borrero remembers coming upon a colossal freighter loaded with bags of cement that had been flipped on its back with its propeller in the air.
“This was the most extreme tsunami event since 1960,” says Borrero, referring to the 8.6-magnitude Chilean earthquake and tsunami that punished the Pacific, including the leveling of Hilo, Hawaii, 15 hours after the quake.
Titov will never forget the scene of widespread devastation he witnessed on Sumatra even months after the tsunami waters had subsided.
“We took a boat all the way from the middle of the island up to Banda Aceh, the hardest hit area, and for hundreds of kilometers it was as if somebody had taken an eraser and erased everything underneath the 20-meter line,” says Titov. “The sheer scale of the destruction was just mind-boggling.”
Dave Roos is a freelance writer based in the United States and Mexico. A longtime contributor to HowStuffWorks, Dave has also been published in The New York Times, the Los Angeles Times and Newsweek.
Results of the Washington Primary February 8th 2004 - History
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Right: Attorney Robert Raich (Angel’s ex-husband), Lead Plaintiff Angel Raich, Attorney Randy Barnett, Plaintiff Diane Monson, and Attorney David Michael standing on the steps of the Ninth Circuit Court of Appeals in San Francisco California after Oral Arguments.
Angel McClary Raich, et al. v. John Ashcroft, et al.
The Ashcroft v. Raich case was heard before the United States Supreme Court on November 29, 2004 at 10:00 am, in Washington D.C.
SUPREME COURT DECISION TIMELINE: A decision in Ashcroft v. Raich most likely will come down around February 2005 or March 2005, about three to four months after the oral argument. The Court may also determine to sit for the purpose of announcing opinions on any other day, which often happens near the end of the term during the May-June period.
I f you would like to read the briefs filed in the United States Supreme Court Click Here.
October 13, 2004. Angel Raich filed her Merits Brief in the United States Supreme Court for the Respondents.
October 13, 2004. Amicus Curiae Brief filed in Support of Respondents from the Institute for Justice.
October 13, 2004. Amicus Curiae Brief filed in Support of Respondents from Constitutional Law Scholars.
October 13, 2004. Amicus Curiae Brief filed in Support of Respondents from the State of California Washington and Maryland.
October 13, 2004. Amicus Curiae Brief filed in Support of Respondents from the State of Alabama Louisiana and Mississippi.
October 13, 2004. Amicus Curiae Brief filed in Support of Respondents from Lymphoma Foundation of America HIV Medicine Association of the Infectious Diseases Society of America American Medical Students Association Dr. Barbara Roberts and Irvin Rosenfeld.
October 13, 2004. Amicus Curiae Brief filed in Support of Respondents from the Leukemia and Lymphoma Society, Pain Relief Network, California Medical Association, AIDS Action Council Compassion in Dying Federation End-of-Life Choices National Women's Health Network Global Lawyers and Physicians and AUTONOMY, Inc.
October 13, 2004. Amicus Curiae Brief filed in Support of Respondents from the California Nurses Association and DKT Liberty Project.
October 13, 2004. Amicus Curiae Brief filed in Support of Respondents from Marijuana Policy Project and Rick Doblin, Ph.D.
October 13, 2004. Amicus Curiae Brief filed in Support of Respondents from the Cato Institute
October 13, 2004. Amicus Curiae Brief filed in Support of Respondents from the National Organization for the Reform of Marijuana Laws (NORML) The NORML Foundation the National Association of Criminal Defense Lawyers Washington Association of Criminal Defense Lawyers and Oregon Criminal Defense Lawyers Association.
October 13, 2004. Amicus Curiae Brief filed in Support of Respondents from the Reason Foundation.
August 11, 2004. John Ashcroft filed his Merits Brief in the United States Supreme Court for the Petitioners.
August 11, 2004. A Joint Appendix was filed in the United States Supreme Court by both parties.
August 11, 2004. Amicus Curiae Brief filed in Support of the Petitioners Robert L. Dupont, M.D., Peter B. Bensinger and Herbert Kleber, M.D.
August 11, 2004. Amicus Curiae Brief filed in the United States Supreme Court in Support of the Petitioners from The Drug Free America Foundation, Inc., The Drug Free Schools Coalition, Save Our Society From Drugs, The International Scientific and Medical Forum on Drug Abuse, The Institute on Global Drug Policy, and Students Taking Action Not Drugs, et al.
August 11, 2004. Amicus Curiae Brief filed in the United States Supreme Court in Support of the Petitioners from Mark E. Souder U.S. Representative, Cass Ballenger U.S. Representative, Dan Burton U.S. Representative, Katherine Harris U.S. Representative, Ernest J. Istook, Jr. U.S. Representative, Jack Kingston U.S. Representative, and U.S. Representative, Doug Ose
August 11 2004. Amicus Curiae Brief filed in the United States Supreme Court in Support of the Petitioners from Community Rights Counsel
August 11, 2004. Amicus Curiae Brief filed in the United States Supreme Court in Support of Neither Party
June 10, 2004. John Ashcroft, et al. filed their Reply Brief for the Petitioners in the Supreme Court.
June 7, 2004. Angel McClary Raich, et al. filed their Respondents' Brief in Opposition in the Supreme Court.
May 14, 2004. After nine weeks of negotiations, attorneys for both sides finally agreed upon the language for the following Preliminary Injunction.
United States District Court Judge Martin J. Jenkins filed the Preliminary Injunction Order that said, "In Raich v. Ashcroft , 352 Fed. 3d 1222 (9th Cir. 2003), the United States Court of Appeals for the Ninth Circuit held that the Plaintiffs have demonstrated a strong likelihood that 'as applied to them, the [Controlled Substances Act] is an unconstitutional exercise of Congress' Commerce Clause authority.' Id. at 1227. According,
"IT IS HEREBY ORDERED THAT, during the pendency of this action Defendants, and their agents and officers, and any person acting in consort with them, are hereby enjoined from arresting or prosecuting Plaintiffs Angel McClary Raich and Diane Monson, seizing their medical cannabis, forfeiting their property, or seeking civil or administrative sanctions against them with respect to the interstate, noncommercial cultivation, possession, use, and obtaining without charge of cannabis for personal medical purposes on the advice of a physician and in accordance with State law, and which is not used for distribution, sale, or exchange." To read more of this Preliminary Injunction please go to the court document page of the www.angeljustice.org website fs24softlineat http://angeljustice.org/article.php?list=type&type=11
April 20, 2004. United States Attorney General John Ashcroft and DEA Administrator Karen Tady filed a Petition for Certiorari in the United States Supreme Court. Once the federal government filed their Petition for Certiorari the name of the case was changed from Raich v. Ashcroft to Ashcroft v. Raich . Ashcroft became the Petitioner and Raich became the Respondent.
March 11, 2004. The United States District Court filed notice stating, "YOU ARE NOTIFIED THAT the Court has scheduled a Status Conference for Tuesday, April 6, 2004 @ 2:00 p.m. before the Honorable Martin J. Jenkins." Conference will be held in courtroom 11, on the 19th floor, U.S. Courthouse, 450 Golden Gate Avenue, San Francisco, California 94102.
March 8, 2004. We received notice from the District Court letting us know they received the Mandate from the Ninth Circuit Court of Appeals.
March 5, 2004. The Ninth Circuit Court of Appeals issued it's mandate stating, "APPEAL FROM the United States District Court for the Northern District of California (San Francisco). THIS CAUSE came on to be heard on the Transcript of the Record from the United States District Court for the United States Northern District of California (San Francisco) and was duly submitted. ON CONSIDERATION WHEREOF, It is now here ordered and adjudged by this Court, that the judgment of the said District Court in this cause be, and hereby is REVERSED AND REMANDED."
February 25, 2004. The Ninth Circuit Court of Appeals DENIED John Ashcroft, et al. on petition for rehearing and rehearing en banc. In the rehearing was before Judges Pregerson, Beam, and Paez. "Judges Pregerson and Paez have voted to deny appellees petition for rehearing and rehearing en banc. Judge Beam voted to grant the petition for rehearing. Judge Beam is from the Eight Circuit. The full court has been advised of the petition for rehearing en banc and no judges has requested a vote on whether to rehear the matter en banc. The petition for rehearing and for rehearing en banc was DENIED."
January 23, 2004. Appellees filed petition for rehearing and rehearing en banc in the Ninth Circuit Court of Appeals.
December 16, 2003. Ninth Circuit Court of Appeals rules in support of patients and caregivers -- holding that the Federal government's actions against them are unconstitutional.
October 7, 2003. Hearing in the Ninth Circuit Court of Appeals in San Francisco. The case was heard before judges Pregerson, Beam (8th Circuit), and Paez.
August 12, 2003. Plaintiffs-Appellants’ Motion to Assign Related Cases for Oral Argument on the Same Date and Before the Same Panel But to be Argued Separately.
July 25, 2003. Order to Assign Case to the Next Available Merits Panel.
July 10, 2003. Appellants Letter of Recent Decision in the Lawrence v. Texas case.
June 17, 2003. Amicus Curiae Letter from Butte County requesting to join the Amici Curiae Brief submitted by the State of California, Alameda County and the City of Oakland in Support of the Appellants.
June 11, 2003. Appellants file reply brief and then await a hearing date.
May 28, 2003. Appellees (Defendants) (Ashcroft & Hutchinson) filed their Answering Brief in the Court of Appeals.
April 23, 2003. Appellants (Plaintiffs) filed their Opening Brief in the Court of Appeals.
April 29, 2003. Amicus Curiae Letter and Brief in Support of Appellants from the State of California, Alameda County, and the City of Oakland.
April 30, 2003. Amicus Curiae Brief in Support of Appellants from the California Medical Association and the California Nurses Association.
April 30, 2003. Amicus Curiae Brief in Support of Appellants from Marijuana Policy Project, Rick Doblin, Ph.D and Ethan Russo M.D.
March 12, 2003. The Plaintiffs filed a Notice of Appeal to the United States Court of Appeals for the Ninth Circuit.
March 5, 2003. The Court filed an order denying the preliminary injunction, despite finding that "the equitable factors tip in plaintiff’s favor."
December 17, 2002. Hearing before United States District Judge Martin J. Jenkins on the motion for preliminary injunction.
October 9, 2002. Two medical cannabis patients, Angel McClary Raich, Diane Monson, and two caregivers, John Doe Number One, and John Doe Number Two filed a complaint and motion for preliminary injunction against Attorney General John Ashcroft and former DEA Administrator Asa Hutchinson. McClary Raich and Monson are asking Judge Martin J. Jenkins to issue a preliminary injunction during the pendency of this action and a permanent injunction enjoining defendants from arresting or prosecuting plaintiffs, seizing their medical cannabis, forfeiting their property, or seeking civil or administrative sanctions against them for their activities.
According to the complaint, John Ashcroft and Asa Hutchinson are unconstitutionally exceeding their authority by embarking on a campaign of seizing or forfeiting privately-grown intrastate medical cannabis from California patients and caregivers, arresting or prosecuting such patients, mounting paramilitary raids against patients and caregivers, harassing patients and caregivers, and taking other civil or administrative actions against them.
Results of the Washington Primary February 8th 2004 - History
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1966 – 1976 |1976 – 1986 |1986 – 1996 | 1996 – 2006
1966 (June) National Organization for Women (NOW) is established by a group of women, including Betty Friedan and Pauli Murray, who meet to discuss alternative action strategies during the Third Annual Conference of Commissions on the Status of Women in Washington, D.C. Friedan famously writes the acronym NOW on a paper napkin.
1966 (October) NOW holds its founding conference. Betty Friedan is elected president and Kay Clarenbach, chair of the board. Aileen Hernandez is elected executive vice president in absentia Richard Graham, vice president and Caroline Davis, secretary-treasurer. NOW sets up seven Task Forces: Equal Opportunity of Employment Legal and Political Rights Education Women in Poverty The Family Image of Women and Women and Religion.
1966 NOW officers and members begin petitioning EEOC for public hearings on its advertising guidelines and pressuring the Commission to enforce its prohibition against sex discrimination. NOW officers and 35 members file a formal petition with the EEOC for hearings to amend regulations on sex-segregated “Help Wanted” ads.
1967 At its second national conference, NOW adopts passage of the Equal Rights Amendment (ERA), the repeal of all abortion laws, and publicly-funded child care among its goals in a “Bill of Rights for Women.” NOW is the first national organization to endorse the legalization of abortion.
1967 NOW’s National Board adopts by-laws providing for the establishment of chapters, and establishing the national conference as the supreme governing body of the organization.
1967 In May, the EEOC holds hearings on sex discrimination in employment ads as a result of NOW’s 1966 petition. NOW members demonstrate at EEOC field offices across the country in protest of EEOC’s failure to end sex-segregated “Help Wanted” advertising. In December, four NYC newspapers, including the New York Times, de-sexigrate their Help Wanted ads.
1968 NOW chapters around the country demonstrate at facilities that deny admittance or service to women, demanding equal treatment of women in all public accommodations.
1968 NOW boycotts Colgate-Palmolive products, and demonstrates for five days in front of the company’s NYC headquarters, protesting company rules that kept women out of top-paying jobs with a prohibition against lifting more than 35 pounds.
1968 In November, NOW member Shirley Chisholm becomes the first Black woman elected to the U.S. House of Representatives.
1969 On February 9, NOW proclaims “Public Accommodations Week,” and holds national actions at “men only” restaurants, bars, and public transportation. A month before, the U.S. Court of Appeals rules in favor of EEOC guidelines prohibiting sex-segregated job advertising.
1969 In March, NOW attorney Sylvia Roberts (later NOW’s Southern Regional Director, from Baton Rouge, LA) argues the first sex discrimination case appealed under Title VII. Roberts argues in the Fifth Circuit U.S. Court of Appeals that it was sex discrimination for Lorena Weeks, a secretary, to be restricted from higher-paying employment as a “switchman” because of a 30-pound lifting limit. Weeks entered the courtroom with her typewriter, which she was regularly required to lift and move — yes, it weighed more than 30 pounds. The court later rules in Weeks v. Southern Bell that the weight limitation rule for women violated Title VII of the Civil Rights Act.
1969 NOW holds a week-long action called “Freedom for Women Week” at the White House, beginning on Mother’s Day. Demonstrators call for “Rights, Not Roses.”
1969 NOW chapters work to establish women’s studies courses, beginning at universities in California and Michigan, and at Princeton.
1970 In February, about 20 NOW members, led by Wilma Scott Heide and Jean Witter, disrupt the Senate hearings on the 18-year-old vote to demand hearings on the Equal Rights Amendment. At a signal from Heide, the women rise and unfold posters they had concealed in their purses.
1970 NOW establishes a Federal Compliance Committee to press for enforcement of federal equal opportunity laws requiring that federal contractors not discriminate against women. NOW files a sex discrimination complaint with the Office of Federal Contract Compliance against 1,300 corporations for failing to file affirmative action plans for hiring women.
1970 NOW organizes “Women’s Strike for Equality” on the 50th Anniversary of the 19th Amendment, with actions in more than 90 cities and towns in 40 states. 50,000 women march on Fifth Avenue in New York.
1970 In August, after an intense campaign by NOW, the House passes the ERA by a vote of 350-15.
1970-71 NOW campaigns for the Comprehensive Child Care Act, sponsored in the Senate by Walter Mondale and Jacob Javits, and in the House by Shirley Chisholm and Bella Abzug NOW lobbies the comprehensive legislation through both houses of Congress, but it is vetoed by President Richard Nixon, who calls it the “Sovietization of American children.”
1971 NOW protests the Department of Health, Education and Welfare’s failure to deal with discrimination complaints against universities, and work begins on what will eventually become Title IX.
1971 NOW petitions the Federal Communications Commission (FCC) to have women included in affirmative action programs for radio and television ownership and employment
1971 NOW stages nationwide demonstrations protesting AT&T’s discriminatory practices towards women, thus beginning a campaign that will last several years and end in massive back pay for women who had been excluded.
1971 NOW adopts a resolution recognizing that lesbian rights are “a legitimate concern of feminism.”
1972 NOW endorses Shirley Chisholm, a NOW member, in the democratic primary. Chisholm is the first African American woman to run for President, and NOW’s first presidential endorsement.
1972 NOW organizes a national campaign to pass a law guaranteeing women and girls equal educational opportunities, including higher education admissions and athletic participation. In June, Congress passes the Education Amendments of 1972, which includes Title IX, a guarantee of equal educational opportunities, including sports.
1972 – 1982 After the Senate passes the ERA 84-8, NOW leads ERA ratification campaigns in all 50 states. By 1977, 35 of the necessary 38 states have ratified the amendment.
1973 Roe v. Wade invalidates all state laws that restrict abortion in the first three months of pregnancy, grounding the decision on the right to privacy, and permits second-trimester regulations only to protect the woman’s health. NOW chapters begin escorting patients into the newly established clinics, which are already being picketed.
1973 The NOW Task Force on Rape is created to set up Rape Crisis Centers and hotlines across the country NOW begins campaigns to redefine rape as a crime of violence.
1973 NOW establishes the Task Force on Sexuality and Lesbianism.
1973 Conceived by NOW, August 26, the anniversary of the passage of the suffrage amendment, is declared Women’s Equality Day by Congress and the President.
1973 In June, after a five-year campaign by NOW and more than three years of litigation of the NOW complaint, the U.S. Supreme Court rules to prohibit sex-segregated employment advertisements.
1973 NOW organizes an International Feminist Planning Conference in Massachusetts.
1974 NOW passes resolutions calling for the impeachment of Richard Nixon. In September, President Gerald Ford meets with NOW President Karen DeCrow and other women leaders.
1974 NOW helps defeat a proposal by the NCAA to narrow the scope of Title IX the Educational Equity Act passes Congress after pressure from NOW and other feminist organizations.
1975 NOW calls all members to the streets to protest violence against women and to “claim the night and the streets as ours” – the first “Take Back the Night” actions.
1975 Congress opens U.S. military academies to women and NOW pushes for an immediate effective date.
1975 In October, NOW sponsors “Alice Doesn’t Day,” a women’s strike, to draw attention to the many unnoticed services women provide.
1975 NOW Media Task Force testifies against the funding of the Corporation for Public Broadcasting due to its poor record on women.
1976 – 1986
1976 NOW opens its Action Center in Washington, D.C., and projects its first $1 million budget. NOW continues its campaign for ERA ratification.
1976 The NOW Task Force on Battered Women is established.
1977 At the historic Houston Women’s Conference, led by NOW President Eleanor Smeal, activists pass controversial lesbian rights plank despite opposition by conference organizers. Betty Friedan speaks in favor of the plank. The conference’s final Plan of Action echoes NOW’s “Bill of Rights” proposed a decade earlier.
1977 NOW adopts bylaws establishing regional election of board members and delegated National Conferences which elect full-time salaried national officers.
1977 In August, NOW organizes the first ERA march, demanding that President Jimmy Carter take action to ratify the ERA. Four thousand people attend. Days later, ERA walkathons on Women’s Equality Day across the country raise $150,000 for the NOW ERA Strike Force.
1977 After considerable debate, NOW conference delegates resolve to form a Political Action Committee to influence the election of feminists to office.
1978 In June, NOW members demonstrate across the country on Gay Freedom Day.
1978 In July, NOW organizes over 100,000 people to march down Constitution Avenue to the Capitol, demanding an extension of the ERA ratification deadline. The House and Senate vote to extend the ratification deadline from 1979 until 1982–only half of the seven years extension that was requested, contributing to the defeat of the amendment.
1978 NOW continues to boycott states that have not ratified the ERA, gaining the support of 321 organizations and 35 cities and counties. NOW issued by John Ashcroft, Missouri’s attorney general, claiming the ERA boycott is unlawful NOW prevails, establishing the right to use a boycott for the purpose of petitioning the government.
1978 NOW helps pass a Rape Shield Law, protecting the privacy of rape survivors by preventing cross-examination into the woman’s prior sexual history.
1978 The Pregnancy Discrimination Act, drafted by NOW founder Phineas Indritz, ends employment discrimination based on pregnancy, requiring that it be treated as any temporary disability by employers who are covered by Title VII.
1979 NOW testifies in Congress against restrictions on abortion funding for military personnel and dependents.
1979 NOW unites with other organizations to counter a lobbying effort to limit Title IX.
1979 NOW launches a new National ERA Campaign action teams are set up in ratified states to prevent rescission. NOW activists defeat ERA rescission efforts in 13 states.
1979 NOW Minority Women’s Committee organizes the conference “Racism and Sexism-A Shared Struggle for Equal Rights,” in Washington, D.C.
1980 NOW conference adopts an affirmative action bylaw, reserving a minimum number of board seats for women of color.
1980 Over 90,000 ERA supporters gather in Chicago for a march coordinated by NOW.
1980 NOW delegation fights to pass the strongest ERA and reproductive rights planks in history at the 1980 Democratic Convention, over the objections of eventual party nominee, incumbent President Jimmy Carter.
1980 NOW announces opposition to the draft but states that if there is a draft, NOW supports the inclusion of women on the same basis as men.
1981 Sandra Day O’Connor is appointed to the US Supreme Court by President Ronald Reagan. NOW President Eleanor Smeal testifies in favor of her appointment.
1981 NOW launches a nationwide campaign to stop the so-called Human Life Amendment, which would prohibit all abortions and ban the use of some contraceptive pills and IUDs. State and local chapters across the country organize to counter anti-choice legislation.
1981 ERA Countdown Campaign Offices are opened nationwide, and rallies around the country occur to kick off the campaign. The “Last Walk for ERA” raises close to a million dollars.
1982 The ERA falls three states short of ratification. Supporters continue to reintroduce it in every session of Congress thereafter
1982 On Women’s Equality Day, NOW’s PACs launch a $3 million fundraising drive for fall state and congressional elections as part of our ERA vow to “Remember in November”
1983 NOW activists defeat almost all anti-abortion bills introduced in state legislatures this year. The U.S. Supreme Court rules 6-3 that government can not interfere with women’s abortion rights unless it is clearly justified by “accepted medical practice.”
1983 With other leading civil rights groups, NOW is a lead organizer of the 20th-anniversary march commemorating the 1963 Martin Luther King, Jr. “I Have a Dream” march. At NOW’s urging, Equality is added to the march theme, making it a march for Peace, Justice, and Equality.
1983 NOW leads a successful campaign to reinstate the canceled TV series Cagney and Lacey, with Tyne Daly and Sharon Gless, which was the first to portray female police officers and strong role models for women.
1983 NOW endorses the Economic Equity Act. NOW chapters nationwide participate in a “National Day of Protest” against Allstate Insurance for employment discrimination.
1984 NOW makes its second presidential endorsement, supporting women’s rights champion Walter Mondale, former Vice President, in the democratic primary. With NOW’s urging a “Woman VP NOW,” Mondale selects Geraldine Ferraro for Vice President. NOW campaigns nationwide for Mondale/Ferraro. Press Conference JULY 12, 1984 Video Credit: CSPAN
1984 NOW’s first Lesbian Rights Conference is held in Milwaukee, WI.
1984 NOW chapters around the country picket Republican Party offices in protest of President Reagan’s anti-abortion leadership carry out publicity campaigns with Women’s Truth Squads. NOW pickets the White House, and demands an end to anti-abortion violence and harassment.
1984 – 1988 NOW works to pass the Civil Rights Restoration Act, reversing Supreme Court cases that limited federal laws combating discrimination based on gender, race, age, and disability.
1985 NOW chapters conduct around-the-clock vigils in 30 abortion clinics in 18 states to guard against potential violence NOW activists continue to provide clinic escort services for patients.
1985 In June, NOW organizes a national march in D.C. and “Witness for Women’s Lives” rallies in 13 cities protesting the Catholic leadership’s opposition to abortion and contraception.
1986 NOW organizes the first East/West Coast March for Women’s Lives, drawing 125,000 demonstrators to Washington, DC and 30,000 to Los Angeles despite torrential rains.
1986 NOW Foundation is formed as the tax-deductible litigation, education, and advocacy arm of NOW.
1986 After numerous assaults on abortion clinics, NOW announces that it has filed a federal civil suit in Delaware against Joseph Scheidler, the Pro-Life Action League, and other groups attacking the clinics, for violation of anti-trust and other federal laws.
1986 – 1996
1987 NOW convenes the first conference on Women of Color and Reproductive Freedom, followed by regional conferences.
1987 NOW launches “The Great American Mother’s Day Write-In” to counter the right-wing assault to prevent the passage of the Family and Medical Leave Act.
1987 NOW “Campaign to Free Sharon Kowalski,” successfully brings attention to the rights of lifetime partners in making medical decisions for each other.
1987 NOW participates in organizing the National Gay and Lesbian Rights March that drew hundreds of thousands to D.C.
1987 NOW unites with NAACP and others to coordinate the “Jobs with Justice” march in Texas.
1988 NOW holds its second Lesbian Rights Conference in San Diego, CA.
1988 Congress overrides President Reagan’s veto to pass the Civil Rights Restoration Act, for which NOW fought. The act restored Title IX equal education laws, which had been effectively suspended since the 1984 Grove City v. Bell decision in the Supreme Court.
1988 NOW begins a long battle with Operation Rescue, defending clinics across the country from blockades and suing (and eventually bankrupting) leader Randall Terry for breaking the law.
1989 NOW’s 2nd March for Women’s Lives brings a record-setting 500,000 to the National Mall to influence the Supreme Court considering a reversal of Roe v Wade.
1989 After Supreme Court decisions gut employment discrimination laws, NOW helps draft a new Civil Rights Act, which passes in 1991, giving women the right to money damages and jury trials for sex discrimination and sexual harassment.
1989 In November, NOW organizes another 350,000 people for a mass rally at the Lincoln Memorial, “Mobilization for Women’s Lives” is an unprecedented second mass action in a single year.
1990 – 1994 NOW lobbies for four years to pass the Violence Against Women Act (VAWA), which is signed in 1994 with an unprecedented $1.6 billion dollar budget for violence prevention and services.
1990 NOW’s Freedom Caravan for Women’s Lives begins state tours to recruit feminist candidates.
1991 After employees are fired based on sexual orientation, NOW demands fair hiring practices at Cracker Barrel Country Stores.
1991 NOW’s National Conference in New York includes a march and rally of more than 7,500 people to protest the “gag rule.” Congress votes to overturn the George H. W. Bush Administrations’ “gag rule” that barred federally financed family planning clinics from giving women information about abortion, but Bush vetoes the legislation and the House does not have enough votes to override. NOW chapters nationwide protest at Bush administration speaking events.
1991 NOW’s WomenElect 2000 campaign helps recruit dozens of women candidates for the Louisiana legislature, which had just passed the country’s worst abortion bill. The 9-month campaign takes the legislature from two women to ten women!
1991 NOW participates in a march for peace in the Middle East.
1991 After two years of intense lobbying, the Civil Rights Act of 1991 finally passes Congress with jury trials and money damages for sex discrimination – but recovery of punitive damages is capped at $250,000 in order to prevent a Bush veto.
1992 NOW’s 25th Anniversary celebration includes a Global Feminist Conference that attracts women leaders from around the world.
1992 NOW’s 3rd March for Women’s Lives sets a record for the largest civil rights demonstration in the US to date, with 750,000 marching. NOW chapters and National NOW participate in efforts throughout the year to defend clinics. As a commencement to a campaign of non-violent civil disobedience, NOW and Feminist Majority organize illegal speak-out in front of the White House protesting the U.S. Supreme Court decision in Casey v. Planned Parenthood.
1992 NOW runs “Elect Women for a Change” campaigns in several states, helping feminist candidates to win congressional, state, and local primaries. The Founding convention of the 21st Century Party takes place in D.C.
1993 Dr. David Gunn, an abortion provider, is murdered in Pensacola. NOW demands that the Clinton administration assign a multi-agency task force to identify and prosecute the perpetrators of this and other ongoing clinic violence.
1993 NOW demands that newly-elected President Bill Clinton and Congress support a ban on discrimination against lesbians and gay men in the military.
1993 A Texas school reverses a decision to ban pregnant girls from the cheerleading squad after NOW threatens to file a lawsuit.
1994 U.S. Supreme Court in NOW v. Scheidler unanimously upholds our right to use the anti-racketeering law against those coordinating violence against clinics.
1995 NOW delegates at ERA Summit adopt outline of an expanded amendment calling for full Constitutional Equality.
1995 NOW brings over 250,000 people to D.C. to rally against Violence Against Women, pressuring the Newt Gingrich Congress to release VAWA funding.
1996 – 2006
1996 NOW’s Women Friendly Workplace campaign names Mitsubishi Motors, where race and sex discrimination and harassment were rampant, its first NOW Merchant of Shame.
1996 NOW launches “Hungry for Justice,” a 17-day hunger strike in front of the White House to pressure President Clinton to veto the punitive welfare “reform” bill that had just passed Congress and would increase U.S. poverty among women and children.
1996 NOW “comes out” in favor of same-sex marriage rights.
1997 NOW pressures Congress to pass the Domestic Violence Option, allowing states to grant women escaping violence exemptions from punitive new welfare reform provisions.
1997 NOW National Conference resolution supports recognition of transgender oppression and calls for education on the rights of transgender people.
1998 After 12 years of litigation, NOW wins a unanimous jury verdict against Joseph Scheidler, Operation Rescue, and others under RICO (anti-racketeering law) a nationwide injunction against violence at abortion clinics follows.
1998 NOW campaigns for legislation to put teeth into the Equal Pay Act, allowing compensatory and punitive damages and making it easier to bring class-action lawsuits.
1998 After years of lobbying, NOW allies in Congress add sex, sexual orientation, and disability to federal hate crimes legislation.
1998 NOW holds its first Women of Color and Allies Summit, during which activists support equal wages for women janitors in the U.S. Capitol.
1999 NOW and NOW Foundation host the 3rd Lesbian Rights Summit.
1999 NOW forms Family Law committee, recognizing the impact of family courts on women’s lives NOW challenges anti-woman agenda of spreading “father’s rights” movement.
1999 Fortune 500 Project launched as part of NOW’s Women-Friendly Workplace Campaign
2000 NOW conference endorses multiple strategies aimed at achieving ratification of a constitutional equal rights amendment.
2000 In October, NOW organizes the U.S. event of the World March of Women the same weekend NOW Foundation hosts the Women’s International Symposium on Health (WISH)
2000 NOW activists across the country campaign against the election of George W. Bush as president. NOW PAC supports the election of feminists across the country, increasing our representation in Congress.
2001 NOW declares a state of emergency and organizes the “Emergency Action for Women’s Lives” in D.C. to call attention to the Bush Administration’s anti-woman agenda, including one of his first acts as president — reinstating the Global Gag Rule which cut off funding to international family planning organizations.
2001 Following the 9-11 tragedy, NOW joins labor and civil rights advocacy organizations and speaks out for low-wage workers and calls for a real “economic stimulus” package, including extending unemployment and health insurance for laid-off workers. NOW calls for lifting the time limit on benefits for welfare recipients in light of the massive layoffs in the service sector.
2001 NOW immediately begins fighting Bush’s judicial nominees, as he nominates even more extremists in the wake of 9-11.
2002 NOW releases report “Our Courts at Risk” and is one of the first groups to press for a filibuster strategy to save Roe v. Wade from extremist judges.
2002 Bush administration “marriage initiatives” targeting women on welfare raise ire, and NOW campaigns for their defeat with op-eds, letters to the editor, and grassroots lobbying.
2002 NOW Launches “The Truth About George” campaign and website, a public information campaign designed to keep the public eye trained on the Bush administration’s track record on women’s rights, civil liberties, judicial nominees, the environment, the economy, and protections for the elderly and the poor.
2002 – 2006 NOW’s Women Friendly Workplace Campaign names Wal-Mart a Merchant of Shame because of their sex discrimination policies in hiring, pay, and promotions. NOW chapters picket local stores for four years.
2002 Federal Marriage Amendment is introduced in Congress NOW lobbies against the FMA and continues campaigning for equal marriage rights.
2003 NOW endorses Carol Moseley Braun, the second African-American woman to run for U.S. President
2003 NOW launches campaign to pressure the Food and Drug Administration (FDA) to sell emergency contraception over the counter, and to restrict the availability of dangerous silicone gel breast implants.
2003 NOW is a lead organizer and speaker for the 40th anniversary of the 1963 MLK March on Washington
2003 NOW Foundation hosts Women with Disabilities and Allies Summit to draw attention and educate activists on disability rights and accessibility issues.
2004 NOW organizes a campaign to expose threats posed to women by the Bush administration’s proposed privatization of Social Security.
2004 NOW is a lead organizer of the massive March for Women’s Lives in Washington, DC. With 1.15 million marchers, it was the largest civil rights march in US history.
2004 NOW launches its formal Equal Marriage Campaign and committee and hosts the Equal Marriage coalition meetings at the NOW Action Center. Information Kits are delivered to every member of Congress and chapters receive brochures and organizing materials.
2004 NOW Foundation undertakes campaigns to register voters, particularly women voters, achieving over 7 million voter contacts.
2005 NOW protests Justice Department’s “medical guidelines” for treating rape survivors – it fails to mention emergency contraception, a standard precaution against pregnancy after rape.
2005 Second NOW Women of Color and Allies Summit draws hundreds of women to draft an action plan to empower and energize women of color.
2005 NOW declares a State of Emergency upon the resignation of Sandra Day O’Connor, holding a rally and demonstration the following day to demand that O’Connor’s replacement be supportive of women’s rights and civil rights.
2005 NOW establishes an advisory committee on Mothers and Caregivers Economic Rights.
2006 “Enraged and Engaged” NOW campaign brings activists from across the country to fight the nomination of Samuel Alito to replace O’Connor on the Supreme Court.
2006 NOW is a lead organizer of the huge anti-war march in NYC, the March for Peace, Justice, and Democracy in April, as part of our ongoing “Peace is a Feminist Issue” opposition to the war in the Middle East.
2006 NOW opposes punitive immigration “reform” measures and participates in national immigrants’ rights marches in New York and Washington, DC
2006 In February, the Supreme Court rejects NOW’s racketeering lawsuit against Joe Scheidler, Operation Rescue, and others, and directs the lower court to invalidate the nationwide injunction that has protected clinics across the country for 7 years. Within two months after the injunction is revoked, Operation Rescue (now called Operation Save America) attempts to mount a July siege of the last remaining clinic in Mississippi, and of course, NOW is there.
2006 NOW celebrates “Forty Fearless Years” at the national conference in Albany, NY, which includes a Young Feminist Summit and a tribute to our founders and past presidents.
NOW is Taking Action
Attacks on abortion care keep coming. But NOW is defending our access to reproductive freedom.