Many figures in political history are defined by their landmark legislative achievements, particularly in sectors as critical as health care. John McCain, the esteemed senator from Arizona, was not primarily known for spearheading sweeping health care reforms. Yet, his legacy in this domain is undeniable, shaped less by a deep-seated policy focus and more by his unwavering stance against perceived injustices and his advocacy for the underdog.
While McCain played a crucial role in the enactment of the Americans With Disabilities Act of 1990, a significant civil rights milestone, numerous other health-related initiatives he championed faced roadblocks, often clashing with traditional Republican ideologies. His proposals frequently leaned towards greater government oversight and increased taxation, approaches that diverged from core Republican principles.
In 2008, as the Republican presidential nominee, McCain surprised many within his own party with a health care platform that sparked concern over potential tax hikes and a significant reshaping of the employer-based insurance system prevalent in the U.S. Referencing his 2008 health care plan
However, McCain is perhaps most vividly remembered for his dramatic “thumbs down” vote in 2017, which effectively thwarted his party’s concerted effort to repeal the Affordable Care Act (ACA), President Obama’s signature domestic policy achievement. This decisive vote drew sharp and persistent criticism from President Donald Trump, underscoring the deep divisions within the Republican party.
McCain passed away on August 25th after a courageous battle with brain cancer at the age of 81. News report on McCain’s death Intriguingly, his passing coincided with the anniversary of Senator Ted Kennedy’s death, who also succumbed to a similar form of brain cancer nine years prior, adding a poignant layer to McCain’s health narrative.
The timing of McCain’s cancer diagnosis shortly before his pivotal ACA vote fueled speculation. Some posited that his health condition might have precipitated a change of heart, influencing his decision to oppose the Republican repeal efforts. This theory suggested a possible link between John McCain’s diagnosis led to health care no, implying a shift in his political stance due to his personal health crisis.
Alt text: Senator John McCain participating in a Senate session, highlighting his long-term engagement with legislative processes.
Yet, a deeper look into McCain’s extensive 35-year career in Congress reveals a consistent pattern of challenging established powers. He frequently took on formidable adversaries, from health insurance giants and the tobacco industry to, ironically, the Affordable Care Act itself, despite its aim to broaden health coverage. McCain’s concern with the ACA stemmed from its perceived failure to address the escalating costs within the healthcare system.
His political battles often targeted entities perceived as “bullies,” a theme resonant in his campaign messaging throughout his career. Douglas Holtz-Eakin, a key policy advisor during McCain’s 2008 presidential bid, aptly described McCain’s empathy as “I’ll punch the bully for you,” capturing his combative approach to advocacy and his inclination to stand up for the “little guy.”
McCain’s opposition to the Affordable Care Act was well-documented and rooted in his philosophical belief that less government intervention, rather than more, was the solution to healthcare system flaws. Echoing Republican orthodoxy, he consistently pledged to repeal and replace the ACA with a more effective alternative.
However, the Republican party’s internal discord over healthcare reform led to a protracted and ultimately unsuccessful search for a unified approach. McCain expressed disappointment with the last-minute proposal presented to senators before the crucial vote – a “skinny repeal” measure designed to weaken the ACA, relying on future bipartisan efforts to devise a comprehensive replacement. This strategy, in McCain’s view, was flawed and unlikely to succeed given the preceding years of failed attempts.
More fundamentally, McCain objected to the procedural tactics employed by his party. The “skinny repeal” was fast-tracked, bypassing committee review and direct Senate floor consideration. He criticized this approach, recalling his censure of Democrats for passing the ACA in 2010 without any Republican support. McCain lamented the abandonment of Senate traditions of compromise and deliberation in favor of partisan expediency.
In his 2018 memoir, “The Restless Wave,” McCain recounted a call from President Obama expressing gratitude for his vote against the ACA repeal. McCain acknowledged the irony, writing, “I was thanked for my vote by Democratic friends more profusely than I should have been for helping save Obamacare. That had not been my goal.” This quote emphasizes that his vote was not an endorsement of the ACA, but rather a protest against the repeal process and broader Republican strategy.
Alt text: A photograph of Senators John McCain and Ted Kennedy in a bipartisan discussion, representing their collaborative efforts across party lines on various legislative issues.
While campaign finance reform and military matters were McCain’s signature policy areas, he did contribute to a landmark health legislation – the Americans With Disabilities Act (ADA) of 1990. As an early advocate and co-sponsor, he passionately championed the rights of individuals with disabilities, often referencing the service members and civilians he encountered who had sustained disabilities in military conflicts. McCain himself experienced limited arm mobility due to injuries sustained as a prisoner of war in Vietnam, though he generally focused on others’ struggles rather than his own when advocating for policy changes.
Despite these instances of success, two of McCain’s most ambitious health care initiatives ultimately fell short.
In 1998, he introduced a comprehensive bill aimed at regulating the tobacco industry and increasing cigarette taxes. Details of the 1998 tobacco bill The goal was to deter teenage smoking and generate funds for research and healthcare costs associated with smoking-related illnesses. However, the bill faced strong opposition, including from within his own Republican party, and failed to pass.
McCain also collaborated with Democratic Senators Ted Kennedy and John Edwards in 2001 to advance a patients’ bill of rights. Information on the patients’ bill of rights effort Initially hesitant due to concerns about provisions allowing patients to sue health care companies, McCain was eventually persuaded by the personal stories of individuals harmed by the existing system, as recounted by Sonya Elling, a former health aide in his office.
This legislation sought to guarantee patients with private insurance access to emergency and specialist care and establish avenues for legal recourse in cases of wrongful denial of care. President George W. Bush threatened to veto the bill, arguing it would spur frivolous lawsuits, and ultimately, it did not become law.
McCain’s willingness to engage in bipartisan efforts on health care enhanced his reputation as a lawmaker who could bridge partisan divides. Senator Chuck Schumer, now the Senate Majority Leader, collaborated with McCain on legislation in 2001 aimed at expanding access to generic drugs. Details on the generic drug access legislation In 2015, McCain spearheaded a bipartisan coalition to pass legislation strengthening mental health and suicide prevention programs for veterans, one of several measures he championed to improve veterans’ healthcare.
His relationship with Ted Kennedy was particularly notable, creating an eerie parallel when McCain received his glioblastoma diagnosis shortly before his ACA vote, mirroring Kennedy’s own battle with the same aggressive cancer that claimed his life in 2009, just before the passage of the ACA – a legislative victory he tirelessly pursued.
“I had strenuously opposed it, but I was very sorry that Ted had not lived to see his long crusade come to a successful end,” McCain reflected in his 2018 memoir, underscoring his respect for Kennedy’s dedication despite their policy disagreements.
While some of McCain’s major healthcare initiatives did not succeed, these experiences bolstered his political profile, contributing to his presidential campaigns in 2000 and 2008.
In 2007, facing an uphill battle in the Republican primaries, McCain surprised his advisors by requesting a comprehensive health care proposal, a move considered unconventional for a Republican primary candidate. Analysis of McCain’s 2008 health plan
The resulting plan was radical, proposing the elimination of the tax exclusion for employer-provided health benefits and replacing it with refundable tax credits for individuals to purchase insurance independently. McCain argued that employer-sponsored insurance inflated costs and suppressed wages.
This proposal proved highly controversial and generated significant backlash as McCain’s campaign gained momentum. However, Holtz-Eakin noted that McCain remained committed to this policy vision. “He might not have been a health guy, but he knew how important that was,” Holtz-Eakin stated. “And he was relentless about getting it done,” emphasizing McCain’s tenacity and dedication to his policy convictions, regardless of political expediency or personal health challenges.
Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.
