Politics of Healthcare (Part 2): The Reagan Years

President Ronald Reagan

President Ronald Reagan

President Ronald Reagan, aka: The Gipper, led our country from January 1981- January 1989 and under his leadership our country changed in many ways. Democrats snarl and Republicans gleam when his name is mentioned.  Whether or not you agreed with his politics, it is impossible to deny the policies that were implemented during this important time.  Since my focus is on pharmacy and healthcare, we will review a few important pieces of legislation that were enacted under President Reagan that had a healthcare impact.  I’m also going to add a few personal thoughts imagining how these laws would be shaped by the 21st century media and politics.  Remember that President Reagan dealt with a Congress completely controlled by the Democratic party, so to accomplish anything the two parties had to compromise.

Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

  • Signed into law by President Reagan on April 7, 1986
  • Under the new budget reconciliation process, major policy changes were now tied in with the Federal Budget

Impact on Healthcare:

  • Increased Health Insurance Portability
  • Allowed employees to continue to keep their health insurance benefits when they lose or leave a job (they may be responsible for up to 102% of the premium to maintain the coverage)
  • This impacts all employees in the plan

My Thoughts:

  • This is a progressive piece of legislation that increases job mobility (ie: you can leave your job to pursue another position without being tied to health benefits) and protects individuals who unexpectedly lose their job
  • While Reagan is often criticized by the left for his “Trickle-down” economics, many forget that during his administration steps were taken to protect vulnerable individuals (like someone laid off after a factory closes)
  • In today’s political environment, President Reagan would have been blasted by the right for allowing this mandate


Omnibus Budget Reconciliation Act of 1987 (OBRA ’87)

  • Signed into law by President Reagan on December 22, 1987
  • Another Federal Budget act that had a major impact on healthcare in the United States, nursing homes in particular

Impact on Healthcare:

  • Major Nursing Home Reform
  • Established higher standards of nursing home care
  • Established a number of “quality of life” patient rights
  • Addressed nursing home staffing and set requirements
  • Addressed physical restraint use in nursing homes
  • Established an enforcement system (State Survey process)
  • Merged Medicare and Medicaid standards into a single process for nursing homes (Remember Medicaid is a state controlled, Medicare is Federal)

My Thoughts:

  • After working in Long-Term Care pharmacy, I can’t imagine what these facilities were like pre-1987.
  • This has to be one of the most “game-changing” policies for geriatric care institutions in the United States
  • Again, if this legislation came before Congress today, we would hear cries of “socialism” from certain political figures.  I find it interesting that President Reagan’s signature is on this law…


Prescription Drug Marketing Act of 1987 (PDMA)

  • Signed into law by President Reagan on April 22, 1988
  • Believe it or not, this was not tied to the Federal Budget
  • This was an amendment to a little law called the Food, Drug, and Cosmetic Act.
  • Created in response to reports of drug counterfeits

Impact on Healthcare:

  • Prohibited drug reimportation
  • Prohibited sale of drug samples
  • Restricts distribution of drugs to only licensed wholesalers or suppliers

My Thoughts:

  • This law was a major step in addressing drug distribution and supply chain issues
  • Unfortunately, drug counterfeiting is still a major concern and more needs to be done to prevent misbranded or adulterated products from reaching consumers
  • Reimportation has resurfaced as an issue due to the price differences drug companies set for different countries (Example: Canada)
  • The invention of the internet and online markets has exacerbated the counterfeiting issue
  • This law adds more licensing and Federal oversight requirements…very progressive.
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Joey Mattingly, PharmD, MBA is an assistant professor at the University of Maryland School of Pharmacy located in Baltimore, Maryland. Joey has managed retail and long-term care pharmacy operations in Kentucky, Illinois and Indiana. Leading Over The Counter is a blog of Joey's views and opinions on the topics of pharmacy leadership and management and do not represent the University of Maryland, Baltimore. Joey can be followed on Twitter @joeymattingly.

5 Responses to “Politics of Healthcare (Part 2): The Reagan Years

  • Karen A
    3 years ago

    Great article, but you make a mistake when you think conservatives today wouldn’t support such legislation. That kind of thinking is a prejudice that pervades the political climate—to be a Republican is evil. When you begin with that premise, it totally creates a bias in your opinions. Your opinion should reflect what you think of the legislation, not an opportunity to cast aspersions on one party or the other.

    • I don’t think I’m making a mistake by assuming the current Republican party wouldn’t support such legislation. I completely disagree with your premise that there is “prejudice” in assuming the current Republican party would blast Reagan for cooperating with a Democratic Congress and passing very progressive legislation (See: Every Republican primary election over the past decade). Most recently in Kentucky, members of the Republican party attacked longtime Senator Mitch McConnell in a heated primary and in Virginia, Senator Eric Cantor lost his bid for the Republican nomination.

      I’ve supported Democrats and Republicans officially and unofficially (actually volunteering for a Republican State Representative in Indiana and also serving as a page for a Democratic State Representative in Kentucky). I’m sorry you feel my article was written with such “prejudice” and “bias” and I welcome your comment, as you are entitled to your opinion.


  • Check out Nixon’s record if you really want to see what a progressive Republican does. He governed to the left of Clinton. I know it was before your time, but the joke on Reagan and nursing home reform was that he was taking care of his friends!

    Bush 1 was to the left of Reagan and Clunton effectively ran as a conservative alternative to Bush and won on it. Bush 2 was closely aligned with Reagan. He had his progressive legislative efforts as well. Most prominantly education reform where he partnered with Ted Kennedy and huge amounts of aid to the African aids crisis where Bono had ear. Bush also passes Medicare reform that many in his party disliked.

    Republicans would still support Reagan’s agenda, just as Democrats swallowed hard on welfare reform under Clinton. Both of those guys built a consensus that didn’t rely on total support from their own party. Both took their case to the public to put pressure on congress. Both were great politicians.

    It’s never as simple as democrat and republican. Take Rand Paul for instance. Seems more aligned with liberals than conservatives. I find it halt opus how much some republicans love him and democrats hate him. I want to tell them to read a newspaper.

    • Great comment. This post is merely Part 2 in a several part series looking at legislation that has had a profound impact on healthcare. While the Affordable Care Act is most likely going to be my big finale, I wanted to go pretty far back and look at major bills and the political players involved (I covered HIPAA earlier this week with the Clinton vs Gingrich/Dole dynamics that are interesting). I think the most interesting thing about the research on policy and healthcare is that many major laws are primarily focused on the budget, and healthcare regulation is somehow attached sometimes haphazardly.

      I love the history of policy and the politics involved. My goal is to present factual information along with my personal thoughts on these healthcare-related laws for discussion. I hope to challenge all Democrats and Republicans to think about the actual policies versus the people proposing them. Thanks again for checking out the blog!

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