Begala was a chief strategist for the 1992 Clinton-Gore campaign, which carried 33 states and made Clinton the first Democrat to occupy the White House in 12 years.

Following his loss, Begala wrote a tongue-in-cheek complaint for the Daily Texan, arguing "I cannot help but feel Hank's platform is illusory at best...I must say that the candidate himself lacks substance".

[3] Begala, along with business partner James Carville, helped then-Governor of Arkansas Clinton win the 1992 presidential election.

Begala later served as a counselor to the President in the Clinton White House, where he coordinated policy, politics, and communications.

Senator Frank Lautenberg, and the gubernatorial victories of Robert Casey in Pennsylvania in 1986, Wallace G. Wilkinson in Kentucky in 1987, and Zell Miller in Georgia in 1990.

Begala later revealed he had favored his former client, Pennsylvania senator Harris Wofford, over Al Gore as Bill Clinton's running mate in the 1992 presidential election.

From 1999 until its cancellation in 2000, Begala co-hosted the political debate show Equal Time with Oliver North on MSNBC.

He is a member of the board of directors of Democratic Majority for Israel, an organization that promotes U.S.-Israel cooperation and whose political arm, DMFI PAC, ran attack ads against Senator Bernie Sanders's candidacy before the 2020 presidential election.