Health insurance reform has been a hot topic throughout the Obama presidency. But the debate surrounding health care is nothing new. In fact, it’s been around for over a century in the United States and has led to both continuing controversy and historical changes. Read about 10 moments in health care that will go down in history and how these events led to the Affordable Care Act becoming law.
The concept of universal health care started in Europe in the late 1800s. Beginning in Germany, compulsory sickness insurance originated to protect against wage loss, maintain income stability for workers and gain political favor. Soon after, other European countries followed with their own versions of national health insurance.
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In the United States, the federal government left health insurance matters to the States up until the early 20th century. The States, in turn, left health insurance up to private and voluntary programs. However, the Progressive Era would bring with it calls for social insurance to improve conditions for the working class. Although it would take several more decades, those calls would eventually lead to landmark legislation throughout the 20th and 21st centuries.
Here are 10 moments in health care history that would bring about major health insurance reforms and carry us from the 20th century to today.
1. 1915: The American Association of Labor Legislation (AALL) drafts a model health insurance bill that would cover the working class and all others who make less than $1,200 a year. Opponents denounce the bill as socialist insurance. With the U.S. entry into World War I and subsequent Red Scare, the national health insurance debate would come to an end for the time being.
2. 1935: President Roosevelt signs the Social Security Act into law. The Act establishes a system of social welfare and social insurance programs, including provisions for the elderly, disabled persons, widows and widowers, children, and the unemployed. In the midst of the Great Depression, the Act omits compulsory health insurance in favor of unemployment insurance and benefits for seniors.
3. 1939: The Wagner National Health Act proposes a national health program funded by federal grants to states and administered by states and localities. Southern Democrats and Republicans unite to oppose the bill, viewing it as a form of government expansion.
4. 1940s: Employers begin to provide employee health benefits in order to overcome wage and price controls set during World War II and to compete for workers. With a cushion against health care costs, workers show minimal interest in a national health insurance plan.
5. 1945: President Truman calls for a single national health insurance program that would provide benefits for all Americans. Strong opposition to the proposal, which was labeled socialized medicine, among other things, would lead to its death in congressional committee. From this defeat, however, an interest in hospital insurance for the elderly would arise.
6. 1965: While the 1950s see an increase in health care costs and expanded medical treatments, multiple legislative proposals for health insurance fail. But in the 1960s, the growing need for health insurance for the elderly and those outside the workplace gains national attention. In 1965, President Johnson signs the Medicare and Medicaid programs into law, providing comprehensive, low-cost health insurance coverage to millions of Americans in need.
7. 1990s: The 1970s bring HMO’sand battling national health care proposals, while the 1980s establish COBRA and the Americans with Disabilities Act. Then in 1993, aiming for a broad reworking of the health care system, President Clinton proposes a universal health care plan. Officially known as the Health Security Act, the bill fuels opposition from Republicans, the health care industry and employers. It also draws competing plans from Democrats in Congress and eventually suffers defeat in 1994. However, in
8. 1997, Congress approves the State Children’s Health Insurance Program (SCHIP), which expands health care coverage for children in low-income families that do not qualify for Medicaid.
9. 2003: President Bush signs the Medicare Modernization Act (MMA), which includes a prescription drug benefit. The bill passes by a narrow margin and comes under fire for its complex funding and subsidies to private insurers.
10. 2010: After an intense, yearlong debate, President Obama signs the Affordable Care Act into law. This sets in motion a series of comprehensive health insurance reforms, including the creation of health insurance marketplaces, free preventive care and coverage for adults under 26 years old. The Affordable Care Act struggles through its share of controversy, from the individual mandate to a fumbled website rollout. And it undergoes multiple votes for repeal in the House of Representatives. Nevertheless, it remains the law of the land, with the Supreme Court upholding it as Constitutional in 2012.
2014 and Beyond: Some of the most significant (and contentious) parts of the Affordable Care Act came into effect on January 1st of this year. These include banning pre-existing conditions, eliminating lifetime limits on coverage, the expansion of Medicaid and the individual mandate, which requires Americans who can afford health insurance to purchase minimum coverage.
As the effects of the Affordable Care Act continue to unfold, we’ll have a better picture of the law in practice. Based on its history, debates on health care are a guarantee. So are reforms, which history shows could be as little as an election cycle or several decades away.
What other events would you add to the long list of historical moments in health care history? What’s your take on health care’s future?