Health Policy History in the U.S.

In 1912, Teddy Roosevelt and the Progressive Party advocated for social insurance, including health insurance, as part of their platform.

The National Convention of Insurance Commissioners created the first model state law for regulating health insurance in 1912.

In 1915, the American Association for Labor Legislation drafted a bill pushing for mandatory health insurance. However, the bill wasn't enacted due to the onset of World War I.

The Sheppard-Towner Act of 1921 provided matching funds to states for prenatal and child health centers. However, this act expired in 1929 without being reauthorized.

The Committee on the Costs of Medical Care, formed in 1927, conducted a study on the economics of medical care. In 1932, the committee's majority report endorsed medical group practice and voluntary health insurance.

In 1929, Baylor Hospital initiated a prepaid hospital insurance plan, considered the forerunner of Blue Cross plans.

In 1935, the Social Security Act was passed. It included grants for Maternal and Child Health, reviving many programs established under the Sheppard-Towner Act.

The National Health Conference, convened in 1938, recommended a National Health Bill. This bill, however, failed to pass in Congress in 1939.

The Wagner-Murray-Dingell bill aimed to provide universal, comprehensive health insurance and expand Social Security to provide lifelong coverage. It was a major step towards a national health program, but it failed to pass Congress.

Roosevelt's Economic Bill of Rights in 1944 included the right to adequate medical care, emphasizing the importance of health as a fundamental right for all Americans.

The Hill-Burton Act of 1946 provided federal funding for hospital construction, but it also included controversial provisions like allowing "separate but equal" facilities.

The National Health Assembly in 1948 supported the idea of voluntary health insurance but stressed the need for universal coverage, illustrating the growing support for a national health program.

The American Medical Association (AMA) launched a campaign against national health insurance in 1948, opposing government-run healthcare programs.

The Federal Employees Health Benefit Plan (FEHBP) started in 1960, providing health insurance to federal workers, demonstrating an early step towards expanding health insurance coverage.

The Kerr-Mills Act in 1960 provided federal funds to states for medical care programs for the poor and elderly, laying the groundwork for Medicaid.

The White House Conference on Aging in 1961 recommended health insurance for the elderly under Social Security, an important step towards Medicare.

The King-Anderson bill proposed a government health insurance program for the elderly, met with opposition from the AMA and insurance companies.

Medicare and Medicaid programs were signed into law in 1965, expanding healthcare coverage significantly for the elderly and low-income individuals.

Neighborhood Health Centers (NHCs), established in 1965, provided healthcare and social services to underserved communities, serving as predecessors to Federally Qualified Health Centers (FQHCs).

The Supplemental Security Income (SSI) program began in 1972, providing cash assistance to disabled individuals.

In 1974, Hawaii's Prepaid Health Care Act required employers to provide insurance for employees working over 20 hours, while ERISA exempted self-insured employers from state regulations, reflecting the evolving landscape of employer-sponsored health insurance.

The Health Planning Resources Development Act of 1974 required states to prevent duplication of healthcare services through Certificate of Need (CON) programs, aiming to ensure the efficient allocation of healthcare resources.

In 1981, the federal budget reconciliation required states to make additional Medicaid payments for hospitals serving a high proportion of Medicaid and low-income patients. It also repealed the requirement for Medicaid to pay hospital rates equal to Medicare rates.

The introduction of Diagnostic Related Groups (DRGs) in 1983 aimed to improve cost efficiency within the Medicare system by using pre-determined payment rates for different medical treatments.

President Bill Clinton established a task force with Hillary Clinton as chair, aiming to develop comprehensive health reform. The Health Security Act, introduced in 1993, although met with opposition, initiated significant efforts to address the issue of health care in the United States.

State-driven expansion of Medicaid coverage and the shift towards managed care for service delivery by states during the Clinton administration. States gained greater flexibility with Medicaid waivers, allowing them to tailor the program to their specific needs and expand coverage for uninsured populations.

A program implemented in 1993 to provide federally purchased vaccines to states, ensuring access for children regardless of their parents' financial situation.

A significant legislation passed in 1996, which limited the use of pre-existing conditions, established medical record privacy standards, and offered tax benefits for long-term care insurance.

An act from 1996 that decoupled Medicaid from cash assistance eligibility, granting states freedom to set higher coverage rates for families. However, it also restricted coverage for newly arrived legal immigrants for their initial five years in the United States.

Passed in 1996, this act prohibited group health plans from imposing lower annual or lifetime limits for mental health benefits compared to medical or surgical benefits, effectively promoting equal access to mental health care.

Passed in 1997, this act aimed to slow Medicare spending and established the Medicare + Choice program (later renamed Medicare Advantage). It also introduced the State Children’s Health Insurance Program (S-CHIP) to provide health insurance coverage for low-income children.

A program created by the Balanced Budget Act of 1997, this program offered block grants to states to expand health insurance coverage to children from low-income families who did not qualify for Medicaid.

The Ticket to Work Incentives Improvement Act, enacted in 1999, expanded Medicaid coverage for working individuals with disabilities, enabling them to earn above 25% of the poverty level without losing benefits. States gained the authority to implement income-based premiums for these individuals.

A 2000 law that allowed states to provide Medicaid coverage to uninsured women diagnosed with breast or cervical cancer through CDC screening programs, irrespective of their income.

During President Bush's administration, this initiative expanded the number of community health centers catering to underserved populations, bolstering healthcare access in underserved communities.

The Medicare Drug, Improvement, and Modernization Act of 2003 established the Medicare Part D prescription drug benefit, offering a subsidized, voluntary program for Medicare beneficiaries.

Enacted in 2003 alongside the MMA, these accounts allowed users to set aside pre-tax funds for current and future medical expenses, offering a tax-advantaged savings option for healthcare costs.

This act, enacted in 2005, made adjustments to aspects of Medicaid, including premiums, cost-sharing, benefits, and asset transfer provisions, aiming to refine and optimize the program’s operation.

The Healthy Americans Act, introduced in 2007 by Senators Wyden and Bennet, aimed to mandate private health insurance coverage through state pools, eliminating employer-sponsored insurance. Although it garnered bipartisan support, the act failed to pass.

In 2008, both major presidential candidates proposed comprehensive health reform plans. Senator Baucus, Chair of the Senate Finance Committee, put forward a comprehensive national health plan, drawing inspiration from the Massachusetts model.

The Patient Protection and Affordable Care Act (ACA) of 2010 was a landmark health care reform law that aimed to expand health insurance coverage to millions of Americans. It introduced several key provisions, including an individual mandate to have health insurance, Medicaid expansion, insurance exchanges with subsidies, and coverage protections against pre-existing conditions and gender discrimination.

The individual mandate required most Americans to have health insurance or pay a penalty. However, this requirement was eliminated in 2016 by President Trump.

Medicaid expansion, part of the ACA, aimed to extend Medicaid eligibility to more individuals and families. This expansion has significantly reduced the number of uninsured in many states.

Insurance exchanges, also known as marketplaces, were created under the ACA to provide a platform where individuals could compare and purchase health insurance plans. The government offers subsidies to help make insurance more affordable.

The ACA prohibited insurance companies from denying coverage based on pre-existing conditions, a policy that has had a significant impact on individuals with health issues.

Operation Warp Speed (OWS) was a collaboration between the Department of Health and Human Services and the Department of Defense that accelerated the development and production of COVID-19 vaccines.

Telehealth and telemedicine services, especially those offered remotely, saw a surge in use during the COVID-19 pandemic. This increased access to healthcare, particularly for rural and underserved communities.

The Biden administration has taken steps to lower healthcare costs and increase enrollment in the health care marketplace.

The American Rescue Plan Act (ARPA) and the Inflation Reduction Act both expanded and enhanced the Affordable Care Act subsidies. These changes led to increased enrollment in the healthcare marketplace and Medicaid.

The uninsured rate in the US is decreasing, but millions of Americans remain uninsured. Barriers to enrollment include affordability issues, eligibility confusion, and system mistrust.

Those with insurance may face high deductibles and cost-sharing, leading them to postpone or forgo necessary medical care.

The 'family glitch' is a provision where an entire family may be ineligible for subsidies even if their employer-sponsored plan is not affordable for all family members.

Mistrust in the healthcare system, unclear enrollment processes, and limited navigator support all contribute to lower enrollment rates in the health insurance marketplace.

Individuals with incomes too low for Marketplace subsidies and above the Medicaid eligibility threshold in non-expansion states face a 'Medicaid gap', leaving them without affordable health insurance options.

Undocumented immigrants are ineligible for subsidized coverage through the ACA, leaving them without access to affordable healthcare.