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Timeline of American Health Care Reform since 1812

Important points in time when attempts were made to move toward universal health care.

Frank Erickson

on 9 February 2013

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Transcript of Timeline of American Health Care Reform since 1812

Former President Theodore Roosevelt champions national health insurance as he tries to ride his progressive Bull Moose party back to the White House. It is an idea ahead of its time; health insurance is a rarity and medical fees are relatively low because doctors cannot do much for most patients. But medical breakthroughs are beginning to revolutionize hospital care and drive up costs. Roosevelt loses the race to Wilson. Baylor hospital in Texas originates group health insurance. Dallas teachers pay 50 cents a month to cover up to 21 days of hospital care per year.
The plan grows into Blue Cross (now Wellpoint). After five years of work, up to 50 doctors, economists and hospital administrators on the independent Committee on the Costs of Health Care publish their report on the increasing costs of health care and the number of people going untreated. They say health care should be made available to all and be paid for as a group.* 7 doctors and one non-physician on the Committee file a minority report** disagreeing with universal coverage. They also object to the corporate practice of medicine. The AMA objects strongly to the CCHC's call for group coverage. In addition to mainstream media headlines calling the CCMC’s stance on group payment “socialized medicine,” editorials appeared in the Journal of the American Medical Association that described it as “Sovietism.” These labels and the public's perception that doctors oppose universal coverage dominate the debate for decades. Americans struggle to pay for medical care amid the Great Depression. President Franklin D. Roosevelt favors creating national health insurance, but decides to push for Social Security first. He never gets the full health program passed. Roosevelt establishes wage and price controls as part of the nation's emergency response to World War II. Business can't attract workers with higher pay so instead they compete through added benefits, including health insurance, which unexpectedly grows into a workplace perk. Workplace health plans get a boost the following year when the government says it won't tax employer's contributions to employee health insurance. Saying medical care is a right of all Americans, President Harry Truman calls on Congress to create a national insurance program for those who pay voluntary fees. The American Medical Association denounces the idea as “socialized medicine.” Truman tries for years but can't get it passed. President Dwight Eisenhower proposes a plan to back insurance companies against losses on health insurance as part of a comprehensive health and welfare program that Congress ultimately rejected. Candidate John F. Kennedy makes health care a major campaign issue but as president can't get a plan for the elderly through Congress. Medicare for people age 65 and older and Medicaid for the poor is signed into law. President Lyndon B. Johnson's legendary arm-twisting and a Congress dominated by his fellow Democrats succeeded in creating the kind of landmark health care programs that eluded his predecessors. Harry and Bess Truman, Hubert Humphrey and the First Lady et al look on as LBJ signs Medicare Bill Senator Edward M. Kennedy, D-Mass., offers his proposal for a government-run plan to be financed through payroll taxes. He negotiates in secret with Richard M. Nixon, but they fail to reach agreement. President Richard M. Nixon puts forth a plan to cover all Americans through private insurers. Employers would be required to cover their workers and federal subsidies would help others buy insurance. The Watergate scandal intervenes. President Jimmy Carter pushes a mandatory national health plan, but a deep economic recession helps push it aside. Congress passes and President Ronald Reagan signs into law COBRA, a requirement that employers let former workers stay on the company health care plan for 18 months after leaving a job, with the worker bearing the cost.
The Emergency Medical Treatment and Active Labor Act (EMTALA) is a U.S. Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions.

Congress expands Medicare by adding the Prescription Drug Benefit and Catastrophic Care coverage.
It doesn't last long. Barraged by protests from older people upset about paying a tax to finance additional coverage, Congress repeals the law the next year. President Bush proposes a tax credit for buying insurance, as opposed to a government plan during his re-election campaign. He loses the race and the plan isn't implemented. Newly elected President Bill Clinton puts First Lady Hillary Rodham Clinton in charge of developing what becomes a 1,300-page plan for universal coverage. It requires businesses to cover their workers and mandates that everyone have insurance. The plan meets strong Republican opposition, divides congressional Democrats and comes under a firestorm of lobbying from businesses and the health care industry.
It never gets to a vote in the Democrat-led Senate. President George W. Bush persuades Congress to add prescription drug coverage to Medicare in a major expansion of Johnson's “Great Society” program for seniors, but outlaws negotiation of drug prices as a group. Hillary Rodham Clinton makes a sweeping health care plan, including a requirement that everyone have coverage, central to her bid for the Democratic presidential nomination. She loses to Barack Obama, who promotes his own less comprehensive plan. President Barack Obama and the Democratic-controlled Congress spend an intense year ironing out a compromise that requires companies other than very small businesses to cover their workers, mandates that everyone have insurance or pay a fine, requires insurance companies to accept all comers, regardless of any pre-existing conditions and assists people who can't afford insurance.
In the process, big-money health care donors dominate the proceedings, excluding consideration of single payer financing* and preventing universal coverage and a public option. Congress passes the Patient Protection and Affordable Care Act, designed to extend health care coverage to more than 30 million currently uninsured people. Obama signs it into law March 23rd.
The 30 million currently uninsured will be compelled to buy health insurance by the law, prompting a Constitutional challenge by multiple state Republican Attorneys General.

The Supreme Court agrees to hear challenges to the landmark 2010 health care overhaul law, derided as “Obamacare” and opposed by Republicans in Congress and those running for the GOP presidential nomination. On June 28th, they announce PPACA on the whole is constitutional only striking down the provision for with-holding Medicaid funds if States refuse to accept federal added funds for expanding Medicaid coverage to more citizens. The SCOTUS decision supports Obama's effort to reform.

As of July 10, 2012 five GOP state governors (Texas, Florida, Mississippi, Louisiana and South Carolina) have announced their intent to refuse to participate with the expansion of Medicaid required by PPACA to cover those up to 133% above the poverty line, which could add 19 million new customers to the ranks of the insured. Failing to comply with the law only raises the cost of coverage for all. At least 8% - roughly 26 million would remain uninsured even if PPACA is fully complied with and implemented. Many more Americans remain under-insured with increasing premiums, co-pays and deductibles protecting the profitability of providing health insurance. The risk of bankruptcy related to a new cancer diagnosis ranges up to 7.7% within 3 years (Scott Ramsey, Fred Hutchinson Cancer Research Center, Univ. of Washington, June 7, 2011). KEY MOMENT: Asked about his greatest regret as a legislator, Ted Kennedy would usually cite his refusal to cut a deal with Richard Nixon on health care.

...At first, Kennedy rejected Nixon's proposal as nothing more than a bonanza for the insurance industry that would create a two-class system of health care in America. But after Nixon won reelection, Kennedy began a series of secret negotiations with the White House that almost led to a public agreement. In the end, Nixon backed out after receiving pressure from small-business owners and the American Medical Association. And Kennedy himself decided to back off after receiving heavy pressure from labor leaders, who urged him to hold out for a single-payer system once Democrats recaptured the White House in the wake of the Watergate scandal. http://en.wikipedia.org/wiki/History_of_health_care_reform_in_the_United_States
















hcao.org References Timeline of American Health Care Reform since 1812 1912: Roosevelt 1929: Group Health Insurance 1932: Report 1854 - A Federal proposal 1854 Bill for the Benefit of the Indigent Insane, which would have established asylums for the indigent insane, as well as the blind, deaf, and dumb, via federal land grants to the states. This bill was proposed by activist Dorothea Dix (who became Superintendent of Army Nurses during the Civil War), which passed both houses of congress, but was vetoed by president Franklin Pierce. Pierce argued that the federal government should not commit itself to social welfare, which he believed was properly the responsibility of the states. After the Civil War, the federal government did establish the first system of national medical care in the South. Known as the Freedmen's Bureau, the government constructed 40 hospitals, employed over 120 physicians, and treated well over one million sick and dying former slaves. The hospitals were short lived, lasting from 1865 to 1870. Freedmen's Hospital in Washington, DC remained in operation until the late nineteenth-century before it became part of Howard University. 1865 - The Freedmen's Bureau 1812 - The Naval Home The first Federal agency to provide health care, the home was created in 1812 in Philadelphia and was followed by the creation of Soldiers Home in 1853 and St. Elizabeth’s Hospital in 1855. Congress created the National Home for Disabled Volunteer Soldiers in 1865 in response to the high number of Civil War casualties. These homes were initially intended to be room and board for disabled veterans. However, by the late 1920’s, the homes were providing a level of care comparable to hospital care. 1945 - VA Medical Care System consolidated 1930 - Hoover President Hoover created the Veterans Administration (VA) in 1930 to consolidate all veteran services. General Omar N. Bradley was appointed to VA administrator and Bradley appointed Major General Paul Hawley as director of VA medicine, both in 1945. Hawley successfully established a policy that affiliated new VA hospitals with medical schools. Hawley also promoted resident and teaching fellowships at VA hospitals. Ultimately, Hawley was responsible for starting the hospital-based research program at the VA. 2011 Vermont passes Single Payer bill In May of 2011, the state of Vermont became the first state to pass legislation establishing a Single-Payer health care system. The legislation, known as Act 48, establishes health care in the state as a "human right" and lays the responsibility on the state to provide a health care system which best meets the needs of the citizens of Vermont. The state is currently in the studying phase of how best to implement this system. Several single payer referendums have been proposed at the state level, but so far all have failed to pass through April 2011: California in 1994, Massachusetts in 2000, and Oregon in 2002. HB 3510 the Affordable Health Care for All Oregon Act failed to get out of committee in Oregon in 2011 after allowing public testimony. The state legislature of California has twice passed SB 840, The Health Care for All Californians Act, a single-payer health care system. Both times, Governor Arnold Schwarzenegger (R) vetoed the bill, once in 2006 and again in 2008. Minority report recommendations: Limit the government’s medical activities to care for the indigent, government institutions, public health, and veteran’s affairs; expand government care of the indigent, relieving the burden on medical professionals to provide charity care; improve coordination of services; restore the role of the general practitioner to the center of medical practice; eliminate the corporate practice of medicine; and examine and tailor payment methods to fit institutions and practices. ** 1935: The Depression In its majority report, the CCMC presented five recommendations to address the economic issues of the nation’s healthcare system. First, it advocated for group practice between physicians and dentists in a hospital setting and the development of community health centers. Second, it proposed the expansion of public health services, especially at the state and local levels. Third, it recommended group payment for healthcare, calling for health insurance coverage to be provided by private sources, government, or a combination of both; it did not specify the type of insurance mechanism because a few members advocated for universal compulsory coverage, while others endorsed voluntary insurance schemes. Fourth, it called for stronger coordination of medical and health services, proposing the establishment of state and local agencies to study and evaluate these services. Last, it proposed improving the education and training of medical professionals, including physicians, nurses, dentists, pharmacists, and healthcare administrators. * 1942: Roosevelt 1945: Truman 1954: Eisenhower 1960: Kennedy 1965: Medicare 1971: Kennedy 1974: Nixon 1976: Carter 1986: Reagan

COBRA and EMTALA 1988: Protests 1992: Tax Credit 1993: Clintons 2003: Bush
Medicare Part D 2008: Clinton II 2009: Obama 2010: PPACA Health Care Law * C-Span May 5th, 2009 6:26 In the wake of single payer health care being blocked at the Federal level, individual states took up the task. 2012: Supreme Court weighs in ?
When will America get privately delivered, publicly financed, improved Medicare for All? Despite recent efforts at reform, America continues to have poorer health care outcomes while paying almost twice what other countries pay with some version of single payer systems and universal coverage. Americans continue to live in fear of medical bill-related bankruptcies, and fear losing health care coverage if they lose their jobs. Insurance companies continue to find ways to profiteer through higher premiums, higher deductibles and higher co-pays which reduce access to care. Senator Max Baucus and Liz Fowler, former Wellpoint executive becomes Senator Max Baucus health care adviser Sept. 9th, 2009 First published by Frank Erickson, MD on July 7th, 2012 2003 - John Conyers, Jr.

HR 676 The United States National Health Care Act*, or the Expanded and Improved Medicare for All Act (H.R. 676), is a bill first introduced in 2003 in the United States House of Representatives by Representative John Conyers (D-MI). The bill had 25 cosponsors in 2003 and has been reintroduced each year since, never being allowed to get to the floor for debate. There were 88 cosponsors as of October 7, 2009. The act calls for the creation of a universal single-payer health care system in the United States, the rough equivalent of Canada's Medicare, the United Kingdom's National Health Service, and Taiwan's Bureau of National Health Insurance, among other examples. Under the policies this Act would enact, all medically-necessary medical care decided between doctor and patient would be paid for automatically and directly by the Government of the United States, ending the need for private insurance for such care, and probably recasting private insurance companies as purely supplemental coverage, to be used when non-essential care is sought, as often happens in the United Kingdom for things like dentistry services.

The national system would be paid for through taxes, and these monies, which replace insurance premiums and, with them, the main core justification for private insurances to begin with. Advocates of this "single-payer health care", such as economist Paul Krugman, have argued that by eliminating insurance companies as they exist now, and thus also their administrative overhead, overall health care costs would be reduced sufficiently to cover the presently uninsured—and everyone else—with ease and possibly even ultimately a monetary surplus. * As of 2012, advocacy of HR 676 has once again faded to the sidelines, and even many of its most intense advocates seem to have accepted that single-payer health care is now once again a long-term project that is years, perhaps decades, away from realization. Some in the movement have presently proposed a shift in emphasis away from an effort at a national law and more efforts towards enactments of single-payer systems within individual U.S. states, the idea being that state-level single-payer coverage, as enacted in the US state of Vermont in 2011, would serve as living models for the arguments for federal coverage.* * A June 2012 Reuters-Ipsos poll indicated that much of the opposition to the law was because Americans wanted more reform, not less. Candidate Obama would have supported single payer
"if we didn't have a legacy of employer-based health care..." 24 January 2008 1:31 Start Away from the televised meetings, the legislation became a "bonanza" for lobbyists, including secret deals that were initially denied but subsequently confirmed. The Sunlight Foundation documented many of the reported ties between "the healthcare lobbyist complex" and politicians in both major parties. The Senate bill, the Patient Protection and Affordable Care Act, bore similarities to prior healthcare reform proposals introduced by Republicans. In 1993 Senator John Chafee introduced the Health Equity and Access Reform Today Act which contained a "Universal Coverage" requirement with a penalty for non-compliance. In 1994 Senator Don Nickles introduced the Consumer Choice Health Security Act which also contained an individual mandate with a penalty provision. However, Nickles removed the mandate from the act shortly after introduction, stating that they had decided "that government should not compel people to buy health insurance." 2006 Romney On April 12, 2006, Governor Mitt Romney signed the health legislation. Romney vetoed eight sections of the health care legislation, including the controversial employer assessment. Romney also vetoed provisions providing dental benefits to poor residents on the Medicaid program, and providing health coverage to senior and disabled legal immigrants not eligible for federal Medicaid. The legislature promptly overrode six of the eight gubernatorial section vetoes, on May 4, 2006, and by mid-June 2006 had overridden the remaining two. The Massachusetts health care insurance reform law, St. 2006, c.58, informally referred to as Romneycare, enacted in 2006, mandates that nearly every resident of Massachusetts obtain a state-government-regulated minimum level of healthcare insurance coverage and provides free health care insurance for residents earning less than 150% of the federal poverty level (FPL). The bill aims to cover 95% of the state's 500,000 uninsured within a three year period. The law was amended significantly in 2008 and twice in 2010 and major revisions related to health care industry price controls were introduced in the Massachusetts legislature in May 2012 with expectation that some version of these controls will pass by July 2012. How does America rank among developed nations regarding health care?
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