If you haven’t already, check out Part I from yesterday!
In 1929, a company was formed, Blue Cross, whose founder, Justin Ford Kimball, saw a need for insurance outside of employment. Blue Cross was originally established so that individual hospitals could sell insurance for use in their network. While most employers had their own in-house insurance coverage for sickness and injury, it wouldn’t be until 1934 when General Tire and Rubber Company would purchase a group medical plan for their employees. In 1939, Blue Shield was founded. Blue Shield differed from Blue Cross because it allowed groups of physicians to bond together and sell group policy plans. Blue Shield would become a major player in selling group policies to companies for their employees. At this point, while individual options were available, there was still no legislation on the federal level to help those that did not work or could not afford to purchase their own insurance.
The Great Depression, leaving poverty and devastation in its path, played a large role in the inception of federal healthcare initiatives. As Franklin Roosevelt had promised he would, once he was elected president, in 1932, he immediately started to work on a progressive economical and social plan to repair the current disarray which had engulfed the country’s public. This plan, known as the New Deal, factored in Social Security benefits and national health insurance—among many other things. In 1933, Roosevelt renamed and revamped the Emergency Relief Administration (ERA), which was previously established, by President Herbert Hoover, as the Federal Emergency Relief Administration (FERA) and made it the first of many promising relief operations under the New Deal. It was here that President Roosevelt first declared that he believed that healthcare was a fundamental human right. As Roosevelt had planned on including healthcare in the Social Security Act of 1935, pressure, especially from the American Medical Association (AMA), would see to it that any mention of a universal healthcare plan was weeded out of this legislation.
With World War II in full force, the additional attention (including federal healthcare reform) that Roosevelt had intended to give to America fell by the wayside. During his State of the Union Address, in January of 1944, President Roosevelt proposed a “Second Bill of Rights.” The bill of rights would make up for the original Bill of Rights which had “proved inadequate to assure us equality in the pursuit of happiness.” The new bill of rights would guarantee: employment, freedom from monopolies, housing, medical care, education, and social security. President Roosevelt would pass away, in April of 1945, before any progress could be made in healthcare reform. Upon his death, Vice President Harry Truman (now of course newly appointed President) would attempt to carry on his legacy of healthcare reform.
Immediately, President Truman passed two acts; both of which were intended to fund federal projects for the betterment of healthcare. The first of these was the National Mental Health Act (NMHA). With World War II over, thousands of American soldier were coming home, while not physically injured, mentally “injured.” The stress and trauma of the events on the battlefields had caused many mental health issues to surface in a large percentage of the population coming back from war. The NMHA would disburse funds to see to the needs of these returning American heroes. The second act passed was the Hill-Burton Act. This act was intended to provide the necessary funds to allow pre-existing hospitals to improve facilities across the country and to have the necessary beds to tend to the sick.
In 1949, President Truman met with Congress to request that universal healthcare be amended as an expansion to the Social Security program already implemented. While Truman did gain expansions to Social Security and added assistance in public housing, the AMA would continue to successfully suppress the progress of federal healthcare reform and deter change.
As the 50’s rolled along, competition in the health insurance game started to heat up. Companies were undercutting each other in attempts to get younger, healthier clients. This led to the implementation of individual rates. If one was not included in a group policy through their employer, Blue Cross, or Blue Shield they would be individually assessed based on their health risks and charged accordingly. The individual rated plans led to higher premiums and even refusing to provide coverage for those deemed potentially risky.
As a society, no one bothered to worry about the poor and their inabilities to afford healthcare. It was not until the 60’s when everyone realized that the upcoming elderly population was growing—very quickly—and they needed insurance. At this point—and to the reluctance of many and the AMA (shocker, right?)—President Lyndon B. Johnson passed Medicare. Medicare would guarantee access to health insurance for all Americans 65 and older, as well as people with disabilities and people with end stage renal disease.
1970’s: the missed opportunity, the United States’ first real chance to have universal healthcare. It was simple, Republican President Richard Nixon was president and wanted to reform healthcare. Now, many assume that Nixon’s intentions were not for American’s healthcare and what was best for society, but for attempting to seek another term for a Republican in the White House. Either way, Nixon attempted to make strides and the Democrats, under the lead of Edward Kennedy, thwarted away his progressive ideology. The HMO Act of 1973 was passed, but this was all. Nixon had legislation, the Comprehensive Health Insurance Act (CHIA), which would mandate that employers participate in health insurance plans covering their employees, and that those not working would get a federal public option. The CHIA was deemed insufficient by the Democratic members of Congress and the development of universal healthcare was halted.
In the last thirty years, there has been a significant increase in job mobility. As employees desired to move from job to job, it made it hard to accomplish with the strict insurance rules. A large stress in seeking new employment was worrying about insurance. Congress passed the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), which allowed portability in insurance; however, this led to a drastic hike in premiums. Now individual health plans were more expensive than ever.
Over the next 25 years, small goals were set and passed by the federal government. Some of these programs include: S-CHIP, HIAA, and Medicare-D. While these federal programs were all helpful, it didn’t help with millions of those that still didn’t have insurance. In 2009, current President Barack Obama was ushered in by majority vote, and with this came immediate healthcare reform. His Affordable Care Act would closely resemble, in ways, the same ideas that Nixon had attempted to pass in 1974. In March of 2010, the Affordable Care Act was signed into law. With its recent success in passing the National Federation of Independent Business v. Sebelius (after a little tweaking), it now appears that very soon, all Americans will have universal healthcare.