This timeline provides milestones regarding health care and government policies through American history.
Social insurance, including health insurance, gains public attention when Theodore Roosevelt and his Progressive Party campaign on the issue. The American Association for Labor Legislation also publishes and promotes a draft bill for compulsory health insurance, but the effort is derailed when the United States enters World War I.
Baylor Hospital in Dallas, Texas, starts a prepaid hospital insurance program with a local teachers union and creates what is thought to be the nation’s first example of modern health insurance.
The Depression shifts attention to unemployment insurance and “old age” benefits. President Franklin Roosevelt creates the Committee on Economic Security to address these issues as well as medical care and insurance. But when the Social Security Act is passed, health insurance is omitted. The American Medical Association strongly opposes a national health insurance program, saying it would increase bureaucracy, limit doctors’ freedom and interfere with the doctor-patient relationship.
In his State of the Union address, President Franklin Roosevelt outlines an “economic bill of rights” that includes the right to adequate medical care and the opportunity to achieve and enjoy good health. During World War II, U.S. businesses begin to offer health benefits as they compete for workers, giving rise to the employer-based system in place today.
Shortly after becoming president, Harry Truman proposes a broad health care restructuring that includes mandatory coverage, more hospitals, and double the number of nurses and doctors. Denounced by the American Medical Association and other critics as “socialized medicine,” his plan goes nowhere in Congress.
The Hill-Burton Act (Hospital Survey and Construction Act) pays for the construction of hospitals, especially in rural areas, to close the gap in access to medical care. It also prohibits discrimination on the basis of race, religion, or national origin in the provision of hospital services, but allows for “separate but equal” facilities. Hospitals are required to provide a “reasonable volume” of charitable care.
President Lyndon Johnson signs into law the most significant health reform of the century: Medicare, which provides comprehensive health care coverage for people 65 and older, and Medicaid, which helps states cover long-term care for the poor and disabled.
Congress establishes a comprehensive health insurance program for the elderly. Medicare, which receives a portion of Social Security payroll taxes, is extended to cover disabled people in 1972.
There is a shift toward privatization of health care as corporations begin to integrate the hospital system (previously a decentralized structure) and enter many other health-care-related businesses and consolidate control. In 1987, the Census Bureau’s annual estimate of health insurance coverage in the United States finds 31 million uninsured (13 percent of the population).
The Family and Medical Leave Act of 1993 is adopted by Congress and signed into law by President Bill Clinton. The law enables an employee to take up to 12 weeks of unpaid leave in any 12-month period for: the birth or adoption of a child; acquiring a foster child; the serious illness of a child, spouse or parent; and the serious illness of the employee. The right to take leave applies equally to male and female workers.
Massachusetts implements laws to provide health care coverage to nearly all state residents and calls for shared responsibility among individuals, employers and the government in financing the expanded coverage. Within two years, the state’s uninsured rate is cut in half. Vermont also passes comprehensive health care reform aiming for near-universal coverage. The law creates a health plan for uninsured residents and focuses on improving overall quality of care.
President Barack Obama signs landmark health care legislation. The Patient Protection and Affordable Care Act requires that all individuals have health insurance beginning in 2014. Those with low and middle incomes who do not have access to affordable coverage through their jobs will be able to buy coverage with federal subsidies. Health plans cannot deny coverage for any reason, including a person’s health status, nor can they charge more because of a person’s health or sex.
The U.S. Supreme Court largely upholds President Barack Obama’s Affordable Care Act in a 5-4 decision. A lawsuit had challenged a key provision – the individual mandate that required all Americans to buy insurance or pay a fine – as unconstitutional under the commerce clause. But the opinion, written by Chief Justice John G. Roberts Jr., says that the fine is a tax, which the government has the authority to impose. The ruling does restrict the law’s expansion of Medicaid. States are given some flexibility not to expand their programs without facing financial penalties outlined in the law.
The Supreme Court rules, 5-4, that the Affordable Care Act violates a federal law protecting religious freedom by requiring family-owned corporations to pay for insurance coverage for contraception. The coverage was challenged by two corporations, Hobby Lobby and Conestoga Wood Specialties, whose owners said they try to run their businesses based on Christian principles.
Justice Samuel Alito, in the majority opinion in Burwell v. Hobby Lobby, stresses that the Court had decided only that the Religious Freedom Restoration Act applied to “closely held” for-profit corporations run on religious principles. The Court rejects the government’s argument that neither the owners nor the corporations could bring a religious-freedom claim. “Protecting the free-exercise rights of corporations like Hobby Lobby … protects the religious liberty of the humans who own and control those companies,” Alito writes. Justice Ruth Bader Ginsburg’s dissenting opinion criticizes the ruling as a radical overhaul of corporate rights.
The U.S. Supreme Court rejects a major challenge to President Barack Obama’s health care law. The justices decide, 6-3, that the subsidies that millions of Americans received to make insurance affordable do not depend on where they live. The ruling in King v. Burwell protects 6.4 million people who were at risk of losing the aid because they reside in states that did not set up their own health exchanges.