Health Care Reform in the United States: History and Future

By bistrib
  • American Association for Labor Legislation publishes draft bill for compulsory health insurance.

    It fails to be enacted as the United States enters World War I.
  • Baylor University introduces a prepaid hospital insurance plan for a group of school teachers.

    It's considered the forerunner of future Blue Cross plans.
  • Pres. Franklin D. Roosevelt creates Committee on Economic Security to address old-age and employment issues, as well as medical care and insurance.

  • Social Security Act passed by Congress

    It included grants for maternal and child health.
  • Department of Health and Human Services is born.

    It was signed into law by Pres. Franklin D. Roosevelt.
  • Physicians start to organize the first Blue Shield plans to cover the costs of physician care.

  • Legislation is introduced as part of a vision to operate health insurance as part of social security, adcovting "cradle to grave" social insurance.

  • Social Security Board calls for compulsory national health insurance in their annual report.

  • Pres. Truman calls for a national health program in a special address to Congress.

  • American Medical Association launches a national campaign against national health insurance proposals.

  • Federal Security Agency proposes enactment of health insurance for social security beneficiaries

  • Federal Security Agency is makde a cabinet-level agency and renamed the Department of Health Education and Welfare.

  • A military "medicare" program is enacted.

    It provided goverment health insurance for dependents of those in the armed forces.
  • AFL-CIO decides to support government health insurance.

    The American Medcial Association reiterates it's opposition.
  • Federal Employees Health Benefit plan initiated to provide health insurance coverage to federal workers.

  • Kerr-Mills Act passes, using federal funds to support state programs providing medical care to the poor and elderly.

    It's considered a precursor to the Medicaid program.
  • Pres. Kennedy addresses the nation on Medicare

    The American Medical Association issued a rebuttal.
  • Pres. Johnson advocates for Medicare in a special message to Contress

  • Medicare and Medicaid programs are signed into law

  • Social Security Amendments pass, adding optional Medicaid categories

  • Supplemental Security Income program begins providing cash assistance to elderly and disabled

  • Hawaii Prepaid Health Care Act passes

    It required employers to cover any employee working more than 20 hours a week.
  • Pres. Carter proposes Medicaid expansion for poor children under 6

    The proposal fails to come to a vote in Congress.
  • The Health Care Financing Administration is established

    At the time, it was within the Department of Health Edcuation and Welfare, which later became the Department of Health and Human Services.
  • The Tax Equity and Fiscal Responsibility Act (TEFRA) allowed states to extend Medicaid coverage to children under 18 with disabilities.

    It applied to "Katie Beckett" children under age 18 with disabilities requiring institutional care but living at home by waiving requirements to that families fall within income restrictions.
  • Emergency Medical Treatment and Active Labor Act, as a part of COBRA, is passed.

    The bill required hospitals participating in Medicare to screen adn stabilize everyone in emergency rooms regardless of ability to pay.
  • COBRA allows employees who lose their jobs to continue on their health plan for 18 months afterward.

  • States get Medicaid option to cover infants, young children and pregnant women at a higher level.

    The option would cover them up to 100 percent of the federal poverty level, regardless of whether they receive public assistance. That number was later increased to 185 percent of the federal poverty level.
  • Medicare is expanded to include coverage of prescription drugs

    It also included a cap on beneficiaries' out-of-pocket expenses. The expansion was later retracted.
  • Medicaid is expanded to cover children ages 6-18 under the federal poverty level.

  • Pres. Clinton convenes White House Task Force on Health Reform in his first week of office.

    He appoints First Lady Hillary Rodham Clinton as the chair of the task force, which sparks a wave of controversy and trouble from the get-go.
  • Hillary Clinton meets with Republican and Democratic senators behind closed doors.

    She is frustrated because she is getting little cooperation in the health care effort and tells them she is having trouble getting meetings with Republicans. It is common knowledge among many of those present that the staff of Senate Minority Leader Bob Dole has told Republicans they are not to meet with the First Lady.
  • The first of four scheduled internal health policy meetings take place.

    Although the meeting is meant to be private, accounts of the session appear in the Washington Post and the New York Times shortly thereafter. The next three debates were indefinitely postponed. This incident make the Clintons feel they are being subjected to intentional acts of disloyalty.
  • The Clinton Health Care Task Force is officially disbanded.

  • The Vaccines for Children program is established

  • The Health Insurance Association of American begins running its famous "Harry and Louise" ads on television.

    In what has become an American advertising classic, the ads feature a middle-class couple worried about Clinton's health plan.
  • Hillary Clinton launches an attack against the insurance industry to counter the "Harry and Louise" ads

    She accuses the industry of greed and lying about reform to protect its profits. Rarely, if ever, has a First Lady publicly attacked any American industry or industry group.
  • A Health Care bill is presented to Congress on the last day of the session.

  • The Ways and Means Health Subcommittee starts considering a bill to expand Medicare.

    Medicare C, as the bill is called, becomes the House version of the Clinton plan.
  • Ted Kennedy reports a strong version of the Clinton plan from his Labor and Human Resources committee.

    Pat Moynihan, while searching for a deal with Bob Dole, introduces his own version of the bill, knowing Clinton's plan has no Republican support and lots of Democratic opposition.
  • George Mitchell pulls the plug on health care reform.

  • Voters break the 40-year hold of Democrats in Congress, restoring Republicans to power at nearly every level.

    In two years the Democrats have gone from a controlling majority 258 seats in the House of Representatives to a minority of 204. In all the contests House, Senate, and gubernatorial seats, not a single Republican seeking reelection lost.
  • Clinton drafts a new budget, which doesn't contain any new health care proposals or savings for Medicare.

    Republicans complain that Clinton is walking away from the problem.
  • Republican Medicare and Medicaid plans pass the House and Senate an almost strictly party-line vote.

    President Clinton vetoes the bill knowing he won't be overridden.
  • HIPAA is signed into law

    The law restricts use of pre-existing conditions in health insurance coverage determination, sets standards for medical records privacy and establishes tax-favored treatement of long-term care insurance.
  • Medicaid rules created for legal immigrants

    Legal immigrants admitted on or after this date are ineligible for Medicaid until they've lived in the United States for five years, unless it's for emergency care.
  • Balanced Budget Act is signed into law

    The legislative package slowed Medicare spending growth, but enacted the State Children's Health Insurance Porgram (S-CHIP), which provides grants to states to help cover low-income kids above Medicaid eligibility levels.
  • Pres. Clinton signs the Mental Health Parity Act into law

    The Mental Health Parity Act prohibits health plans from having lower limits on mental health benefits except substance abuse and chemical dependency.
  • Work Incentives Improvement Act passed

    The law allows states to cover the working disabled up to 250% of the federal poverty level and impose income-related premiums.
  • Breast and Cervical Cancer Prevention and Treatment Act passes

    Through the act, states are allowed to provide medical coverage to uninsured women for treatment of breast or cervical cancer if they've been diagnosed through a CDC screening program, regardless of income or resources.
  • President Bush begins a five-year initiative to expand the number of community health centers for teh medically underserved

  • Maine passes a comprehensive health care reform plan

    Their plan provides subsidized coverage to individuals and small employers and expands Medicaid.
  • Pres. Bush signs the Medicare Drug Improvement and Modernization Act into law

    The act creates voluntary, subsidized prescription benefits under Medicare.
  • Health Savings Accounts are created

    This allows pre-taxed income to be set aside for future medical expenses. HSAs must be used in conjucntion with a high-deductible plan.
  • Massachusetts passes legislation to provide health care coverage for nearly all state residents.

    The plan requires them to obtain health insurance. Individuals, employers and government share responsibility in financing the expansion. Within two years, the state's uninsured rate is cut by half.
  • Vermont passes statewide health care legislation similar to Massachusetts'.

  • The City of San Francisco creates a universal access program for city residents

  • The Healthy Americans Act is introduced in Congress

    The law would require individuals to obtain private coverage through state health insurance purchasing pools. It gains some bipartisan support.
  • President Bush proposes a plan that would alter the tax structure for having health insurance.

    The plan would replace the tax preference for employer-sponsored insurance with a standard health care deduction. The plan gets no action in Congress.
  • Congress reaches a compromise of a bill to reauthorize the State Children's Health Insurance program (S-CHIP)

    Even though the reauthorization, which would have extended benefits until March 2009, had bipartisan support, President Bush vetoed the bill a month later and there weren't enough votes in Congress to override the veto.
  • California tries passing health reform

    Eventually, the initiatives failed. the plan called for reform with individual mandates and shared financial responsitbility, much like Massachusetts' plan. Governor Schwarzenegger suported the plan, but it couldn't pass their state senate.
  • The Mental Health Partiy Act of 1996 is amended

    The amendments require full parity, and requires insurance companies to treat and cover mental health conditions, including substance abuse on an equal basis with physical conditions.
  • Sen. Max Baucus, D-Montana, releases "White Paper" proposal

    The chairman of the Senate Finance Committee releases the proposal on health reform, outlining a plan based around Massachusetts'.
  • The Children's Health Insurance Porgram (CHIP) is reauthorized

    The reauthorization provided states with additional funding and reached 4.1 millino children through Medicaid and CHIP who otherwise would have been uninsured by 2013.
  • President Obama releases a 2010 budget outlining reform principles

    The budget report outlined eight principles for health reform and proposed setting aside $634 billion in a health reform reserve fund.
  • White House holds Health Care Summit

  • President Obama creates the Office of Health Reform

  • Congressional bills pass committee in the House and Senate

    They both pass one bill and not the other. Challenges to reconcile the bills include the option of a public plan to compete with private insurance companies, the coverage of abortion servies by a federally-funded plan, financing mechanisms and others. Most vocal opposition comes from the newly formed Tea Party.
  • EFFECTIVE: A voluntary long-term program will begin, financed through payroll deductions.

  • President Obama releases a proposal bridging the two plans

    He also hosts a second Health Care Summit, but little consensus is acheived between Democrats and Republicans.
  • President Obama lays out his plan and how to pass it

    In a speech, he suggests that the Senate ought to use their supermajority powers to pass major reform legislation.
  • The House of Representatives passes the Senate version of the bill

    Known as the Patient Protection and Affordable Care Act, the House is able to send it to Obama's desk for signature. The House also passes an act to amend the Senate bill to reflect negotiations and includes reform of the nations' student loan system. The reconciliation vote is sent to the Senate for a final vote.
  • President Obama signs the Patient Protection and Affordable Care Act

    Most of the legislation will go into effect in 2014.
  • EFFECTIVE: States may establish and operate offices of health insurance customer assistance or ombundsmna programs.

    These offices can assist with filing of complainst and appeals, collect and track inquiries, educate and assist consumers in plans and resolve problems with obtaining subsidies.
  • EFFECTIVE: provisions to grandfathered plans

    Immediately, the preservation of the right to maintain existing coverage is enacted. Certain provisions to the plans apply: excessive waiting periods, lifetime limits, rescissions, dextension of dependent coverage, and others.
  • President Obama signs the amendment to the legislation

    It had to go through another round of Congressional votes before being sent to the President's desk.
  • EFFECTIVE: Medicare Part D "donut hole" $250 rebate

    As of June, a $250 rebate will be available to seniors reaching the "donut hole."
  • DEADLINE: The Secretary of Health and Human Services must establish a temporary high-risk health insurance pool program.

    This program would be for people with preexisting conditions who have been without coverage for at least six months. North Dakota's current high risk pool, the Comprehensive Health Association of North Dakota (CHAND) doesn't meet requirements. Requirements include: having no preexisting condition exclusions, cover at least 65% of total allowed costs, an out-of-pocket limits no greater than the limit for high deductible health plans, and others.
  • DEADLINE: Secretary of Health and Human Services must also establish a temporary reinsurance program to reimburse early retirees

    The plan should reimburse employment-based plans for 80% of costs incurred by retirees over the age of 55, but not eligible for Medicare between $15,000 and $90,000 annually.
  • DEADLINE: The Secretary of Health and Human Services bust create a web portal to identify affordtable coverage options

    The website should be able to help individuals and small businesses identify affordable coverage options.
  • EFFECTIVE: Plans may not establish lifetime limits on the dollar value of essential benefits.

  • EFFECTIVE: A plan may not impose any preexisting condition exclusions for those under the age of 19.

  • EFFECTIVE: Insurers cannot rescind coverage after a sickness.

    Coverage may be rescinded only for fraud or intentional misrepresentation of material fact.
  • EFFECTIVE: Plans must provide coverage without cost-sharing for various preventative care and screenings

    Among the care includes services recommended by the U.S. Preventative Services Task Force, immunizations recommended by the Advisory Committee on enactment Immunization Practices of teh Centers for Disease Control, preventative care and screenings for infants, children, adolescents and women supproted by the Health Resources and Services Administration.
  • EFFECTIVE: Plans that provide dependent coverage must extend coverage to adult children up to age 26.

  • DEADLINE: All plans must submit details in plain language to the Secretary of Health and Human Services, state insurance commissioners and make available to the public.

    The information includes claims payment policies and practices, periodic financial disclosures, data on enrollment and disenrollment, data an the number of claims that are denied, data on ratings practices and information on cost-sharing and payments with respect to out-of-network coverage.
  • EFFECTIVE: Some provisions of patient protection

    1. A plan that provides for designation of a primary care provider must allow the choice of any participating primary care provider who is available to accept them, including pediatricians.
    2. If a plan provides coverage for emergency services, the plan must do so without prior authorization, regardless of whether the provider is a participating provider.
    3. A plan may not require authorization or referral for a female patrient to receive obstetric or gynecological care from a provider.
  • Throughout 2010: a tax credit will be available to small businesses offering coverage to employees

  • EFFECTIVE: Higher loss ratios are required for plans.

    Loss ratio is the fraction of revenue from a plan's premiums that goe to pay for medical services. On this date, medical loss ratios go to 80 percent for individual/small group plans and 85 percent for large group plans.
  • EFFECTIVE: all hospitals must establish and make public a list of its standard charges or items and services, including for diagnosis-related groups.

  • STUDIES: a study of self-insured and fully-insured plans comparing to employers, benefits, reserves, etc., will be conducted by the Secretary of health and Human Services.

    The study will determine the extrent to which the bill's market reforms will cause adverse selection in the large group market and prompt small and mid-size employers to self insure. The Government Accountability Office is also to conduct a study of the incidence of denials of coverage for medical services and denials ofapplication to enroll in health insurance plans by group health plans and health insurance issuers.
  • DEADLINE: Secretary of Health and Human Services must develop and implement standards for summary of benefits and coverage explanations.

    These standards must be provided to all potential policyholders and enrollees.
  • The Secretary of Health and Human Services must determine whether states intend to operate health benefit exchanges

  • Rules for simplifying administration, developed by the Secretary of Health and Human Services, go into effect.

    The rules will regard electronic exchange of health information, transaction standards for electronic funds transfers and requirements for financial and administrative transactions.
  • Employers must start providing employees with written notice at the time of hiring, informing them of the existence of the Exchange and the availability of subsidies.

  • State health benefit exchanges must be operational

    There must be two exchanges: a non-group market exchange and an exchange for small businesses. Some functions include:
    -Certify qualified plans to be sold in the exchange
    - Maintain a website
    - Provide for initial, annual and special open enrollment periods
    - Create a rating system for plans and perform satisfaction survey
    - Provide a calculator to determine enrollee premiums and subsidies
    - Identify those individuals exempt from the individual mandate and notify treasury
  • Employers must provide a voucher toward the group health plan to each employee whose household income is below 400 percent of the federal poverty level.

    Other qualifications for the vouchers apply. Employees may use these vouchers to purchase coverage through the Exchange.
  • An insurance plan may not impose any preexisting condition exclusions on anyone.

  • U.S. citizens and legal residents are required to have qualifying health coverage.

    Those without coverage must pay a tax penalty, which will be phased in over two years and then increase by a cost-of-living adjustment.
  • Plans beginning this year must guarantee renewability, availability of coverage, non-discrimination, employer coverage offers, and more

    Plans may not establish rules for eligibility based on health status-related factors, coverage must be comprehensive, group plans may not impose waiting periods of longer than 90 days, coverage for individuals participating in approved clinical trials, and more.
  • More state participation in a "health care choice compact"

    Under the compact, individual market plans could be offered in all states, subject to the laws and regulations of th estate. Plans must be licensed in each state in which they sell coverage.
  • States may apply for waivers for some requirements

    Some requirements that couple apply are:
    - for qualified health benefits plans
    - for health insurance exchanges
    - for reduced cost-sharing in qualified health benefits plans
    - for premium subsidies
    - for the employer mandate
    - for the individuals mandate
  • New taxes on so-called "Cadillac" health insurance policies are imposed