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Health Policy Timeline

  • Marine Hospital Service established

    Marine Hospital Service established
    John Adams signs a bill authorizing medical care for merchant seamen and establishing the U.S. Marine Hospital Service to address health issues relating to maritime trade, such as yellow fever, scurvy and health threats brought to the U.S. from other countries on ships. The Marine Hospital Service later became the Public Health Service. A monthly hospital tax of 20 cents was deducted from the pay of merchant seamen in the first prepaid medical care plan in the United States.
  • AMA Founded

    AMA Founded
    "The American Medical Association was founded in 1847 under the leadership of Dr. Nathan Davis, and that he influenced the Association to make reform of medical education one of its primary goals."
  • Medicine unregulated at end of Civil War

    Medicine unregulated at end of Civil War
    "The condition of the American medical profession at the close of the Civil War was, in almost every particular, significantly different from that which obtains today. The profession was, throughout the country, unlicensed and
    anyone who had the inclination to set himself up as a physician could do so, the exigencies of the market alone determining who would prove successful in the field and who not."
  • AMA recommends licensure to practice medicine

    "At its Cincinnati meeting in 1867, the AMA endorsed a
    resolution urging "upon the members of the profession in the different States to use all their influence in securing such immediate and positive legislation as will require all persons, whether graduates or not, desiring to practice medicine, to be examined by a State Board of Medical Examiners, in order
    to become licensed for that purpose,"
  • Federal Quarantine Act was passed

    Federal Quarantine Act was passed
    The first Federal Quarantine Act was passed April 29. On December 21, Congress appropriated funds 'for investigating the origin and causes of epidemic diseases, especially yellow fever and cholera.'" (
  • Forerunner of National Institute of Health established

    Forerunner of National Institute of Health established
    "In 1887 a Hygienic Laboratory was established at the Staten Island Marine Hospital to apply the new bacteriologic principles to the study of disease in this country. It quickly proved its worth and was soon transferred to Washington where it became the forerunner of today's National Institute of Health" (Haughton, 1968)
  • Commissioned Corps of the Public Health Service established

    Commissioned Corps of the Public Health Service established
    "After the establishment of the Commissioned Corp of the Public Health Service in 1889 the Congress, in 1893, gave the Service full responsibility for foreign and interstate quarantine, emphasizing cooperative relationships with State health departments." (Haughton, 1968)
  • State Licensing Boards Spur Reform

    "In 1891 the National Confederation of State Licensing Boards voted to require a minimum of three years of medical training. This decision to deny licensure to laggard schools was critical. It initiated at last an appreciable nationwide movement toward reform."
  • Wald founds Henry Street Settlement

    Wald founds Henry Street Settlement
    "In 1893, after witnessing first-hand the poverty and hardship endured by immigrants on the Lower East Side, she founded Henry Street Settlement. She moved into the neighborhood and, living and working among the industrial poor, she and her colleagues offered health care to area residents in their homes on a sliding fee scale." (
  • Sioux Valley Opens

    Sioux Valley Opens
    "From 1894 until 1901, hospital care in Sioux Falls had been limited to large rented homes, such as the Cameron residence. Erected in 1901 at Nineteenth Street and Minnesota Avenue, this building was the city’s first hospital building, forerunner to Sioux Valley Hospital. The original impetus toward having a hospital building in Sioux Falls came after residents returned from the 1893 Chicago Columbian Exposition, where they had seen exhibits of medical care." (
  • Biologics Control Act

    Biologics Control Act
    "As the production and interstate sale of biologic products for the prevention and treatment of infectious diseases expanded, the Congress gave responsibility for their licensing and regulation to the Public Health Services under the Biologics Control Act of 1902." (Haughton, 1968)
  • Pure Food and Drug Act

    The Pure Food and Drug Act of 1906 ended the patent medicine market.
  • Flexner Report

    Flexner Report
    "In his Report on Medical Education in the United States and Canada to the Carnegie Foundation in 1910, Abraham Flexner mercilessly exposed the gross deficiencies still existing in the programs of the generality of American medical schools."
  • McKennan Hospital opens

    McKennan Hospital opens
    The first McKennan Hospital building was constructed in 1911.
  • Typhoid Mary quarantined for life

    Typhoid Mary quarantined for life
    Mary Mallon, known as Typhoid Mary, was a carrier of typhoid who was presumed to have infected 51 people, three of whom who died. She was isolated against her will by public health authorities and died after nearly three decades in isolation.
  • Clark Stanley fined $20 for false advertising

    Clark Stanley fined $20 for false advertising
    Clark Stanley enters plea of nolo contendere in a suit in which the U.S. accused Stanley of failse and fraudulent representation of his Stanley Snake Oil Liniment as a remedy for all pain and lemness, for rheumatism, neuralgia, sciatica, sprains, bunions, and sore throat,
  • Concept of HealthInsurance Promoted

    Concept of HealthInsurance Promoted
    Former President Teddy Roosevelt, who had served two terms in office as a Republican, runs again as a third-party candidate and calls for universal health care for all Americans. Health insurance was largely unabailable at the time, and paid sick days or maternity leave were unhead-of.
    Roosevelt's Pregressie Party loses to the Republican ticket. The election causes many moderates to leave the GOP and sets the tone of a more consedrvative party ideology that has lasted generations." (CNN, 2009)
  • Wall Street Crash

    Wall Street Crash
    Dow Jones Industrial Average plummets. This date often cited as start of the Great Depression.
  • Period: to

    Great Depression

    "The Great Depression was a worldwide economic crisis that in the United States was marked by widespread unemployment, near halts in industrial production and construction, and an 89 percent decline in stock prices. It was preceded by the so-called New Era, a time of low unemployment when general prosperity masked vast disparities in income. The start of the Depression is usually pegged to the stock market crash of “Black Tuesday,” Oct. 29, 1929." (NY Times)
  • Social Security Act

    Social Security Act
    "In the midst of the Great Depression, President Franklin D. Roosevelt signs the Social Security act into law to establish 'a system of old-age benefits' and to provide states with funds to build local health departments.
    Roosevelt chooses not to include a health care provision because he thought it might jeorpardize the entire bill's passage. The AMA, fearful that nationalized health care would take away a doctor's sutonomy, lobbies heavily against compulsory health insurance." (CNN, 2009)
  • Polio outbreak in 1940 and 1950's

    Polio outbreak in 1940 and 1950's
    "Iron lung" treatment for polio victims of the 40's & 50's. Photo from
  • Roosevelt calls for social insurance

    Roosevelt calls for social insurance
    "In his State of the Union message, President Franklin D. Roosevelt calls for social insurance 'from the cradle to the grave.' Months later, comprehensive health care legislation dubbed the Wagner-Murray-Dingell bill is introduced to the full Congress. It calls for a compulsory national health insurance plan to be implemented within the Social Security act. But opponents kill any vote on the legislation." (CNN, 2009)
  • Period: to

    Post WWII

  • Truman signs "Hill-Burton" Act

    Truman signs "Hill-Burton" Act
    "In an effort to address rising and unequal costs of hospital care, President Truman signs the Hospital Survey and Construction Act, giving states access to federal grants to help pay for the maintenance and construction of public health centers.
    The act includes a provision requiring facilities to provide access to all patients without discriminating on the basis of race, nationality or religion." (CNN, 2009)
  • Dept. of Health, Education and Welfare established

    Dept. of Health, Education and Welfare established
    (The Department of Health, Education and Welfare--the forerunner of the Department of Health and Human Services--is established under President Eisenhower." (CNN, 2009)
  • USD School of Nursing opens

    USD School of Nursing opens
  • Brown v. Board of Education

    Brown v. Board of Education
    "Brown v. Board of Education (1954), now acknowledged as one of the greatest Supreme Court decisions of the 20th century, unanimously held that the racial segregation of children in public schools violated the Equal Protection Clause of the Fourteenth Amendment. Although the decision did not succeed in fully desegregating public education in the United States, it put the Constitution on the side of racial equality and galvanized the nascent civil rights movement into a full revolution." (PBS.o
  • President Eisenhower signs Internal Revenue Act of 1954

    President Eisenhower signs Internal Revenue Act of 1954
    "President Eisenhower, a strong advocate of private health insurance, signs the Internal Revenue Act of 1954, which creates tax exclusions for many employer-provided benefits including retirement, child care and medical expenses.
    Eisenhowever would also authorize the 'military Medicare' program extending health insurance to dependents of US Armed Forces service members, & the Federal Employee Benefits Act, providing members of Congress and federal employees with health coverage." (CNN, 2009)
  • Period: to

    Civil Rights Movement

    "Nearly 100 years after the Emancipation Proclamation, African Americans in Southern states still inhabited a starkly unequal world of disenfranchisement, segregation and various forms of oppression, including race-inspired violence. “Jim Crow” laws at the local and state levels barred them from classrooms and bathrooms, from theaters and train cars, from juries and legislatures. In 1954, the U.S. Supreme Court struck down the “separate but equal” doctrine." (
  • Period: to

    Hippie Movement

    "The hippie subculture developed as a youth movement that began in the United States during the early 1960s and spread around the world. Its origins can be traced back to classical culture, and to European social movements in the early 20th century i.e.: Fabians and Bohemians. From around 1967, its fundamental ethos — including harmony with nature, communal living, artistic experimentation particularly in music, and the widespread use of recreational drugs — spread around the world." Wikpedia
  • Civil Right Act of 1968

    Civil Right Act of 1968
    "In 1964, Congress approved the Civil Rights Act of 1964 into law. The law essentially made it illegal to discriminate against any individual because of his/her race, color, religion, sex, or national origin in employment or service." (
  • "War on Poverty"

    "War on Poverty"
    "The Economic Opportunity Act is signed by President Johnson as part of his administration's 'War on Poverty', a series of legislative efforts to address high levels of unemployment and poverty. An amendment in the act by Sen. Ted Kennedy creates a national system of health centers." (CNN, 2009)
  • Griswold v. Connecticut

    Griswold v. Connecticut
    "In Griswold v. Connecticut (1965), the Supreme Court ruled that a state's ban on the use of contraceptives violated the right to marital privacy. The case concerned a Connecticut law that criminalized the encouragement or use of birth control." (
  • Medicare and Medicaid signed into law

    Medicare and Medicaid signed into law
    "As worker-based insurance plans become the norm, it gets harder for retired Americans to find good health coverage. Under the auspices of his 'Great Society' reforms, President Johnson signs into law the Medicare and Medicaid programs in order to provide the elderly with medical coverage. Medicare Part A covers hospital care, and Medicare B covers general doctor care. Medicaid is set up to support state-run programs that assist the poor with medical costs." (CNN, 2009)
  • OSHA passed

    OSHA passed
    "Efforts by the federal government to ensure workplace health and safety were minimal until the passage of OSHA. The American system of mass production encouraged the use of machinery, while the statutory regime did nothing to protect workplace safety. For most employers, it was cheaper to replace a dead or injured worker than it was to introduce safety measures." (Wikpedia)
  • Medicare disability coverage

    Medicare disability coverage
    "President Nixon signs the Social Security Amendment, extending Medicare coverage to individuals under 65 with long-term disabilities or end-stage renal disease." (CNN, 2009)
  • Roe v Wade

    Roe v Wade
    "Roe v. Wade (1973) ruled unconstitutional a state law that banned abortions except to save the life of the mother. The Court ruled that the states were forbidden from outlawing or regulating any aspect of abortion performed during the first trimester of pregnancy, could only enact abortion regulations reasonably related to maternal health in the second and third trimesters, and could enact abortion laws protecting the life of the fetus only in the third trimester. "(
  • Rapid City Regional Hospital opens

    Rapid City Regional Hospital opens
    "In the early 1970s spiraling costs and new developments in medical technology cast doubt on the feasibility of maintaining two hospitals (Saint John's McNamara and Bennett-Clarkson) in Rapid City. A seven-member Hospital Action Committee was formed to explore the possibility of merging the two hospitals.
    Officially incorporated on July 1, 1973, Rapid City Regional Hospital began with 80 physicians on the Medical Staff and 280 licensed beds." (
  • Hawaii enacts near universal health coverage

    Hawaii enacts near universal health coverage
    "Hawaii was the first U.S. state to enact laws creating a near universal health care coverage system, with the Hawaii Prepaid Health Care Act (PHC), Haw. Rev. Stat. §§ 393-1 - 393-51, which was passed in 1974 and implemented in 1975." (Library of Congress)
  • Carter proposes National Health Plan

    Carter proposes National Health Plan
    "President Carter proposes a 'National Health Plan' that would provide coverage to low-income and disabled Americans, as well as consolidate Medicare and Medicaid into one federal program. The plan would be funded by employer and employee payroll taxes. The legislation fails to get enough backers in Congress, however." (CNN, 2009)
  • Diagnosis Related Groups

    Diagnosis Related Groups
    In 2007, author Rick Mayes described DRGs as:
    “ ...the single most influential postwar innovation in medical financing: Medicare's prospective payment system (PPS). Inexorably rising medical inflation and deep economic deterioration forced policymakers in the late 1970s to pursue radical reform of Medicare to keep the program from insolvency. Congress and the Reagan administration eventually turned to the one alternative reimbursement system that analysts and academics had studied more than a
  • Reagan enacts EMTALA

    Reagan enacts EMTALA
    "In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) and stablizing treatment for emergency medical conditions (EMC), including active labor regardless of ability to pay." (
  • Reagan enacts continuation health coverage

    Reagan enacts continuation health coverage
    "The Consolidated Omnibus Budget Reconciliation Act gives workers and their families who lose health benefits the ability to continue to receive benefits for a certain period of time and under certain conditions, such as job loss, divorce or death of a spouse." (CNN, 2009)
  • Period: to

    Cost Containment Era

  • Clinton attempts US Health System Overhaul

    Clinton attempts US Health System Overhaul
    President Clinton seeks to completely overhaul the U.S. health care system by with the Heath Security Act to 'ensure individual and family security through health care coverage for all Americans.' The bill is immediately met with intense opposition from Republicans and industry groups, particularly the health insurance industry and the American Medical Association. The bill fails to pass before Congress adjourned and is not reintroduced." (CNN, 2009)
  • State Children's Health Insurance Program

    State Children's Health Insurance Program
    "The State Children's Health Insurance Program extends health coverage to children from low-income families who do not qualify for Medicaid. The program is administered by the states but receives matching funds from the federal government." (CNN, 2009)
  • Bush signs Medicare Part D

    Bush signs Medicare Part D
    "President George W. Bush signs the Medicare Prescription Drug Improvement and Modernization Act, known as Medicare Part D, to provide prescription drug insurance coverage to those who are enrolled in or entitled to Medicare. The insurance is administered by private health insurance plans." (CNN, 2009)
  • Bush Proposed Medicare Spending Cuts

    Bush Proposed Medicare Spending Cuts
    "The administration's budget proposes cuts to a wide variety of health programs, including the Centers for Disease Control and Prevention and aid to children's hospitals. It would freeze funding for many more, including the National Institutes of Health.But the biggest proposed spending cuts are in Medicare, the federal health program for the elderly and disabled. The budget would reduce Medicare spending by just short of $36 billion." (NPR, 2006)
  • Bush signs Genetic Information Non-Discrimination Act (GINA)

    Bush signs Genetic Information Non-Discrimination Act (GINA)
    The Genetic Information Nondiscrimination Act of 2008 (Pub.L. 110–233, 122 Stat. 881, enacted May 21, 2008, GINA, pronounced J-eye-na), is an Act of Congress in the United States designed to prohibit the use of genetic information in health insurance and employment. The Act prohibits group health plans and health insurers from denying coverage to a healthy individual or charging that person higher premiums based solely on a genetic predisposition to developing a disease in the future. (Wikpedia)
  • CHIP extended through 2013

    CHIP extended through 2013
    "President Obama extends the State Children's Health Insurance Program through 2013, saying it is a 'down payment on my commitment to cover every single American.'" (CNN, 2009)
  • Affordable Care Act signed

    Affordable Care Act signed
  • Massachusetts enacts Mandated Heatlh Insurance Law

    Massachusetts enacts Mandated Heatlh Insurance Law
    "Massachusetts enacts the Mandated Health Insurance Law, which requires all adults who can obtain affordable health insurance to do so. It also establishes a subsidized program for low-income adults who do not receive employer-sponsored care adn cannot afford private insurance. The program includes an employer contribution requirement and is funded by state and local governments." (CNN, 2009)
  • Supreme Court holds Affordable Care Act is Constitutional

    Supreme Court holds Affordable Care Act is Constitutional