American Healthcare History and Financing
Yesterday Yvonne saw Understanding the Healthcare Law, a great presentation by Dr. James Rohack on Health System Reform. Rohack is a practicing cardiologist and Director of Scott & White Center for Healthcare Policy. He is also a professor at Texas A&M Health Science Center and was the president of the American Medical Association from 2009 to 2010 during debates over Obama’s Healthcare Law. [Note that the AMA was a powerful lobbying force “against” healthcare reform since the 1930s.]
The presentation was held in Sun City, a planned community north of Austin for retirees with active lifestyles. It didn’t include handouts, but I was able to find some of Rohack’s slides online and offer them below with my notes.
Understanding the Health Care Law, by Dr. James Rohack
A TIMELINE HISTORY OF OVERHAULING HEALTH CARE
The New York Times provides this timeline of nearly 100 years of legislative milestones and defeats, summarized below:
1912 – Theodore Roosevelt campaigned on the Progressive Party ticket promising national health insurance, along with women’s suffrage, safe conditions for industrial workers, and other social issues.
1929 – Baylor Hospital in Dallas started a prepaid program to create the nation’s first example of modern health insurance.
1931 – The average family spent $250/year on health care. Farmers’ Union Co-operative Health Association pioneered the H.M.O. movement with a flat fee whether or not treatment is needed.
1932 – The Wilbur Commission found adequate medical attention beyond reach of millions of Americans and recommends group insurance to spread the risk. Critics denounce that as “socialist.”
1934 – Franklin D. Roosevelt’s New Deal included Social Security and unemployment insurance but was unable to include health insurance, thanks largely to opposition from the AMA and doctors.
1938 – Prepaid hospital insurance increased in popularity but excludes the unemployed and people 66 and older.
1945 – Harry S. Truman proposed a health care overhaul, but again the AMA and other critics called his plan “socialized medicine.”
1946 – Congress passed the Hill-Burton Act to finance rural hospital construction, require charity care, and prohibit discrimination based on race, religion or nationality.
1949 – The Supreme Court upheld a National Labor Relations Board ruling that health benefits can be part of collective bargaining.
1951 – The Health Insurance Council, an industry trade group, estimated that 77M Americans have purchased some type of voluntary accident or sickness insurance.
1954 – The Internal Revenue Act exempted employee benefits, like pensions and health insurance, from income taxes. That tax exemption has been hotly debated ever since.
1962 – John F. Kennedy took up the issue of health benefits for Social Security recipients, but his proposal stalls in Congress due to powerful lobbying by the medical industry.
1965 – After a Democratic sweep of Congress, Lyndon B. Johnson signed Medicare and Medicaid legislation for people over 65, the poor, blind, and disabled.
1968 – Health costs began to increase.
1971 – Edward Kennedy began a career-long push for universal single-payer health reform, as Richard Nixon wanted employers to provide insurance to workers but maintain private insurer competition.
1973 – Nixon promoted Health Maintenance Organizations with $375M public financing.
Everything Changed in 1973 when Nixon did a personal favor for his friend and campaign financer, Edgar Kaiser, then president and chairman of Kaiser-Permanente. He signed the Health Maintenance Organization Act of 1973. The bill gave medical insurance agencies, hospitals, clinics, and even doctors, the ability to begin functioning as for-profit business entities instead of the service organizations they were intended to be. So which insurance company got the first taste of federal subsidies to implement HMOA73? Yes, it was Kaiser-Permanente!!!
1974 – Congress passed the Employee Retirement Income Security Act (ERISA) to exempt large corporations’ self-insured health plans from state regulations.
1976 – Jimmy Carter called for a comprehensive national health insurance system, but a deep economic recession consumed lawmakers’ priorities.
1986 – Congress required hospitals to screen and stabilize all ER patients and passed COBRA, a system that allows employees to continue their group health plan up to 18 months after losing their jobs.
1988 – Ronald Reagan signed The Medicare Catastrophic Coverage Act, which set ceilings on Medicare patients’ payments. It had overwhelming congressional support.
1989 – Congress surprisingly repealed The Medicare Catastrophic Coverage Act a year later because affluent seniors resented paying a surtax to help finance it and protested in town hall meetings.
1993 – Bill Clinton pushed for universal coverage based on the idea of “managed competition” with private insurers competing in a tightly regulated market.
1994 – Clinton’s Health Security Act fails in Congress due to fierce partisan politics, special interest lobbying, and congressional distraction by other major issues.
1996 – Congress established HIPPA standards for medical record privacy and protected people in group insurance plans from being barred for pre-existing conditions.
1997 – Clinton signs the Children’s Health Insurance Program (CHIP).
2002 – The cost of health care, which had stabilized in the mid-1990s with the advent of managed care, climbed rapidly again. Employers passed on more of the costs to employees.
2003 – George W. Bush expanded Medicare to include prescription drug coverage called Part D., but a significant and confusing gap in coverage became known as “the doughnut hole.”
2006 – Health spending toped $2 trillion, or $7,421 per person and 16.2% of GDP.
2008 – 46M Americans were estimated to lack health insurance coverage. Obama, campaigning on Health Care Reform, is elected president.
June 2009 – Senator Edward Kennedy proposes that all Americans have “essential health care benefits” with no annual or lifetime limits. (The time-line condenses from here out. Follow link for details.)
July 5, 2009 – House Democratic leaders introduce a bill to expand insurance coverage and slow Medicare growth. Three House committees announced plans to begin the process in the same week.
July 22, 2009 – Obama delivers speech to rally public support for health care reform (follow the link to watch the video).
August 2009 – The health debate turned hostile and intensely partisan at town-hall-style meetings. (And you thought our current town halls are contentious.)
Sept. 29, 2009 – The Senate Finance Committee voted to reject the Democratic proposal for a public option.
Oct. 29 2009 – CBO said the 1,990-page bill would cover 36 million people and cost $1.05 trillion over 10 years, but with cuts to Medicaid growth and new fees and taxes, it could reduce deficits by $104B over 10 years.
Nov. 3 2009 – Republicans present their own health care plan, which would reward states for reducing the number of uninsured, limit malpractice damages, and allow small businesses to band together and buy insurance exempt from most state regulation.
Nov. 7 2009 – With only one Republican vote, House Democrats pass their bill.
Dec. 24 2009 – Senate Democrats pass their version of the health care bill 60-39.
Jan. 19 2010 – Republican Scott Brown shocks Dems by winning a special election to fill Senator Edward Kennedy’s vacated seat, denying Dems a 60-vote filibuster-proof majority.
Feb. 13 2010 – Anthem Blue Cross tells subscribers in California that average individual insurance premiums would rise 25%, with some rates going up 39%. Obama said that’s why the ACA was needed.
Feb. 22 2010 – Prior to a Health Care Summit meeting, Obama laid out a compromise plan, blending House and Senate bills.
March 3 2011 – Obama calls for Congress to set aside political gamesmanship and allow an “up or down vote” on health care reform.
March 21, 2010 – After an abortion deal, House Democrats passed the Senate bill 219-212, The Patient Protection and Affordable Care Act, sending the bill to Obama’s desk for signature on March 23, 2010.
