History of Reform in US

The California Physicians Alliance joins a long and prestigious list of people who advocate for health care reform. A printer friendly version of this timeline can be found here.

Timeline

1798
July 1

Marine Hospital Service for Merchant Seamen Established

Landmark Decision
President John Adams signs into law, "An Act for the Relief of Sick and Disabled Seamen," creating the Marine Hospital Service that later evolves into the Public Health Service. Federal customs collectors tax American ships arriving from foreign ports 20 cents per sailor per month to pay for construction and mainte­nance of marine hospitals. This sum is subtracted from the wages of seamen.
1847
January 17

American Medical Association Founded

The American Medical Association is founded in Philadelphia.
1912
July 23

First Model of State Law

National Convention of Insurance Commissioners develops first model of state law for regulating health insurance.
August 25

Endorse Social Insurance

Landmark Decision
Teddy Roosevelt and his Progressive party endorse social insurance as part of their platform, including health insurance.
1915
June 12

Publishes a draft bill for compulsory health insurance

The American Association for Labor Legislation (AALL) publishes a draft bill for compulsory health insurance and promotes campaigns in several states. A few states show interest, but fail to enact as U.S. enters into World War I. The idea draws initial support from the AMA, but by 1920 AMA reverses their position.
1921
November 23

Sheppard-Towner Act

Women reformers persuade Congress to pass the Sheppard-Towner Act, which provided matching funds to states for prenatal and child health centers. Act expires in 1929 and is not reauthorized.
1927
May 15

Committee on the Costs of Medical Care

Committee on the Costs of Medical Care forms to study the economic organization of medical care. Group is comprised of economists, physicians, public health specialists, and other major interest groups. Recommendations were completed by 1932. While some members would not support the recommendation for medical group practice, the majority did endorse the idea, along with voluntary health insurance.
1929
October 10

Pre-paid hospital insurance plan

Baylor Hospital introduces a pre-paid hospital insurance plan for a group of school teachers, which is considered the forerunner of future nonprofit Blue Cross plans.
October 29

Great Depression Years

Great Depression years begin.
1930
January 1

1930 – 1934 : Floundering Policies

National Health Insurance and the New Deal Hard economic times called for social policies to secure employment, retirement, and medical care. President Roosevelt appointed a committee to work on all these issues, but in the end did not risk the passage of the Social Security Act to advance national health reform
1934
June 29

Committee on Economic Security

FDR creates Committee on Economic Security to address old-age and unemployment issues, as well as medical care and insurance.
1935
January 17

Committee on Economic Security issues final recommendations

Committee on Economic Security issues final recommendations, none of which explicitly address national health insurance; however principles of health reform are outlined. Committee later issues unpublished report "Risks to Economic Security Arising Out of Illness."
June 12

1935 – 1939 : National Health Insurance and the New Deal

President Roosevelt continued to support national health reform throughout his terms. His second push for national health insurance came after the Social Security Act passed. However, the momentum from FDR’s Technical Committee on Medical Care and a National Health Conference were not enough to overcome a Congress that was no longer supportive of further government expansions.
June 12

1935 – 36 : National Health Survey

National Health Survey conducted under the auspices of the U.S. Public Health Service to assess the nation's health and the underlying social and economic factors affecting health – the forerunner to the National Health Interview Survey of today.
August 14

Social Security Act

Landmark Decision
Social Security Act passed by Congress. The Act includes grants for Maternal and Child Health. These grants restored many of the programs established under the SheppardTowner Act and extended the role of the Children’s Bureau to include not only maternal and child health services, but other child welfare services as well. In the end, President Roosevelt did not risk the passage of the Social Security Act to advance national health reform.
August 15

FDR forms Interdepartmental Committee

FDR forms Interdepartmental Committee to Coordinate Health and Welfare Activities.
1937
March 10

Technical Committee on Medical Care

Technical Committee on Medical Care established under Interdepartmental Committee to Coordinate Health and Welfare Activities; publishes its report, A National Health Program in 1938.
1938
July 12

National Health Conference

National Health Conference convened in Washington, D.C.
1939
June 12

National Health Bill

Sen. Wagner introduces National Health Bill incorporating recommendations from the National Health Conference. Proposal dies in committee.
June 12

First Blue Shield plans

Physicians start to organize the first Blue Shield plans to cover the costs of physician care.
July 1

Department of Health and Human Services

Department of Health and Human Services born as the Federal Security Agency bringing together federal agencies concerned with health, welfare, and social insurance.
1943
June 4

War Labor Board rules

War Labor Board rules wage freeze does not apply to fringe benefits, including health insurance benefits.
June 12

Cradle to Grave

Landmark Decision
Senators Wagner and Murray, along with Representative Dingell introduce legislation as part of a broader vision to operate health insurance as part of social security. Wagner-Murray-Dingell bill includes provisions for universal comprehensive health insurance along with other changes to social security meant to move toward a system of "cradle to grave" social insurance.
1944
January 11

Social Security Board

Social Security Board calls for compulsory national health insurance as part of the Social Security system.
January 11

Economic Bill of Rights

FDR outlines 'economic bill of rights' including right to adequate medical care and the opportunity to achieve and enjoy good health in his State of the Union address.
1945
June 12

1945 – 1949 : National Health Insurance and the Fair Deal

President Truman picked up the mantle for a national health program just months after the end of World War II. His election in 1948 appeared to be a mandate for national health insurance, but the opposition, using fear of socialism, coupled with the power of southern Democrats who believed a federal role in health care might require desegregation, effectively blocked all proposals
1946
July 15

Taft-Smith-Ball bill

Truman sends health message to Congress. Revised Wagner-Murray-Dingell bill introduced to Congress again. An alternative Senate bill (Taft-Smith-Ball bill) authorizes grants to states for medical care of the poor. Neither bill gains traction.
August 13

Hospital Survey and Construction Act

Hill-Burton Act (Hospital Survey and Construction Act) to fund the construction of hospitals passes. It also prohibits discrimination on the basis of race, religion, or national origin in the provision of hospital services, but allowed for "separate but equal" facilities. The statute also required hospitals to provide a "reasonable volume" of charitable care.
1947
July 13

National Health Program

Truman, in another special message to Congress calls for a National Health Program. Wagner-MurrayDingell bill and Taft bill both reintroduced.
1948
May 1

National Health Assembly

National Health Assembly convened in Washington, D.C., by the Federal Security Agency. The final report endorses voluntary health insurance but reiterated need for universal coverage.
June 12

National Campaign against National Health Insurance

Landmark Decision
AMA launches a national campaign against national health insurance proposals.
1949
June 12

Supreme Court upholds National Labor Relations Board

Supreme Court upholds National Labor Relations Board ruling that employee benefits can be included in collective bargaining.
1950
August 15

National Conference on Aging

National Conference on Aging is convened by Federal Security Agency.
1951
June 12

Joint Commission on the Accreditation of Hospitals

Joint Commission on the Accreditation of Hospitals (JCAH) formed to improve the quality of hospital care through the voluntary accreditation of hospitals.
1952
February 26

Enactment of Health Insurance for Social Security

Federal Security Agency proposes enactment of health insurance for Social Security beneficiaries.
1953
March 12

Department of Health Education and Welfare (DHEW)

Federal Security Agency made a cabinet level agency, renamed Department of Health Education and Welfare (DHEW).
1954
January 6

Revenue Act of 1954

Landmark Decision
Revenue Act of 1954 excludes employers' contributions to employee's health plans from taxable income.
January 18

Federal Reinsurance Fund to enable Private Insurers

President Eisenhower proposes a federal reinsurance fund to enable private insurers to broaden the groups of people they would cover
1956
February 15

Military “medicare” program

Landmark Decision
Military "medicare" program enacted, providing government health insurance for dependents of those in the Armed Forces.
June 7

The Forand Bill

Legislation introduced in the House (the Forand bill) to provide health insurance for social security beneficiaries; reintroduced again in 1959.
1957
June 12

AFL-CIO decides to support government health insurance

Landmark Decision
AFL-CIO decides to support government health insurance, while the AMA reiterates opposition to national health insurance.
July 12

National Health Interview Survey

First year that the National Health Interview Survey was conducted; survey has been continuously fielded ever since.
1960
June 12

1960 – 1964 : The Great Society – Medicare and Medicaid

The groundwork for the enactment of Medicare and Medicaid began in the late 1950s and early 1960s. As employer-based health coverage grew, private plans began to set premiums based on their experience with health costs and the retired and disabled found it harder to get affordable coverage. Health reformers refocused their efforts toward the elderly.
June 12

Federal Employees Health Benefit Plan (FEHBP)

Federal Employees Health Benefit Plan (FEHBP) initiated to provide health insurance coverage to federal workers.
September 13

Kerr-Mills Act

Landmark Decision
Kerr-Mills Act passes, using federal funds to support state programs providing medical care to the poor and elderly; a precursor to the Medicaid program.
1961
January 12

White House Conference on Aging

White House Conference on Aging is held in Washington, D.C. Presidential task force recommends health insurance for the elderly under Social Security and President Kennedy sends the special message to Congress on health. Rep. King and Sen. Anderson introduce a bill to create a government health insurance program for the aged; King-Anderson bill draws support from organized labor, intense opposition from the AMA and commercial health insurance carriers.
1962
July 4

President Kennedy addresses the nation on Medicare

President Kennedy addresses the nation on Medicare that is televised from Madison Square Garden. AMA issues televised rebuttal.
1963
November 9

King-Anderson bill re-introduced

Kennedy sends a special message to Congress on needs of the elderly. King-Anderson bill re-introduced.
1964
July 2

Civil Rights Act

Civil Rights Act passes.
July 12

President Johnson advocates for Medicare

President Johnson advocates for Medicare in a special message to Congress.
1965
July 12

1965 – 1969 : The Great Society – Medicare and Medicaid

Medicare and Medicaid were incorporated under the Social Security Act and signed by President Johnson in 1965 with Truman by his side. The combination of Johnson’s political skills, a large Congressional Democratic majority, public approval, the support of the hospital and insurance industries, and the fact that no government cost controls or physician fee schedules were enacted contributed to the passage of the most significant health reform of the century.
July 12

Neighborhood Health Centers

Neighborhood health centers (precursors to Federally Qualified Health Centers or FQHCs) are established as part of the Office on Economic Opportunity to provide health and social services to poor and medically underserved communities.
July 30

The Medicare and Medicaid programs are signed

Landmark Decision
The Medicare and Medicaid programs are signed into law. Medicare Part A is to pay for hospital care and limited skilled nursing and home health care. Optional Medicare Part B is to help pay for physician care. Medicaid is a separate program to assist states in covering not only long-term care for the poor but also to provide health insurance coverage for certain classes of the poor and disabled.
1967
January 23

Social Security Amendments Pass

Social Security amendments pass, adding optional Medicaid categories to insure others who are not receiving cash assistance. Early and Periodic Screening and Diagnostic Testing (EPSDT) benefits are also added to Medicaid.
1970
November 12

1970 – 1974 : Competing National Health Insurance Proposals

General inflation and unchecked health care costs were a growing concern by the early 1970s. Sen. Kennedy’s proposal for national health insurance was countered by President Nixon’s own Comprehensive Health Insurance Plan (CHIP). Other Congressmen wrote more incremental plans, all of which splintered support for any one reform. Action on national health insurance was eventually overshadowed by the Watergate hearings and Nixon’s resignation. While President Ford supported national reform in 1974 and Rep. Mills drafted yet another compromise bill, its progress stalled without Mills' leadership following a personal scandal
1971
August 15

Wage and Price Freezes Begin

Wage and price freezes begin, with medical care singled out for specific limits on annual increases in physician and hospital charges. Medical care limits are not lifted until 1974, over a year after other controls had ended.
1972
July 1

Social Security Amendments

Social Security amendments pass allowing people under age 65 with long-term disabilities and end-stage renal disease (ESRD) to qualify for Medicare coverage. Those with long-term disabilities must wait for two years before qualifying for Medicare.
September 2

Employee Retirement Income Security Act (ERISA)

Employee Retirement Income Security Act (ERISA) exempts self-insured employers from state health insurance regulations. Hawaii's new employer mandate is given an exemption from ERISA.
October 30

Supplemental Security Income (SSI)

Supplemental Security Income (SSI) program begins providing cash assistance to elderly and disabled. States are required to cover SSI recipients or apply their 1972 Medicaid eligibility standards for the two groups for coverage under Medicaid.
1974
February 8

Enactment of Health Planning Resources Development Act

Enactment of Health Planning Resources Development Act, mandating states to develop health planning programs to prevent duplication of services. Results in the widespread adoption of Certificate of Need programs.
June 12

Hawaii Prepaid Health Care Act

Hawaii Prepaid Health Care Act passes requiring employers to cover any employee working more than 20 hours/week. In 1989 Hawaii added their State Health Insurance Program to cover "the gap group": those not eligible for Medicaid or employer-based insurance.
1975
June 12

1975 – 1979 : Cost-Containment Trumps National Health Insurance

In the face of stagflation and rapidly rising health care costs, President Carter prioritizes health care cost containment over expanding coverage. Sen. Kennedy, however, drafts another national health insurance proposal, which is then followed by Carter's own plan that would delay implementation until 1983. National health reform efforts were completely stalled in the face of an economic recession and uncontrollable health care costs.
1977
March 8

Health Care Financing Administration (HCFA)

Health Care Financing Administration (HCFA) established within Department of Health, Education, and Welfare (HEW).
June 12

President Carter proposes Medicaid expansion

President Carter proposes Medicaid expansion (Children's Health Assessment Program) for poor children under age 6; proposal fails to come to a vote in Congress.
June 12

National Medical Care Expenditure Surveys (NMCES)

National Medical Care Expenditure Surveys (NMCES) conducted surveying households, their physicians, and health insurers – provides first detailed data on individuals' health care costs.
1980
May 4

Department of Health and Human Services (DHHS)

Department of Health, Education, and Welfare renamed the Department of Health and Human Services (DHHS).
1981
June 26

Federal budget reconciliation

Federal budget reconciliation (OBRA 81) requires states to make additional Medicaid payments to hospitals who serve a disproportionate share of Medicaid and low-income patients. It also repeals the requirement that state Medicaid programs pay hospital rates equivalent to those paid by the Medicare program. Requires states to pay nursing homes at rates that are "reasonable and adequate" under the Boren Amendment (applied to hospitals the following year).
August 13

Omnibus Budget Reconciliation Act

Two types of Medicaid waivers are established under a budget reconciliation act (OBRA 81) allowing states to mandate managed care enrollment of certain Medicaid groups and to cover home and community-based long-term care for those at risk of being institutionalized.
1982
June 12

States allowed to expand Medicaid to children with disabilities

States allowed to expand Medicaid to children with disabilities who require institutional care but can be cared for at home and would not otherwise qualify for Medicaid if not institutionalized; popularly referred to as the Katie Beckett option for the disabled child who garnered national attention on the issue.
1983
April 10

Medicare introduces Diagnostic Related Groups (DRGs)

Medicare introduces Diagnostic Related Groups (DRGs) as a prospective payment system for hospital payment.
1986
April 7

COBRA (Consolidated Omnibus Budget Reconciliation Act)

COBRA (Consolidated Omnibus Budget Reconciliation Act) contains specific regulations that allow employees who lose their jobs to continue with their health plan for 18 months.
October 21

Federal budget reconciliation 1986

Federal budget reconciliation (OBRA 86) gives states Medicaid option to cover infants, young children, and pregnant women up to 100% of the poverty level regardless of whether they receive public assistance. Raised to 185% of the poverty level in legislation for infants and pregnant women the following year. OBRA 86 also allowed state Medicaid programs to pay Medicare premiums and cost sharing for qualified Medicare beneficiaries under 100% of poverty (QMBs). (This was later required in 1989 and increased to certain Medicaid beneficiaries at 120% of poverty in 1990).
October 22

Emergency Medical Treatment and Active Labor Act (EMTALA)

Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals participating in Medicare to screen and stabilize all persons who use their emergency rooms regardless of ability to pay.
1987
June 12

Census Bureau begins annual estimate of health insurance coverage

Census Bureau begins annual estimate of health insurance coverage in the United States with its Current Population Survey finds 31 million uninsureds (13% of the population) in 1987.
June 12

National Medical Expenditure Survey (NMES)

National Medical Expenditure Survey (NMES), built on the NMCES 1977, is conducted with household information supplemented by surveys of medical and health insurance providers used by respondents.
1988
July 1

Medicare Catastrophic Coverage Act (MCCA)

Medicare Catastrophic Coverage Act (MCCA) expands Medicare coverage to include prescription drugs and a cap on beneficiaries' out-of-pocket expenses. However, many believed the costs that were to be born by the elderly outweighed the benefits. Responding to the groundswell of negative reaction, the MCCA is repealed the following year, retracting these major provisions. However, the requirement that states pay Medicare premiums and cost-sharing amounts for poor beneficiaries through Medicaid are maintained.
October 13

The Family Support Act

The Family Support Act requires states to extend 12 months of transitional Medicaid coverage to families leaving welfare due to earnings from work.
1989
December 19

Federal budget reconciliation (OBRA 89) 1989

Federal budget reconciliation (OBRA 89) mandates coverage for pregnant women and children under age 6, at 133% of the federal poverty level.
1990
June 12

1990 – 1994 : The Health Security Act

Making national health reform a priority early in his Presidency, Clinton proposed a "managed competition" approach, sending a detailed plan to Congress in 1993. It called for universal coverage, employer and individual mandates, competition between insurers, with government regulation to control costs. Support from key stakeholders was often limited and conditional. The opposition was led largely by two groups: the Health Insurance Association of America and the National Federation of Independent Businesses, both believing reform would create hardship for their smaller members. Congressional Democrats were divided in their support, and further splintered by a variety of alternative proposals that were then generated all of which blocked progress on the President's plan
June 12

National Committee on Quality Assurance (NCQA)

National Committee on Quality Assurance (NCQA) forms to accredit managed care health plans.
November 5

Federal budget reconciliation (OBRA 90) 1990

Federal budget reconciliation (OBRA 90) legislation mandates Medicaid coverage of children age 6-18 under the poverty level, phased in one year at a time until 2002.
1993
January 10

President Clinton convenes White House Task Force on Health Reform

Within his first week in office, President Clinton convenes White House Task Force on Health Reform and appoints First Lady Hillary Clinton as chair
March 10

Health Insurance Association of America

Health Insurance Association of America begins airing "Harry and Louise" television advertisements portraying a middle-class couple worried about health care under the Clinton health plan.
March 12

The Clinton Administration begins approving Medicaid waivers

The Clinton Administration begins approving Medicaid waivers allowing more statewide expansion demonstrations. Many states turned to managed care for delivery of services and used savings to expand to previously uninsured groups.
August 10

The Vaccines for Children program

The Vaccines for Children program providing federally purchased vaccines to states is established.
September 10

Health Security Act

Landmark Decision
President Clinton's proposal, named the Health Security Act, is introduced in both houses of Congress in November but gains little support. Every American would have a "Health Security Card" to ensure access to care.
September 10

Other national health reform proposals are introduced in Congress

Other national health reform proposals are introduced in Congress, but also fail to garner sufficient support for passage -- the McDermott/Wellstone single payer health insurance proposal and Cooper's proposal for managed competition without a guarantee of universal coverage. By mid-1994 even a bipartisan bill to expand coverage without comprehensive reform is unable to pass.
1996
June 12

Medical Expenditure Panel Survey (MEPS)

Medical Expenditure Panel Survey (MEPS) is conducted. Unlike its survey predecessors, the 1977 NMCES and 1987 NMES, MEPS is designed to be ongoing, providing annual updates on health insurance coverage, access to care, utilization of health services and their costs.
August 21

Health Insurance Portability and Accountability Act (HIPAA)

Health Insurance Portability and Accountability Act (HIPAA) restricts the use of pre-existing conditions in health insurance coverage determinations, sets standards for medical records privacy, and establishes tax-favored treatment of long-term care insurance.
August 22

Personal Responsibility and Work Opportunity Act

Personal Responsibility and Work Opportunity Act delinks Medicaid and cash assistance eligibility and allows states to cover parents and children at current Aid to Families with Dependent Children (AFDC) levels and higher. Bans Medicaid coverage of legal immigrants within their first five years in the country, except for emergency care.
September 26

Mental Health Parity Act

Mental Health Parity Act enacted that prohibits group health plans from having lower annual or lifetime dollar limits for mental health benefits than medical or surgical benefits (except substance abuse and chemical dependency).
1997
August 5

Balanced Budget Act

Census Bureau's Current Population Survey estimates 42.4 million (15.7% of the population) uninsured in the United States. Balanced Budget Act includes many changes in provider payments to slow the growth in Medicare spending. It establishes the Medicare + Choice program, a new structure for Medicare HMOs and other private plans offered to beneficiaries, later renamed Medicare Advantage in 2003.
August 5

Balanced Budget Act (BBA), the State Children’s Health Insurance Program is enacted

Also part of the Balanced Budget Act (BBA), the State Children's Health Insurance Program (S-CHIP) is enacted. Provides block grants to states allowing for coverage of low-income children above Medicaid eligibility levels. BBA also allows states to cover working disabled with incomes up to 250% of poverty, permits mandatory Medicaid enrollment in managed care and repeals the Boren amendment.
1999
December 3

Ticket to Work and Work Incentives Improvement Act

Ticket to Work and Work Incentives Improvement Act of 1999 allows states to cover working disabled with incomes above 250% of poverty and impose income-related premiums.
2000
October 4

Breast and Cervical Cancer Treatment and Prevention Act

Breast and Cervical Cancer Treatment and Prevention Act of 2000 allows states to provide Medicaid coverage to uninsured women for treatment of breast or cervical cancer if they have been diagnosed through a CDC screening program, regardless of income or resources.
2002
December 12

President Bush launches Health Center Growth Initiative

President Bush launches Health Center Growth Initiative significantly expanding the number of community health centers serving the medically underserved.
2003
June 15

Maine passes the Dirigo Health Reform Act

Maine passes the Dirigo Health Reform Act, a comprehensive health care reform plan, that creates the DirigoChoice health plan, providing subsidized coverage to individuals and small employers, expands Medicaid, and creates the Maine Quality Forum.
August 20

Medicare Drug, Improvement, and Modernization Act

Medicare Drug, Improvement, and Modernization Act (MMA) passes, creating a voluntary, subsidized prescription drug benefit under Medicare, administered exclusively through private plans, both stand-alone prescription drug plans and Medicare Advantage plans.
December 23

Medicare legislation creates Health Savings Accounts

Medicare legislation creates Health Savings Accounts which allow individuals to set aside pre-tax dollars to pay for current and future medical expenses. The plans must be used in conjunction with a high-deductible health plan.
2005
September 30

Deficit Reduction Act

Deficit Reduction Act of 2005 makes significant changes to Medicaid related to premiums and cost-sharing, benefits, and asset transfers.
2006
April 10

Medicare Part D Drug

Landmark Decision
Medicare Part D Drug benefit goes into effect in January.
June 12

Massachusetts passes and implements legislation to provide health care coverage

Landmark Decision
Massachusetts passes and implements legislation to provide health care coverage to nearly all state residents. The legislation requires residents to obtain health insurance coverage and calls for shared responsibility among individuals, employers, and the government in financing the expanded coverage. Within two years of implementation, the state's uninsured rate is cut in half.
June 20

Vermont passes comprehensive health care reform

One month following Massachusetts, Vermont passes comprehensive health care reform also aiming for near-universal coverage. In addition to creating the Catamount Health Plan for uninsured residents, the plan focuses on improving the overall quality of care and the management of chronic conditions through the Blueprint for Health.
August 15

City of San Francisco creates the Healthy San Francisco program

City of San Francisco creates the Healthy San Francisco program, providing universal access to health services in the city for residents. A controversial provision requiring city employers to spend a minimum amount per hour on healthcare for their employees is challenged in court. In September 2008, the U.S. Ninth Circuit Court of Appeals upholds the employer requirement saying it does not violate the Employee Retirement and Income Security Act of 1974 (ERISA).
2007
January 18

Healthy Americans Act

Senators Wyden and Bennett introduce the Healthy Americans Act. The proposal would require individuals to obtain private health insurance coverage through state health insurance purchasing pools. The long-standing favorable tax treatment of employer-sponsored insurance premiums would be eliminated. Legislation gains some bipartisan support.
June 28

California fails in its attempt to pass a health reform

Landmark Decision
California fails in its attempt to pass a health reform plan with an individual mandate and shared responsibility for financing the costs. Compromise legislation supported by the Governor passes the Assembly but falls short in the Senate.
October 1

Congress passes two versions of a bill

Congress passes two versions of a bill to reauthorize the State Children’s Health Insurance Program with bi-partisan support, but President Bush vetoes both bills and Congress cannot override the veto. A temporary extension of the program is passed in December 2007.
December 10

Census Bureau estimates 45.6 million uninsured (15.3% of the population) in 2007

Census Bureau estimates 45.6 million uninsureds (15.3% of the population) in 2007. Survey instrument undergoes periodic design improvements over the years that confound trend analyses, yet remains the most widely used estimate of health insurance coverage. President Bush announces health reform plan that would replace the current tax preference for employer-sponsored insurance with a standard health care deduction. The proposal is not acted upon by Congress.
2008
June 12

Mental Health Parity Act

Mental Health Parity Act amended to require full parity. Insurance companies must treat mental health conditions, including substance abuse disorders, on an equal basis with physical conditions when health policies cover both.
November 6

Presidential campaign focuses early on national health reform

The presidential campaign focuses early on national health reform, overshadowed later by housing crisis and economic downturn, yet remains a key pocketbook issue throughout the campaign. Both major party candidates announce comprehensive health reform proposals.
2009
February 4

The Children’s Health Insurance Program (CHIP)

The Children's Health Insurance Program (CHIP) is reauthorized, providing states with additional funding, new tools land fiscal incentives to help reach and estimated 4.1 million children through Medicaid and CHIP who otherwise would have been uninsured by 2013.
February 17

The American Reinvestment and Recovery Act (ARRA)

The American Reinvestment and Recovery Act (ARRA) makes substantial investments to help develop health information technology, expand the primary care workforce and conduct research on comparative effectiveness for health care treatment options.
March 5

Health Reform Summit

White House holds a Health Reform Summit with key stakeholders.
April 8

President Obama establishes Office of Health Reform

President Obama establishes Office of Health Reform to coordinate administrative efforts on national health reform.
May 7

President Obama releases FY 2010 budget

President Obama releases FY 2010 budget which outlines eight principles for health reform and proposes a set aside of 634 billion in a health reform reserve fund.
August 11

Deliberate National Health Reform

Congress continues to deliberate national health reform options.
2010
February 22

Obama’s proposal for health care reform

The White House releases President Obama's proposal for health care reform that bridges elements of the House and Senate bills passed in the last months of 2009.
February 25

Second Health Care Summit

President Obama hosts a second Health Care Summit at Blair House. Little consensus achieved between the Democrats and Republicans
March 3

President Obama lays out his proposal

In a White House speech President Obama lays out his proposal and provides legislative direction indicating that if need be, the reconciliation process (requiring a Senate majority vote vs. 60 votes to pass) should be used to pass major health reform legislation.
March 21

The House of Representatives passes the Senate bill

The House of Representatives passes the Senate bill, the Patient Protection and Affordable Care Act (voting 219-212) and sends it to the President for signature. House also passes the Health Care and Education Reconciliation Act of 2010 that amends the Senate bill to reflect House and Senate negotiations and also includes reform of the nation's student loan system. The reconciliation bill is sent to the Senate for a final vote.
March 23

Patient Protection and Affordable Care Act

Landmark Decision
President Obama signs the landmark legislation, the Patient Protection and Affordable Care Act (P.L. 111-148) at the White House, surrounded by legislative leaders and invited guests, including some who have suffered from the lack of health coverage. The historic health reform legislation requires that all individuals have health insurance beginning in 2014.
  • The poorest will be covered under a Medicaid expansion.
  • Those with low and middle incomes who do not have access to affordable coverage through their jobs will be able to purchase coverage with federal subsidies through new "American Health Benefit Exchanges."
  • Employers are not mandated to provide health benefits, however large businesses whose employees receive insurance subsidies will pay penalties. Small businesses will be able to access more plans through a separate Exchange.
  • Health plans will not be allowed to deny coverage to people for any reason, including their health status, nor can they charge more because of a person's health or gender. Young adults will now have the option of being covered under their parents' plan up to age 26.
 
March 25

Health Care and Education Reconciliation Act of 2010

Senate passes final version of the Health Care and Education Reconciliation Act of 2010 with two education-related changes to the House bill (voting 56-43). House votes on the bill as amended by the Senate (voting 220-207).
March 30

Health Care and Education Reconciliation Act of 2010

President Obama signs the Health Care and Education Reconciliation Act of 2010 (becoming P.L. 111-152) at the Northern Virginia Community College amending P.L. 111-148.