A Historical Perspective on Health Care Reform

Taylor, JerryBy Jerry W. Taylor

While Obamacare has landed itself on the list of most controversial laws in our nation’s history, the concept of health care reform is certainly not new. In fact, the road to health care reform in America is well-traveled: every American president since the end of World War II has, to some extent, proposed or supported changes to the health care and health care payment systems.

This article provides a brief overview of history’s most recent attempts to overhaul the American health care system.

The Kennedy Administration (1961 to 1963)

The Kennedy administration proposed the foundation of what would ultimately become Medicare. Under the King-Anderson bill, coverage would be limited to those 65 years of age and older, and be part of the Social Security benefits package. Opposed by the powerful American Medical Association, the bill was defeated in a congressional committee.

The Johnson Administration (1963 to 1969)

When Johnson won a landslide victory as president in November 1964, the concurrent Senate and House of Representatives elections gave Democrats a super-majority in both houses, and Johnson a receptive body for the extensive social reforms he dubbed the “Great Society.”

Despite vocal opposition from the American Medical Association and some conservative Republicans, the Medicare and Medicaid Act of 1965 steamrolled through Congress, and was signed into law on July 30, 1965.

The Nixon Administration (1969 to 1974)

In 1971, the Nixon administration proposed the National Health Insurance Standard Act (NHISA), which included some provisions similar to the ACA in today’s legislation. Nixon called for government-prescribed, employer-mandated, minimal levels of insurance coverage, financed by employers and employees. The goal was to maintain competition between private insurers and expand coverage, as well as provide government subsidies for premiums for certain employees. It did not gain congressional approval.

The Carter Administration (1977 to 1981)

Carter called for national health care insurance with universal coverage.

His proposal gained little congressional or public support, and ultimately, did not advance far, perhaps because Sen. Edward M. Kennedy, who planned to run against Carter for the Democratic presidential bid, stood in the way.

The Reagan Administration (1981 to 1989)

Reagan entered office on a platform of combating excessive government borrowing and deficit spending. As a result, there were no proposals for new government-run or administered health care programs. But, the Reagan Administration did advance through Congress the first major expansion of Medicare benefits: the Medicare Catastrophic Coverage Act of 1988 (MCCA). The law expanded Medicare coverage for outpatient drugs, put a ceiling on out of pocket co-pays for hospital and physician services, and modestly expanded payments for long-term care.

The George H.W. Bush Administration (1989 to 1993)

Bush inherited a political minefield in the MCCA. Among the elderly, there was widespread disappointment over expanded benefits and higher premiums on taxes. These sentiments led to a senior revolt against the law, and in 1989 – just 17 months after it was enacted – a bipartisan effort in Congress repealed most of the MCCA.

The Clinton Administration (1993 to 2001)

Clinton wasted little time in proposing the American Health Security Act of 1993 (AHSA), calling for affordable health insurance for all through a concept called “managed competition.” Coverage would be provided through private insurers competing for customers in a highly-regulated market, overseen and coordinated by regional health alliances to be established in each state. All health plans would provide a minimum level of benefits, and employers would provide insurance coverage and pay 80 percent of the premium. The AHSA was subjected to bitter partisanship in Congress, and died in the Senate.

The George W. Bush Administration (2001 to 2009)

Consumed with the aftermath of 9/11, it is understandable that health care reform was not at the top of Bush’s agenda. His domestic legacy does, however, include one of the largest expansions of Medicare in the program’s history. The Medicare Drug Improvement and Modernization Act of 2003 (MMA) made numerous changes to the program, including the prescription drug coverage benefit, created as Medicare Part D.

Conclusion

The ACA is, partially, a conglomeration of past proposals for major health care reform. The provision of health insurance coverage through private insurers instead of directly through the government, employer-mandated health insurance, the creation of state, regional or national clearinghouses for insurance, federal subsidies for low-income individuals, and “guaranteed eligibility” have all been proposed in previous attempts at reform.

Partisan divisiveness, congressional fights, grass roots campaigns and political intrigue have played an active role in health care reform efforts.

Ultimately, the democratic process has worked. Legislation deemed not in the public interest has been defeated in Congress, and enacted legislation that proved to be unpopular, or unworkable, has been repealed.

When the final chapter on the efficacy of the ACA is written, it is hoped that history will record that the American system worked yet again – the good, the bad and the ugly.

Jerry W. Taylor is a partner in the Health Care Practice Group at Burr & Forman LLP (Nashville, Tenn.). He counsels health care providers in the areas of regulatory compliance and administrative law. He may be reached at (615) 724-3247 or by email at jtaylor@burr.com.

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