The History of Health Reform and Politics

1986-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.

Carter

* National health reform efforts are completely stalled in the face of an economic recession and uncontrollable health care costs - President Carter prioritizes health care cost containment over expanding coverage

1950's

* President Dwight D Eisenhower takes office in 1953 - Had opposed government health insurance during his campaign * The AMA's war chest helps to defeat over 80%of pro-health insurance legislators in elections. * Minimal advances toward health insurance in the 1950's so private insurance steadily grows... - One exception: Military "medicate" program enacted, providing government health insurance for dependents of those in the Armed Forces.

1980,s Reagan Administration

* Reagan administration arrive in Washington with an agenda that include reducing federal regulatory intervention and cutting social programs - The Medicaid program experienced major cuts - Medicare survived in a large part because of the powerful political mobilization of senior citizens. * 1986-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. - Medicare Catastrophic Coverage Act (MCCA)-to protect seniors from bankruptcy from medical costs.

The "Three Layer Cake"

* Kerr-Mills bill gets combined with Johnson administration bill to create a "three layer cake" - State-based health insurance for the poor - Federal hospital coverage for the elderly - Federal physician coverage for the elderly * Which health insurance programs do these sound like? Medicare and Medicaid

National Health Insurance and the New Deal

* 1934-FDR creates the committee on Economic Security to address elderly and unemployment issues, as well as medical care and insurance. - Committee on Economic Security issues final recommendations, none of which explicitly address national health insurance; however principals of health reform are outlined. * They consider adding health insurance to the Social Security act but The is opposed by the AMA

National Health Insurance and the New Deal

* 1939-Senator Wagner introduces a National Health Bill incorporating recommendations from a recent (1937) National Health Conference - Would create federal funding for states to expand public health, maternal and child health services, medical care for low income, short-term disability insurance, hospital construction, and prepaid medical insurance. - The bill would enable states to uses funding towards universal or mandatory Health insurance programs if they chose to * But once again the opposition from the AMA

1970's

* 1971-Senator Edward M Kennedy holds hearings around the country before issuing a report, "The Health Care Crisis in America" - He presents a plan for universal, single payer system run through the government and financed through payroll taxes * 1974- President Nixon counters with a proposal calling for universal coverage and voluntary employer participation. - The AMA, insurers, and others sponsee their own competing legislative proposals. -Support splinters among various plans and they fail.

The Baylor Plan

* A group of Dallas teachers create a contract with Baylor University Hospital - They would receive up to 21 days of hospitalization at fixed price of $6 - contract ensured teachers has access to hospital care and that the hospital would be paid - Considered the forerunner for Blue Cross plans

1960's

* By the early 1960's, three quarters of Americans have some form of health insurance. - However, this covers only 27% of their medical bills - Because health insurance is so closely tied to full-time employment, retirees, the self employed, the unemployed, and the underemployed are largely left out.

1990's Clinton And The Health Security Act

* Clinton makes national health reform a priority early in his Presidency - Within his first week in office President Clinton convenes WhiteHouse Task Force in Health Reform, and appoints First Lady Hillary Clinton as chair *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.

1910-1920's

* First Health Insurance Bill * Sheppard Towner Act * Baylor Plan

Kerr-Mills Proposal

* In 1960, Mills works with Senator Robert Kerr to stifle a drive toward Medicare by passing a limited program that provides health insurance to only poor elderly citizens -The guidelines for participowerecso stringent that only one percent of elderly received benefits - Senator John F Kennedy calls this inadequate and makes Medicare a major part of his campaign for presidency...

Opposition to the Sheppard-Towner Act

* In Jan 1927, a group of senators initiate a filibuster on the act, with one Senator arguing the the bill was championed by - "...neurotic women, ...social workers who obtained pathological satisfaction in interfering with the affairs of other people'...and Bolsheviks who did not care for the family and its perpetuity ( Bolsheviks became the community party in Russia) * Politicians allow it to expire in 1928 despite it substantially decreasing infant mortality rates in the US ( roughly a net decrease of 19 deaths per 1000 live births)

King-Anderson Bill

* Kennedy administration supports a new bill, the King-Anderson Bill, soon after his election... - Under this bill, some hospital and nursing home costs for patients 65 and older would have been covered - Resistance to the King-Anderson bill comes from providers, the insurance secto, other business interests, conservative national political organizations, and certain members of Congress ( including Wilbur Mills) -Although this bill is defeated in committee, the vote is narrow ( 12-11), signaling a shift in attitudes - A slightly revised King-Anderson bill is reintroduced. - A compromise is reached after much debate, but before it could go anywhere...

1960's

* Kerr-Mills Proposal * King Anderson Bill * The "three layer cake"

The "Three Layer Cake"

* The AMA knee it had that it had been beaten ( Once it lost Mills, it lost Congress) * The House passes the final bill * In the Senate, liberals try to add amendments (which would increase the cost of the legislation) - However, in the conference Committee, Mills blocks each amendment. - Mills makes only one major compromise, that hospitals and doctors would determine "reasonable charges" for costs rather than the government doing so through regulated prices. -He assumes that this would not result in huge costs...

Opposition to the National Health Bill

* The AMA strongly opposes the bill during public hearings - AMA establishes "National Physicians Committee for the Extension of Medical Service" to fight Wagner bill - The proposal dies in the committee * Plans are laid to report out an amended bill in the next session, but the outbreak of WW2 brings about a change of concerns for congress.

Opposition to the Sheppard-Towner Act

* The National Society of the Daughters of the American Revolution ( which had supported the act of 1921) accuse the Sheppard Towner bill of being a communist plot. * The AMA sees the act as a socialist threat to its professional autonomy and increase their lobbying efforts. - The Pediatric Section of the AMA actually endorses the endorsement of the acts renewal and this actually causes them to split off to form the American Academy of Pediatrics.

1921-Sheppard-Towner Act

* The Sheppard-Towner Act established federal subsidies for state run child and maternal health programs - Leads to the creation of 3,000 child and maternal health care centers, many of the in rural areas. - Addresses the need for medicalization of pregnancy and childbirth and high infant mortality rates. * However, when it is time to renew the act, it faces opposition from multiple groups.

1993-1994 Health Security Act

* The opposition was led largely by two groups: the Health Insurance Association If America and the National Federation of Independent Businesses, both believing reform would create hardship for their smaller members - Health Insurance Association If America begins airing "Harry and Louise" television ads * Congressional Democrats we're divided in their support and further splintered by a variety of alternative proposals

1940's

* Truman and the Fair Deal * Wagner, Murray, Dingell Bill

Truman and the Fair Deal (1945-1953)

* Truman campaigned in 1948 on national health insurance * After elected, Truman's health care message to Congress had 5 key health reforms: 1) Hospital construction 2) Expanded maternal and child health 3) Program for medical education and research 4) National Health Insurance ( prepayment of medical expenses) 5) Disability insurance to protect from sickness and injury

Wagner-Murray-Dingell Bill

* WW2 significantly altered the politics of healthcare. As with most counties during the war, the US government dramatically expanded its involvement in medical care - This Bill was the first to propose a nationally administered health plan, including compulsory medical insurance for all employed workers and their dependents. - It fails to survive committee hearings... -Truman was consideredan "accident of history -AMA has launched a national campaign against national health insurance

The Baylor Plan

1929- First Private Health Insurance Program in The US

July 30 1965

Medicare and Medicaid signed into law as Social Security amendments ( Lyndon Johnson)

1930's

National Health Insurance and New Deal

1915-First Health Insurance Bill

The American Association for Labor Legislation(AALL) published a draft bill for government health insurance to be enacted at the state level and promote campaigns in several states. *Bill calls for protection of low income workers and broad hospital and medical benefits to both workers and their dependents * By 1916, 12 states show interest and had sponsors for the bills * Important Groups including the AMA agree to study it and seem supportive * However it fails to pass in important states including NY and CA. * Then the AMA reverses course and declares that it is opposed to this coverage. - Until the Affordable Care Act, the AMA will be one of the leading opponents to universal health coverage * The bill doesn't pass in a single state and the idea is generally forgotten as the US enters WW1...

Medicare Catastrophic Coverage Act (MCCA)

to protect seniors from bankruptcy from medical costs.