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History Of The Health Care Reform Debate

Christian Worstell

by Christian Worstell | Published October 17, 2023 | Reviewed by John Krahnert

The campaign for universal health care coverage in the U.S. has been a long one. Here is an outline of the evolution of these efforts over the past century.

1906: The AALL leads the campaign for health insurance

  • Feb. 15: A group of “social progressives” founds The American Association for Labor Legislation (AALL) — a small, private organization focused on advocating for fair labor laws, whose mandate is to reform capitalism (and thereby, health care) rather than abolish it.

1912: Roosevelt’s Progressive Party becomes the first major American party to lobby for health care reform.

  • The Progressives split from the Republican Party and nominate former President Theodore Roosevelt as their candidate.
  • August 7: Theodore (Teddy) Roosevelt endorses a socialized insurance system in his election campaign platform. Roosevelt is defeated in the election by Woodrow Wilson, and because his conservative successors have no interest in involving the federal government in the management of social welfare, support for social insurance dies with his campaign.  
  • The AALL forms a Social Insurance Committee within the organization.

→ As a result, during the late 1800’s to 1912, the U.S. government takes no actions to subsidize voluntary funds for the sick or to make health insurance compulsory; it leaves these matters to the states, and states leave them to private and voluntary programs.


  • June: The AALL organizes and holds its first national conference on the subject of social insurance. 


  • The AALL spearheads a movement to enact social insurance programs on a state-by-state basis, launching its first major legislative campaign on behalf of state workmen’s compensation laws.


  • By 1915, the AALL’s first legislation has passed in 30 states. Riding the coattails of their success, the Social Insurance Committee decides to concentrate on health insurance and drafts a model bill for compulsory health insurance. They present their proposal for government health insurance to state legislatures, and it becomes known as the AALL proposal.

    • The bill aims to protect low-income workers (and their dependents) against both wage loss and medical costs, limiting participation to the working class and those making less than $1,200 a year. 
    • Stipulations of the AALL Proposal
      • Coverage of medical expenses, including all physicians’, nurses’ and hospital services
      • Sick pay for income lost due to illness
      • A death benefit of $50 to assist with funeral expenses
      • Complete coverage of labor and delivery costs, with an eight-week maternity benefit for insured women and the wives of insured men
    • Costs of the plan are to be divided among employers, workers and the state.

1917: US enters WWI, and anti-German fever buries compulsory health insurance debate

  • The AALL spends the next few years lobbying, and by 1917, they win the support of some major private interest groups, including the American Medical Association (AMA), the National Association of Manufacturers and the American Hospital Association. Sponsors are found to introduce the AALL proposal program in 12 state legislatures.


  • The American Federation of Labor (AFL) helps to build heavy opposition to the AALL proposal for fear that the AALL program would weaken unions by undermining their role in providing social benefits. The commercial life insurance industry also offers resistance because of their amount of business that relies on being the only ones to offer covered funeral expenses.
  • The AMA reverses their position on government health insurance plans, and any momentum that the AALL previously gained comes to a halt.
  • The bill gets buried by a united force of opposition and conservative legislators associating it with Bolshevism and other communist forms of government. The debate over compulsory health insurance ends.


  • Nov. 23: President Warren Harding signs into law the Sheppard-Towner Maternity and Infancy Act — legislation aimed at “reducing maternal and infant mortality.” It provides $1 million annually in federal aid to state programs such as:

    • Health clinics for women and children
    • Visiting nurses who educate and care for pregnant women, mothers and their children
    • Midwife training
    • Public distribution of nutrition and hygiene information


  • The Committee on the Costs of Medical Care (CCMC) — a group created and privately funded by organizations, including the Rockefeller, Millbank and Rosenwald foundations — forms to study the economic organization of medical care in terms of prevention and care of sickness.
  • Over the next 5 years, they publish 26 research volumes and 15 smaller reports and determine a need for more widespread medical care. The CCMC recommends more national resources go towards funding this care.

1929: The Great Depression begins.

  • October 27-29: The stock market crashes and The Great Depression ensues, creating an economic, political and social welfare crisis in the U.S. The Great Depression lasts until the outbreak of World War II.
  • Unemployment insurance takes priority over health care and health insurance.
  • Nov.: The Sheppard-Towner Act expires, and defunding occurs as a result of pressure from opposition groups, including the AMA.


  • Dec. 3: Dr. Morris Fishbein, in the Journal of American Medical Association, denounces the work of the CCMC, saying their report advocates “socialized medicine,” and calling it “an incitement to revolution,” and “communist.”
  • The AMA takes a position of opposition to any further government involvement in medical care and health insurance.
  • The CCMC ceases to meet.


  • March 4: President Franklin D. Roosevelt promises a “New Deal for the American people” in his inaugural speech and focuses all legislation at the beginning of his term on economic recovery and social welfare.
  • May 12: The President signs the Federal Emergency Relief Act into law. The Federal Emergency Relief Administration is created to authorize funding to states for unemployment relief, which is expanded to include medical care to recipients.


  • June 27: The Railroad Retirement Act of 1934 is approved by the president. The Act, to be administered by the Railroad Retirement Board, provides retirement and disability benefits to railroad workers and their survivors.
  • June 29: FDR forms the Committee on Economic Security to study problems related to economic security and make recommendations to address unemployment and retirement issues, as well as medical care and insurance.


  • The Social Security Bill is introduced, proposing the creation of "a system of Federal old-age benefits" for workers and their families and the restoration of many of the programs established under the Sheppard-Towner Act. Under the CES’s advisement, FDR excludes health insurance from the Social Security Act, for fear that it will threaten passage of the legislation.
  • April 19: On April 19, the bill is passed by the House of Representatives and is passed by the Senate on June 19. 
  • May: FDR terminates the Federal Emergency Relief Administration and creates the Works Progress Administration.
  • July 15: The first compulsory health insurance bill, called the “Epstein bill,” is introduced to Congress by Kansas Senator Arthur Capper.
  • Aug. 14: FDR signs the Social Security Act into law.
  • Aug. 15: The President establishes the Interdepartmental Committee to Coordinate Health and Welfare Activities in an effort to pursue a federal health care program. The committee’s primary purpose is to study existing health and welfare programs and to figure out better ways to coordinate them.


  • The election brings about a conservative resurgence that halts innovations in social policies.
  • The Interdepartmental Committee appoints a Technical Committee on Medical Care, which issues a report in February titled “The Need For a National Health Program.”


  • Jan. 14: Amendments to the Social Security Act are recommended.
  • Feb.: Senator Robert Wagner introduces The Wagner Bill, National Health Act of 1939. The bill gives general support for a compulsory national health program to be funded by federal grants and administered by states. Hearings are held, but the bill dies in committee and no further action is taken. Just as the AALL campaign ran into the declining forces of progressivism and then WWI, the movement for national health insurance runs into the declining fortunes of the New Deal and WWII.
  • The Social Security Act Amendments are passed by the House of Representatives on June 10, passed by the Senate on Aug. 5 and signed by the President on August 10. The program is broadened to include benefits for dependents and survivors.
  • The first statewide prepayment plans for physician’s services are established in California and Michigan.

1945: Truman becomes president.

→ National Health Insurance and the Fair Deal: President Truman endorses a national health program just months after the end of World War II.


  • Republicans take control of Congress.
  • May: The Taft-Smith-Ball bill is proposed.
  • July 3: President Harry Truman signs the National Mental Health Act


  • Truman calls for a National Health Program.


  • The Social Security Amendments law was amended to also provide disability benefits.


  • July 30: President Lyndon B. Johnson signs the Social Security Amendments of 1965, which create two public health insurance programs — Medicare and Medicaid — that are part of Johnson’s ambitious Great Society legislative agenda.

    • Medicare is a single-payer, fee-for-service health insurance program designed for those age 65 and older. Medicare is comprised of two components initially: Part A for hospital insurance and Part B for medical insurance.
    • Medicaid is jointly administered by the federal and state governments to provide health insurance to low income individuals and families.


  • Medicare is expanded to include individuals under the age of 65 who have been receiving Social Security disability benefits for 24 calendar months.
  • Individuals under the age of 65 with End-Stage Renal Disease are also included in the Medicare program.


  • Nov. 3: Arkansas Governor Bill Clinton is elected the 42nd President of the United States, defeating incumbent President George H.W. Bush. Clinton campaigns on health care reform and on providing universal coverage for Americans.


  • Sept. 22: President Clinton addresses a joint session of Congress about health care reform. First Lady Hillary Rodham Clinton is chosen to lead the task force to develop the legislation, which becomes known as the Health Security Act. Its opponents label it “Hillarycare.” It fails to get traction in Congress and is ultimately scrapped in September 1994.


  • Aug. 5: The Balanced Budget Act of 1997 includes a provision that creates Medicare Part C, also known as “Medicare+Choice,” which allows Medicare beneficiaries to receive their Medicare benefits from private health plans. The plans must offer the same benefits as Medicare Part A and Part B and may include additional benefits like vision and dental coverage. 


  • Medicare benefits are extended to individuals under the age of 65 diagnosed with Amyotropic Lateral Sclerosis (ALS or Lou Gehrig’s disease). Unlike other disabilities, the 24-month waiting period is waived for ALS patients.


  • Dec. 8: The Medicare Prescription Drug Improvement and Modernization Act is passed and signed into law by President George W. Bush. This legislation is the biggest reform to Medicare since it was created in 1965. The bill renames “Medicare+Choice” to “Medicare Advantage” and makes several changes to the private health plans. The bill also creates Medicare Part D, the program’s prescription drug benefit. Part D coverage becomes available to Medicare beneficiaries in 2006.


  • March 23: The Patient Protection and Affordable Care Act (also known as the ACA or Obamacare) is signed into law by President Barack Obama. It’s the first major health reform passed in the U.S. since Medicare and Medicaid in the 1960s. The legislation enacts sweeping reforms across the U.S. landscape, including:

    • Guaranteed issue rights: Insurance carriers are barred from denying coverage to individuals because they have a pre-existing medical condition. Children are allowed to stay on a parent’s health care plan until age 26.
    • Individual mandate: Individuals are required to have health insurance, either through an employer-based group plan, an individual plan or through a government program like Medicare or Medicaid. If they don’t have coverage, they are required to pay a tax penalty unless they have an exemption.
    • Insurance plan standardization: Insurance plans must cover “essential health benefits” as outlined by the law, cannot impose annual or lifetime coverage limits and must provide a number of preventive services at no cost to the beneficiary. Insurance plans must also be at one of four levels of actuarial value: Bronze, Silver, Gold or Platinum.
    • Creation of Exchanges: The law creates health insurance exchanges for both individuals and small businesses. States can create their own exchanges or the federal government can create one for them.


  • Nov. 8: Businessman Donald Trump defeats former Secretary of State Hillary Clinton in the 2016 presidential election. Trump makes the repeal of the Affordable Care Act a central tenant of his campaign. Republicans maintain majorities in both the House of Representatives and Senate, almost assuring major changes to President Obama’s signature health care law. 


  • March: Republicans in the House of Representatives introduce the American Health Care Act (AHCA), designed to repeal much of President Obama's ACA. After several weeks of debate — and in the face of bipartisan opposition — Republicans decide to pull the bill. This is seen as a setback for President Trump's young administration, but he promises to continue to work toward reform of Obamacare.


Recommended reading: 

7 Common Health Care Delivery Models Explained

Medicare Terminology Explained

Veterans and Medicare

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