Insurance Reform

Government involvement in health care reform dates back to the days just before World War I when President Theodore Roosevelt advocated the passage of social insurance programs during his unsuccessful run for another term in 1912. Based on his belief that a strong country required healthy people, he favored the passage of health insurance legislation. Roosevelt assumed this legislation would originate from the states, rather than the Federal government, and cover only the working classes.

Passage of Federal health insurance legislation did not occur until the term of President Franklin D. Roosevelt, a distant cousin of President Teddy Roosevelt. During the first of FDR's four terms as president, Congress passed the Social Security Act of 1935. This landmark legislation contained insurance for senior citizens, unemployment compensation, and maternal and child health, but not individual health insurance, which was considered too controversial.

National Health Insurance

After FDR's death in 1945, President Harry Truman became the first president to propose national health insurance legislation. Congress repeatedly refused to enact his appeals but in 1950, Truman signed the Social Security Amendments which provided federal funds to states for vendor payments for medical care of the aged and poor called Old-Age Assistance, which was to become the foundation for the current Medicaid program.

The debate over reform of national health insurance legislation has continued to this day. Every president since Truman has debated with Congress on if and how government should handle health insurance for Americans. President John F. Kennedy fought for the passage of the Medicare program but was assassinated before being successful. The program was enacted under President Lyndon Johnson and greatly expanded during the term of President Richard Nixon.

Approaching Crisis

By the time President Ronald Reagan took office the Social Security system was facing a financial crisis. Over the course of President Reagan's two terms, a number of changes were made to Medicare and Medicaid to slow the rise in costs and keep the system from running out of money. Efforts in that area continue to this day.

A proposal for universal health insurance coverage for all Americans finally was proposed by President Bill Clinton in 1993, but his proposal was defeated by opposition leaders in Congress. Alternative proposals advanced by Republican members also were not enacted. During Clinton's term, Congress did pass the Health Insurance Portability and Accountability Act of 1996 (HIPAA) which contained provisions affecting private health insurance.

Latest Efforts

Since the failure of politicians to agree on any form of universal health insurance reform, efforts more recently have centered on improving health insurance for the poor and senior citizens. President George W. Bush was able to see passage of new Health Insurance Flexibility and Accountability waivers designed to increase the number of low-income individuals with health insurance coverage.

In 2003, President Bush signed the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) into law, which included the most significant changes in the Medicare program since its enactment in 1965. Changes included an outpatient prescription drug benefit for senior citizens starting in 2006, a prescription drug discount card available in the interim, new preventive benefits, and many other changes.

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