Who knew healthcare was going to be so complicated? Ted Kennedy knew how difficult it had been and would eventually be. Howard Baker knew how difficult it was, so did Tom Daschle, & George Mitchell (yes, that George Mitchell). Bob Dole knew the complications of health care, even though declaring “There is no crisis in health care” back in 1994 while rebuking the Clinton health care plan. It is not as though no one knew this was a complicated and difficult proposal.
One of the earliest health care reforms in our history was a land-grant bill petitioned to Congress by Dorothea Dix in 1854 under the 14th President, Franklin Pierce. The bill was called the Bill for the Benefit of the Indigent Insane and it was to establish asylums for “indigent (poor) insane, blind, deaf, and dumb” citizens through federal land grants of over 10 million acres to the various states, of which there were 31. This bill was vetoed by Pierce, stating, 1) the Constitution did not allow Congress to pass legislation like this, 2) that by passing this bill, the Federal Government would be overrun with future welfare legislation, and 3) the responsibility of citizen’s health was the states’ burden.
The Freedmen’s Bureau was established in 1865 by President Abraham Lincoln, for former slaves & poor white folks to obtain health care, food, housing, and established schools in the South after the Civil War. Intended to last but one year, it was officially shut down in 1872 by Congress over complaints by white Southerners. Spanning over 40 hospitals, the Washington D.C. hospital was the first to provide medical care to former slaves, and eventually was folded into Howard University Hospital, an historically black private non-profit university hospital.
Sickness insurance, also known as “workingman’s insurance” or industrial sickness funds, were one of the earliest forms of health insurance coverage. This contributed to the logical idea of employer-based health insurance which permeated America in the early part of the 20th century, and set the stage for 3rd-party health insurance burgeoning in the ’30s. However, the idea of employer-based health insurance also tempered the need for government-based health insurance. With the Great Depression came an increased need for health care coverage being that more and more people were out of money and out of work. Franklin Delano Roosevelt tried to introduce publically funded health care programs but was attacked by the American Medical Association on the grounds that the reforms would lead to a “compulsory system of care,” among other things like limiting patient choice, and the increase of cost & standards of medical care. The ideas put forth by the AMA to deny publically funded health care then are used to oppose reform even today.
1965 was a landmark year in health care law. President Lyndon Baines Johnson signed the Social Security Amendments of 1965, commonly known as Medicare. This established a health care program for elderly persons aged 65 or older, as well as poor families. 20 million people enrolled in the program within the first three years, and it is funded through earnings taxes of employees and matched by employers. President Harry S. Truman had explored the idea some 20 years earlier when he commissioned Congress to write legislation to establish a national health insurance plan but had backed off by the end of his Presidency. To show gratitude to Truman’s early efforts, LBJ signed the bill with Truman in the Truman Presidential Library on July 30th, 1965. President Richard Nixon extended Medicare in 1972 to include those who have been severely disabled over two years, or are afflicted by end stage renal disease.
Nixon also put forth two health insurance reforms, one in ’71 and another in ’74. 1971’s proposal was a private health insurance employer mandate, requiring every employer to offer all full-time employees a comprehensive health insurance plan, and the federalization of Medicaid for poor citizens with dependent minor children. February of 1974 brought a more comprehensive bill, still with an employer mandate, and replacing Medicaid with state-run health plans with income-based premiums and cost-sharing between the employee and the health plan. Also included was a plan offered to everyone not eligible for employer-based health coverage, Medicare, or anyone who cannot afford coverage. Neither bill moved on, however, being that both bills did not have the support of the chairs of the House Ways & Means Committee and the Senate Finance Committee. This should come as no surprise given that Nixon would resign in August of ’74.
President Ronal Reagan signed into law the Consolidated Omnibus Budget Reconciliation Act of 1985, known to us as COBRA. COBRA was designed to mandate insurance companies offer a continuation of coverage after you have left an employer for a few reasons, according to the Department of Labor — death of a covered employee, termination or reduction in the hours of a covered employee’s employment for reasons other than gross misconduct, divorce or legal separation from a covered employee, a covered employee’s becoming entitled to Medicare, and a child’s loss of dependent status (and therefore coverage) under the plan. Most coverage is up to 18 months, 29 months if the Social Security Administration has determined you to be disabled, and up to 36 months in the case of widow’s coverage. Unlike employer-provided health insurance, the recipient is fully responsible for the cost of their premiums.
Bill Clinton had campaigned on health care reform in the 1992 Presidential Campaign. After Bill Clinton was sworn into the Presidency, he formed the President’s Task Force on National Health Care Reform designed to draw up the provisions for universal health care for all Americans. Drawn up and sponsored by George Mitchell, the main provision of the Health Securities Act was, again, the employer mandate to provide health insurance to all employees. Republican opposition to the bill was strong, and the bill was weakened by Republicans publically decrying the bill before they had even looked at it. William Kristol wrote, “Any Republican urge to negotiate a ‘least bad’ compromise with the Democrats, and thereby gain momentary public credit for helping the president ‘do something’ about health care, should also be resisted. …The plan should not be amended; it should be erased.” Then, in a bizarre twist, Democrats devised competing plans instead of unifying behind the bill. All of this eventually led to the bill being killed because of Republican messages portraying it as too complex and overreaching. Who knew health care was going to be so complicated?
The biggest step we’ve seen in the history of health care was the passing of the Affordable Care Act in 2010. It came with an individual mandate, as well as an employer mandate, both of which were supported publically by the Heritage Foundation as early as 1989, yet were opposed by Congressional Republicans when included in the ACA, going so far as to call it unconstitutional (let me just say, mandates are how you keep costs down, things are cheaper when more people have them — is this THAT difficult to understand?!). The bill eventually passed the Senate on 12/04/2009, the House on 3/21/2010, and President Barack Obama signed it into law on 3/23/2010 after well over a year of discussions and committees. Since the passage of the law, national uninsured rates were cut in half, from 16% to around 8% (about 20 million people), and every single congressional district from 2013 to 2015 saw a decline in uninsured citizens.
Now the House of Representatives finally passed their version of the Affordable Care Act Repeal & Replace and the ball is now in the Senate’s court. They’ve hinted at overhauling the bill which is very likely to happen, and either way you look at it, this Republican health care option will be much worse than the ACA, even worse than their first attempt at writing a health care bill back in March. The high-risk pools with over 2.2 million people with pre-existing conditions (I.e., cancer, cerebral palsy, mental health issues like anxiety or depression, multiple sclerosis, have had an organ transplant, paralysis, sleep apnea, have had a stroke, etc.) currently in individual state marketplaces would be drastically cut, with only about 5% of those being covered. In addition, House Republicans did not even wait for the Congressional Budget Office to review and grade the bill before voting on it. For comparison, the Affordable Care Act was introduced on September 17th, 2009, passed the House with a perfect 416–0 vote on October 8th, and then passed the Senate on December 24th of that year after being revised. After the amendments were included, it was agreed to by the House again on March 21st of 2010, and signed into law two days later, but not before Congressional Republicans introduced a bill to repeal it on 3/22.
Republicans have had over eight years to come up with a health care plan to replace the Affordable Care Act upon repeal. Surprisingly enough, since the election in November, Obamacare has risen sharply in popularity polls, going from a 42% approval to 55%, a 13% rise in only five months. Their response to that approval is to come up with a bill in their first attempt that doesn’t cover nearly as much, removes the employer mandate that keeps costs down, and shifts the cost to the middle class by removing the taxes on the wealthy that paid for the ACA. Furthermore, the CBO released a report in January of this year regarding the repeal of parts of the ACA, stating 18 million people would be uninsured in the first year of a repeal, increasing to 32 million uninsured by 2026. In addition, premiums would increase by 20–25% in the first year, 50% the next year following the elimination of the Medicaid expansion, then premiums double by 2026. This is the best they could have come up with, and that is a disgrace to every American.
The only alternative to the Affordable Care Act should be a single-payer health system.
