History of attempts to reform US health insurance coverage

Timeline key
Event did nothing to widen health care insurance coverage
Event led to more access to health care insurance
1910s through 1920s
Baylor Hospital
The "Baylor Plan" of 1929 was developed by hospital administrators to help teachers afford hospital care. It was the first prepaid hospital insurance plan in the United States.

Teddy Roosevelt and his progressive party endorse national health insurance as part of their platform but lose the election.


A bill calls for compulsory health insurance and promotes campaigns in several states. A few states show interest but fail to enact as nation enters into World War I. The idea draws initial support from the American Medical Association but by 1920 the group reverses its position. Until the Obama plan, the group would be one of the leading opponents to universal health coverage.


Baylor Hospital introduces a pre-paid hospital insurance plan for a group of school teachers. It is considered the forerunner of Blue Cross.

Depression Era years
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President Franklin D. Roosevelt signs the Social Security Act into law.

The Great Depression leads to working groups on bolstering employment, retirement, and medical care rights. On national health insurance, committees called for a state-run system with compulsory insurance, but states could choose whether to participate and the federal government would provide subsidies and set standards. In the end, however, President Franklin Roosevelt decides to drop the health insurance plan to ease the passage of the Social Security Act.

The 40s
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National health care insurance was a part of President Harry Truman reelection campaign."

The Wagner-Murray-Dingell bill would have instituted national health insurance as part of Social Security, with workers and employers contributing to a fund much like Social Security. It failed.


Harry Truman was reelected in part on a mandate to institute single-payer national health insurance system with subsidies to pay for the poor. Pitched as part of his Fair Deal group of programs, the plan ran into opposition from the AMA, which branded it "socialized medicine," a damning description in the early days of the Cold War. Also, southern Democrats helped block it, fueled by fears it would lead to the desegregation of hospitals.

The 50s

Revenue Act excludes employers' contributions to employee's health plans from taxable income.


Military "medicare" program enacted, providing government health insurance for service members and dependents.

The 60s
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President John F. Kennedy

President Kennedy addresses the nation on the need for a medicare program in a televised broadcast from Madison Square Garden.


The Medicare and Medicaid programs are signed into law. Medicare pays for hospital care and limited skilled nursing and home health care for retirees and offers option to help pay for physician care. Medicaid assists states in covering care for the poor and disabled.

Neighborhood health centers are established to provide services to poor and medically underserved communities.

The 70s
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Sen. Kennedy consulted with doctors and hospital administrators before issuing his report on health care.

Senator Edward M. Kennedy holds hearings around the country before issuing issued a report, "The Health Care Crisis in America." He forwards a plan for a universal, single-payer system run thru the government and financed through payroll taxes.

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President Richard M. Nixon

President Nixon counters with a proposal calling for universal coverage, voluntary employer participation, and a separate program for the working poor and the unemployed. Both his and Kennedy's measures, and several compromise attempts, fail as support splinters among the various plans.

The 80s

COBRA allows those who lose their jobs to continue with their health plan for 18 months.

The 90s
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Within his first week in office President Clinton convenes a health reform task force with Hilary Clinton as chair.

After months of work by Clinton's health reform task force, a proposal that would allow universal coverage, with employer and individual mandates and competition among private insurers, fails in Congress, the victim of fears of overregulation and competing plans, including those for more radical overhauls of the system.


Health Insurance Portability and Accountability Act (HIPAA) restricts use of preexisting conditions in coverage determinations, sets standards for medical records privacy, and establishes tax-favored treatment of long-term care insurance.


The State Children's Health Insurance Program, pushed by Kennedy and Utah Republican Orrin Hatch, provides grants to states allowing for coverage of low-income children above Medicaid eligibility levels.

The 2000s

President Bush greatly expands the number of community health centers.


Congress passes Bush plan to create a prescription drug benefit under Medicare through private plans. Additional legislation creates Health Savings Accounts which allow individuals to set aside pre-tax dollars to pay for expenses.

File 2006/The Boston Globe
Ted Kennedy watched as Gov. Romney signed the Massachusetts health care law.

Massachusetts passes legislation to provide coverage to nearly all residents. Legislation requires residents to obtain insurance and calls for shared responsibility among individuals, employers, and the government in financing the expanded coverage. The state's uninsured rate is cut in half.


Senators Ron Wyden, Democrat of Oregon, and Robert Bennett, Republican of Utah, introduce a bill that would require individuals to obtain private health insurance coverage through state health insurance purchasing pools. The long-standing favorable tax treatment of employer-sponsored insurance premiums would be eliminated. Legislation sputters after gaining some bipartisan support.

Bush announces health reform plan that would replace the tax preference for employer-sponsored insurance with a standard health care deduction. Proposal is not acted upon by Congress.

Manuel Balce Ceneta/AP
Sen. Edward Kennedy worked with Sen. Max Baucus to develop a plan for comprehensive health care reform..

Insurers required to cover mental health issues as other medical issues.

Presidential campaign focuses early on health reform, overshadowed later by economic crisis. Both Barack Obama and John McCain announce comprehensive reform proposals.

Senator Max Baucus, a moderate Democrat from Montana and chair of the Finance Committee, releases a study outlining a national plan based on the Massachusetts model.

Yuri Gripas/Reuters
President Obama spoke after the Senate passed its version of health care overhaul.

President Obama creates office to coordinate health reform efforts.

House and Senate pass competing bills, with differences over the option of a public plan to compete with private plans in an insurance exchange, the level of government subsidies needed to make coverage affordable, financing mechanisms for the reforms, and the coverage of abortion services by federally-subsidized health plans.

This decade
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When Scott Brown won his seat in the Senate, Democrats could no longer overcome Republican filibuster on health care votes.
Spring of 2010

Obama's compromise proposal drops public option and bridges elements of the two bills.

Without the ability to overcome a filibuster, Senate decides to pass compromise bill under the reconciliation process, which is allowed primarily for budgetary matters and needs only a simple majority vote instead of a supermajority. House passes the Senate bill and Obama signs.

June 29, 2012

The Supreme Court, in a 5-4 ruling, declares the national health insurance law constitutional, saying Congress has the right under its taxation powers to mandate that individuals buy insurance.

SOURCE: Kaiser Family Foundation

James Abundis, David butler/Globe Staff