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With healthcare an important topic in the United States, it helps to understand how health insurance began, the evolution of the industry, and the various ideas and legislation that have come before our current Affordable Care Act (ACA) era of individual insurance. HealthMarkets looks back at American healthcare history.

1700s – 1890s

In the 1890s, lumber companies in Washington paid physicians to provide care for their workers. It was the earliest beginnings of what was to become health insurance.1

1900s – 1920s

This is the point in American healthcare historywhen insurance started to become a talking point in the country. In 1912, President Theodore Roosevelt and his Progressive party endorsed social insurance and the National Convention of Insurance Commissioners introduced a prototype for states to follow for to regulate health insurance. In 1915, The American Association for Labor Legislation proposed a bill for compulsory health insurance.2

In 1929, Dallas-based Baylor University Hospital worked with local schools to provide healthcare to teachers for a monthly fee of $6, forming the start of Blue Cross health insurance plans.The plans covered $5 per day for a 21-day hospital visit.1

1930s – 1950s

The Great Depression increased the focus on the need for health insurance. Henry Kaiser arranged a fixed rate of care for his aqueduct workers with a nearby hospital. This became the Kaiser Permanente Health Plan, which would evolve into a managed care system, the basis of modern HMOs and PPOs.4

In 1939, The Department of Health and Human Services began as the Federal Security Agency, which focused on health, welfare, and social insurance. In 1944, the Social Security Board recommended national health insurance as part of the Social Security system.2

President Truman proposed a “universal” health insurance program in 1945, declaring, “By preventing illness, by assuring access to needed community and personal health services, by promoting medical research, and by protecting our people against the loss caused by sickness, we shall strengthen our national health, our national defense, and our economic productivity.”5

In 1948 the National Health Assembly issued a report that endorsed voluntary health insurance and emphasized need for universal coverage.2

In 1952, the Federal Security Agency proposed health insurance benefits for people on Social Security. Legislation was proposed for this initiative in 1956 and 1959. In 1954, President Dwight Eisenhower proposed a federal reinsurance fund for private insurance companies to help expand the availability of health coverage. In 1956, the government enacted a program that provided health insurance for family members of those in the military.2.

1960s  1990s

In 1961, President Kennedy started the groundwork for health insurance for seniors and four years later, President Johnson signed the legislation that created the Medicare system. In 1972, the disabled under age 65 and people with end stage renal disease became eligible for Medicare benefits. 

In 1993, President Clinton proposed the Health Security Act, which would give every American access to healthcare via a “Health Security Card.” In 1993, several bills were introduced in Congress to create national and single-payer insurance programs. None of these efforts were successful.

In 1996, the Health Insurance Portability and Accountability Act (HIPAA) added some protections to people with pre-existing conditions and changed some rules for long-term care insurance. The Balanced Budget Act in 1997 slowed the growth of Medicare spending and created a new insurance structure, Medicare Advantage.

2000s Present2 

The Medicare Drug, Improvement, and Modernization Act passed in 2003, which created Medicare Part D prescription drug benefits. Additional Medicare legislation in the same year created Health Savings Accounts.

Massachusetts and Vermont enacted legislation in 2006 that provided health insurance access to residents, a precursor to the Affordable Care Act. In 2007, the Healthy Americans Act was proposed in the Senate that would have required all Americans to have health insurance.

In 2010, President Barack Obama changed American healthcare history by signing the Affordable Care Act (ACA), which brought big changes to American healthcare, including protections for people with pre-existing conditions and children up to age 25 able to be covered by a parent’s plan.

The Affordable Care Act has helped lower U.S. uninsured rates. This big step forward helped more than 12 million Americans enroll in ACA health insurance plans as of 2021.6

HealthMarkets is proud to have helped over 4 million Americans find policies since 2010. Ready to start your own history of insurance coverage with us? Review and compare health plans today.


1. Health for California Insurance Center. Retrieved from Accessed July 12, 2021. | 2. KFF. Retrieved from Accessed July 12, 2021. | 3. Northwestern University. Retrieved from Accessed July 12, 2021. | 4. Kaiser Permanente. Retrieved from Accessed July 12, 2021. | 5. Truman Library Institute. Retrieved from Accessed July 12, 2021. | 6. KFF. Retrieved from,%22sort%22:%22asc%22%7D. Accessed July 12, 2021. 

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