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History of Health Care

Beginning-1909 | 1910-1929 | 1930-1949| 1950-1969 | 1970-1989 | 1990-Future| Sources

1798 Earliest record of coverage for health services: Congress establishes the U.S. Marine Hospital Service for seamen funded by compulsory deductions from their salaries. First government health care plan
Pre-1900s Life and health insurance offered mainly through fraternal orders and guilds to their members; doctors charge an annual fee. Beginning of employer insurance
1850 First insurance policy for coverage of bodily injury due to railway or steamboat accident. First accident insurance policy
1870-1889 Companies in several industries, including mining, lumber, and railroads, develop group industrial clinics with plans that prepay doctors a fixed monthly fee to provide medical care to employees for industrial accidents and common illnesses. Employers begin to provide for employee healthcare
1899-1908 Aetna Life Insurance Co. and Travelers Insurance Co. offer a new type of health plan providing coverage for temporary total disability caused by all diseases except tuberculosis, venereal disease, insanity, or disabilities due to alcohol or narcotics. By the end of this period most of these restrictions are abandoned. Beginning of private health insurance
1900 Life expectancy in the United States: 47 years Population Statistic
1900-1909 Late 19th century treatments for infections are mastered – simple surgeries become commonplace in the home. Medical science advances
Almost all hospitals are non-profit institutions founded by religious organizations or wealthy donors; they now begin charging for services. Beginning of modern hospital system
Railroads begin providing employee medical programs. Employer insurance expands
1902-1904 The first State workmen’s compensation law is enacted in Maryland; it is declared unconstitutional in 1904. First workmen’s compensation legislation
1904 The American Medical Association forms the Council on Medical Education (CME) to standardize the requirements for MDs (Doctors of Medicine). Medical standards rise
1908 Federal government establishes workmen’s compensation for its civilian employees. Expansion of workmen’s compensation (see


Beginning-1909 | 1910-1929 | 1930-1949| 1950-1969 | 1970-1989 | 1990-Future
1910-1919 World War I leads to groundbreaking treatments for control of contagious disease. Medical science advances
1910 Beginning of organized medicine and AMA’s power: AMA bands together half of the nation’s 140,000 physicians. Doctors organize
First group health insurance policy – Montgomery Ward and Co. seeks to protect its employees from financial hardship, creates plan that pays for lost worktime, not for medical treatment. Employer group health insurance for lost wages
1911 President Theodore Roosevelt makes national health insurance one of the major planks of the Progressive party during his campaign for re-election (which he lost). Shortly afterwards, the American Association for Labor Legislation tries to enact the plan at state levels. Presidential candidate and unions – 1st attempt at national health reform: national insurance
Wisconsin enacts the first state workmen’s compensation law to be held constitutional. Expansion of workmen’s compensation (see 1908)
1912 American College of Surgeons (ACS) is founded to set standards for hospital accreditation. Medical standards rise
1915-1916 State legislatures offer model bills for universal health insurance. All defeated by the following: insurance companies who want to preserve their burial and accident insurances, AMA physicians (despite initial support) who fear limits on their fees, pharmacists who fear the drugs the legislation provides for will undercut their services, and by Samuel Gompers, the head of the American Federation of Labor, who believes government insurance will weaken the unions’ appeal. States call for state government health

insurance / Opposed by: Insurance Companies,

Doctors, Pharmacists, Unions (see 1911)

1919 Illinois study reports that citizens lose four times more wages due to sickness than the amount they spend treating the illness; people purchase “sickness” insurance to replace their wages rather than health insurance to cover costs of medical treatment. Health care spending rises, demand for workmen’s compensation rises
1920-1929 Medicine is seen as science, demand for medical care grows, hospitals become accepted as treatment centers, inadequate medical schools close, the number of trained physicians decreases, fees and overall costs rise. Medical standards rise
General Motors contracts with Metropolitan Life to insure 180,000 workers. Employer insurance expands
1927 President Coolidge convenes committee to address growing health care crisis in terms of access and cost. 1st Presidential referral to US health care as “crisis”
Heart disease becomes (and remains) leading cause of death. Population statistic
1929 Great Depression Looms: Growing national fiscal crisis worsens health care access and cost problems Problems with health care coverage worsen
Urban families have average annual incomes between $2,000 and $3,000; Medical expenses for the average American family are $108, $261 if there are any hospital stays (14%). Health care spending rises
First Health Maintenance Organization – a clinic for Los Angeles’ Department of Water and Power employees provides a wide range of health care services at a set rate. Municipal government creates first HMO
First group hospital health plan (Baylor University Hospital in Dallas, TX) – offered to 1500 schoolteachers in order to stabilize the hospital’s cash flows; other hospitals soon follow, creating competition. First group hospital health plan
American Hospital Association created. Community hospitals organize with each other to offer hospital coverage and to reduce competition, leading to formation of Blue Cross (see 1932). Hospitals join together to offer insurance
Beginning-1909 | 1910-1929 | 1930-1949| 1950-1969 | 1970-1989 | 1990-Future
1930-1939 The Depression leads to public interest in unemployment insurance and senior benefits. American public wants more health protection, income security
1932 First private hospital coverage plan, Blue Cross (Sacramento, CA) – offers free choice of physician and hospital, reimburses for the treatment of low income patients. State legislation allows Blue Cross to act as a nonprofit corporation, tax-exempt and free from insurance regulations. Where these laws exist, the Blue Cross Plan expands to dozens of states. Blue Cross hospital insurance gets nonprofit status – tax-free and free from insurance regulations
1933-1938 The beginning of Kaiser Foundation Medical Care Plan: A physician at Kaiser Co.’s California dam construction site convinces the Kaiser owned construction workers’ insurance company to pay him in advance per employee for providing medical care on-the-job rather than send workers with serious injuries to medical facilities 200 miles away. This kind of prepaid care allows employers to better predict costs. Kaiser also arranges for voluntary salary deductions to cover off-the-job care for the workers and their families. Employer insurance expanded to cover families at employees’ expense
1934 Hospital costs rise to nearly 40%

of a family’s medical bill.

Health care spending rises
The AMA adopts principles to protect physician right to set rates based on patient income and to supervise voluntary insurance; declares it unprofessional for doctors to seek profits in practicing medicine. Doctors commit to independence from

private health insurance

1935 President Franklin Roosevelt bows to the AMA, the insurance industry and business and removes national health insurance from his proposal for Social Security Legislation before presenting it. 2nd attempt at national health reform: national health insurance / Blocked by: Doctors, Insurance Companies, Employers (see 1915)
Social Security Act passes, enables states to raise revenue to care for the retired and the elderly, and to provide for the disabled, maternal and child welfare, public health, workmen’s and unemployment compensation. Social Security Legislation passed to protect the vulnerable, includes legalization of workmen’s compensation
Origin of employer-based health plans: wage and price controls set up to control inflation during World War II make it difficult for employers to attract workers, leading companies to offer health insurance as a fringe benefit as a way to attract workers. Employers begin to regularly offer health insurance
1939 CA governor proposes compulsory health insurance for those earning less than $3,000 a year, which at that time is 90% of the population. Leads to: State government attempt at health insurance
1939-1946 The California Physicians’ Service (CPS) – the first prepayment plan designed to cover physicians’ services. These physician-sponsored plans adopt the income limit from the governor’s plan to capture public support for their own plan. AMA encourages expansion to other states; plans become known as Blue Shield, primarily covering hospital services. Blue Cross-like legislation frees these plans

  • from taxes,
  • from insurance company regulation,
  • from restriction on choice of physician;
  • also allows doctors to charge subscribers the difference between their actual charges (which they could vary by patient) and the amount for which they are reimbursed (see 1932).
Formation of Blue Shield health insurance: gets non-profit status: tax-free and free from insurance regulations
1940-1949 Penicillin comes into use. Medical science advances
Commercial insurance companies enter the health market based on the idea that the insured are employed and thus likely to be young and healthy. Commercial carriers are not subject to the same regulations that govern the non-profit Blue Cross and Blue Shield, and can charge higher rates for sick people. Commercial (for-profit) insurance begins
Labor Unions fight to make the inclusion of health plans in worker contracts widespread. Unions raise demand for employer health benefits
1940 12 million of the nation’s population of 132 million have health insurance. Population Statistic


Congress makes employer-provided health care tax deductible for employers: enrollment in group hospital plans goes from 7 million to 26 million, 20% of population Congress, Employers, Hospitals, Insurance Companies support employer insurance
Henry Kaiser expands the Kaiser Foundation medical care plan for his shipyard employees. Employer insurance expands
1943 Congress makes employer-provided health benefits tax exempt for employees; very limited in scope and applicability. Government makes employee health benefits tax-exempt
1944 President Roosevelt’s State of the Union calls for a second bill of rights that includes “The right to adequate medical care and the opportunity to achieve and enjoy good health.” 3rd call for national health reform: universal health care (see 1935)


Kaiser Health Plans open for community participation. Employer health plan goes commercial
President Truman becomes first president to publicly support national health insurance through support of Murray-Wagner- Dingell bill for compulsory health insurance funded by payroll deductions. 4th attempt at national health reform (see 1944): national insurance / Opposed by Doctors


Hill-Burton Act passes Congress: requires that any hospital receiving federal funds has to offer free hospital care to the uninsured or unable to pay. Congress requires hospitals receiving federal funds to treat everyone
Baby Boom begins with U.S. births up to 3.4 million from 2.8 million in 1945. Population Statistic
1948 All states now have some form of workmen’s compensation Expansion of workmen’s compensation (see 1935)


Truman’s universal health insurance plan is defeated by AMA and Business lobby in the House of Representatives after series of campaigns portray plan as Communist, causing loss of public support. National health reform plan defeated by: Congress, Doctors (see 1945)
U.S. Supreme Court rules that pension and insurance benefits, including health benefits, are to be considered part of “wages,” giving unions authority to

negotiate benefits for employees.

Government supports employer insurance

(see 1943)

Deductibles introduced for the first time: Liberty Mutual introduces Major Medical Insurance to protect individuals against extended illnesses or injuries by expanding basic plans’ (such as Blue Cross/Blue Shield) list of eligible hospital charges and extending their duration of coverage; funded through deductibles Private insurance companies introduce deductibles
Beginning-1909 | 1910-1929 | 1930-1949| 1950-1969 | 1970-1989 | 1990-Future


Federal Government amends the Social Security Act and assumes responsibility for health care for the poor and becomes the primary payer for nursing home care. Federal Government supports health care for the poor and elderly
Those who can afford it purchase private insurance. Over 1/3 of Americans with health insurance are covered by employer-provided plans; by the end of the decade, this becomes the common expectation of workers:

  • the number of medications in common use isgrowing rapidly;
  • the price of hospital care doubles.
Health care developments cause increased demand for health insurance, increased supply of employer insurance


National health care expenditures are $12.7 billion, 4.5% of the Gross National Product. Overall, the # of those insured tops 190 million up from 20.7 million in 1940. Health care spending and the number insured rises
Most states now bar group practices with prepaid monthly fees in favor of fee-for-service providers, due to 2 decades of AMA pressure. Rise in fee-for-service due to AMA
Life expectancy in the United States: 68 years. Population Statistic
1951 As a result of commercial carriers being allowed to charge lower premiums for healthy people, they overtake the nonprofit BlueCross/BlueShield in the insurance market. For-profit insurance expands
Over 100,000 individuals and their dependents have Major Medical Insurance (purchased by employers or individually), which covers more medical expenses for longer periods of time. Over 80 million have basic health insurance. Demand for major medical insurance rises (see 1949)
1954 Congress expands the 1943 ruling setting aside employer health payments as tax-free employee income. Government supports employer insurance

(see 1949)

First successful organ transplant is performed. Medical science advances
Over 60% of population have some type of hospital insurance, typically for surgery, due to efforts of unions to broaden coverage in worker contracts. Unions drive the demand for hospital insurance
1955 Jonas Salk develops polio vaccine. Medical science advances
1957 Vision care benefits are introduced. Insurance market expands
1958 75% of Americans have some kind of private health insurance. Population statistic
1959 Dental care benefits are introduced. Insurance market expands
1960-1969 The major medical carriers endorse expensive medicines, medical school enrollment doubles, the number of doctors who are full-time specialists increases (along with average physician salaries) from 55% to 69% (85-90% of med school graduates are choosing specialty medicine), and for-profit hospitals arise, leading to higher health care costs. Health care spending rises due to growth in expensive medicines, specialty care, for-profit hospitals
1960-1970 There are over 700 insurance companies in the United States, a difficult system to figure out or afford. Insurance market expands


32 million people have Major Medical Insurance (see 1951) . Demand for Major Medical insurance rises
Health care spending is $27 billion, 5.1% of GNP. Health care spending rises
1961-1962 President Kennedy pushes for elderly health insurance funded through Social Security taxes – 69% of public supports. AMA opposes, predicting out-of-control spending and inadequate care; business lobby, pharmaceuticals and insurance companies push defeat in Congress. 5th attempt at national health reform (see 1949): elderly health insurance / Opposed by: Doctors, Employers, Insurance Companies,


1963-1964 Build-up to Medicare: President Johnson devises elderly health plan that will reimburse hospitals for cost of service and “usual and customary” fee-for-service for doctors. Republicans want to exclude the middle and upper classes from this plan, but Democrats fear that then the program will be a “poor program for the poor”. 6th attempt at national health reform: elderly health insurance; supported by Hospitals, Doctors


Over 70% of population have hospital insurance, more than 1/2 of senior citizens are without any coverage: Demand for hospital insurance rises;

elderly are uninsured

Congress passes and Johnson signs legislation:

  • Medicare, compulsory hospital coverage (Part A) and voluntary physician insurance (Part B) for all over 65.
  • Medicaid, state assistance for the nation’s poorest families. Finances through Social Security taxes, modeled on Truman’s plan.
Government passes Medicare/Medicaid /

Opposed by AMA

1966 Doctors earnings rise 11% under Medicare, while many refuse to participate in Medicaid. Doctors are unimpressed with AMA’s fumbling of legislation; membership drops. Medicare covers 19.1 million (9.7% of population), Medicaid covers 10 million(5%). Medicare/Medicaid change doctors’ role in health care delivery
1968 Employer-provided group life and health insurance plans cover more than 2/3 of the labor force. Employer insurance expands
1969 President Nixon announces nation is facing massive health care crisis. 2nd Presidential referral to US health care as “crisis” (see 1927)
Beginning-1909 | 1910-1929 | 1930-1949| 1950-1969 | 1970-1989 | 1990-Future
1970-1979 Health care cost “crisis” continues due to increased medical technology and medicines, expanding hospital profits, heavy Medicare spending and rapid economic inflation. Health care spending rises due to growth in medical treatment, for-profit hospitals, inflation.
The number of female medical students increases from 9% to 25%. Population statistic
1970 Health care spending is $73 billion, 7.1% of GDP; taxpayers pay $27.8 billion, up from $10.8 billion in 1965. 3/4 of population polled believe there is a health care crisis in U.S. Health care spending rises
1971 President Nixon initiates “War on Cancer.” President supports medical advances
AMA membership drops to 1/2 of nation’s doctors. (See 1966) Doctors disband
1973 Congress passes Nixon’s Health Maintenance Organization Act: provides “managed care” via network of providers and set rates rather than fee-for-service.

  • creates HMOs with federal oversight and funding (for non-profits only);
  • sets goal of enrolling 90% of population.
7th attempt at national health reform (see 1963-64): Nixon establishes HMOs; supported by Congress, Insurance Companies, Doctors, Hospitals
1973-1980 Heavy subsidies to managed care and requirements for employers on HMO inclusion continue, though total enrollment reaches only 10 million. HMO enrollment is slow
1974-1976 Nixon supports Secretary of State Caspar Weinberger’s Comprehensive Health Insurance Plan (CHIP):

  • mandates employers to cover employees, share premium costs
  • government funds coverage for unemployed in separate system with co-payments determined by income,
  • one level of service for all;

A Bipartisan-supported effort, but faces opposition:

  • Unions dismiss plan: want free coverage, all fee-for-service replaced by HMOs, no private insurers.
  • AMA wants government funded fee-for-service plan without cost controls.CHIP abandoned after Watergate and US House scandals, despite President Ford’s support.
President calls for National Employer Insurance / Opposed by Unions, Employers, and Doctors
1974-1984 John Hixson and Paul Worthington of the Social Security Administration (in a section that would later become the Health Financing Administration) develop the idea of health banks through which employer healthcare contributions would be deposited in employees’ individual savings accounts at financial institutions in order to pool loans for major medical needs. Hixson later becomes chief economist for the AMA, which during this time supports the idea. Government analysts create idea of Health Savings Accounts (HSAs)
1978 Medical Investment Retirement Accounts appear at banks, President Carter signs Congress’ Revenue Act establishing flexible benefit plans, giving employees

choice in health plans: allows employees to set aside pre-tax income to pay for medical expenses in Flexible Spending Accounts.

Congress first approves Health Savings Accounts
1979 The World Health Organization eradicates smallpox. Medical science advances
1980-1989 There is an overall shift toward private health care and corporate systems buying up regional hospitals. Health care is increasingly privatized
1980 Congress, after a decade of lobbying by universities, passes the Bayh-Dole Act: promotes wider ownership in product development vs. previous open use of tax-payer funded research; benefits drug companies, universities and biotech firms. Congress expands privatization of university research.
Estimate of average annual salary for cardiac surgeon exceeds $500k. Health care spending is now three times higher than in 1970, at $257 billlion, about 10% of GDP. Health Care spending rises
1982 The Centers for Disease Control officially defines an increasingly common collection of symptoms and syndromes as AIDS. AIDS enters the picture.
1983 President Reagan follows insurance company complaints that doctors are exploiting traditional fee-for-service billing, and curtails Medicare and private plan providers’ ability to charge patients varying fees per service; switches to “capitation,” prepaid fee per person/ diagnosis rather than fee per treatment. President limits reimbursements for

doctors, expands insurers ability to establish “reasonable and customary” fees

1984 Hixson associate John Goodman of the National Center for Policy Analysis and Richard Rahn, Chief Economist of the U.S. Chamber of Commerce, publish a plan to use Medical Individual Retirement Accounts to privatize Medicare; leads to development of Medical Savings Account (see 1974-84). Government and think tank analysts promote plan to create savings accounts to privatize Medicare
Congress passes Hatch-Waxman Act: extends monopoly rights for brand-name drugs. Congress expands drug company rights
1986 156 million people have Major Medical Insurance (see 1960). Demand for Major Medical insurance rises
41% of HMOs are non-profit, down from 88% in 1981. Non-profit insurance industry shrinks
1988 3/4 of American workers with employer-sponsored health insurance have traditional/indemnity/fee- for-service plan: subscribers can select any provider and seek reimbursement for bills sent to insurance companies (up to certain %) after deductible is met with no questions asked. Employer insurance is largely fee-for-service
Massachusetts becomes the first state to pass a universal health care bill, though most of its reforms are soon repealed. Health care spending rises
Beginning-1909 | 1910-1929 | 1930-1949| 1950-1969 | 1970-1989 | 1990-Future
1990-1999 Health care costs rise at twice the inflation rate. Health care spending rises
Managed care briefly slows down this growth by requiring 3rd-party pre-approval of all treatments, adding incentives for family doctors to not refer patients to specialists, utilization reviews of medical practices, and enforced discounts with hospitals. Managed Care grows, temporarily curbing


1990 Top 10 drug companies have profits nearing 25% of sales revenue. From 1960 to 1980, prescription drug sales were fairly static as a % of US gross domestic product; from 1980 to 2000, they tripled. Drug companies make huge profits
The Human Genome Project is created. Medical science advances
1991 The % of those with individual coverage who contribute to health care payments rises to 51% from 27% in 1979, with the average monthly premium ($26.60) 2.5 times higher than in 1983 ($10.13). For those with family coverage, 69% pay part of the cost up from 46% in 1980; the average premium in 1990 ($96.97) is 3 times higher than in 1983 ($32.51). Health care spending rises
PPOs (Preferred Provider Organizations) grow due to fact care is paid for as it is received instead of with an advance scheduled fee. PPOs may also offer more flexibility by allowing for visits to out-of-network professionals. Participation in managed care reaches 33% of those with health care (17% HMOs, 16% PPOs) up from 14% in 1986 (13% HMOs, 1% PPOs) and 3% in 1980 (all HMOs). Demand for Managed Care rises though it becomes largely fee-for-service through growth of PPOs
1992 Enrollment in HMOs reaches 39 million (18% of those insured), up from 2 million in 1970. Demand for HMOs rises
1993 President Clinton proposes a national insurance Health Security Plan: all citizens would be enrolled through government-run regional alliances that have the power to regulate costs and quality of managed care. 8th attempt at national health reform(see 1969): national/regional insurance system
1994 A single-payer ballot initiative in California is defeated. American public rejects state health reform
1996-1997 The Clinton plan fails in Congress. The alternative Medical Savings Account plan is introduced. President’s government health plan defeated by: Pharmaceuticals, Insurance Companies, AMA
1997 Food and Drug Administration creates rules that allow drug companies to advertise directly to consumers if such ads balance supposed benefits with possible risks. Because the FDA guidelines are not full-blown regulations, the agency does not have the power to fine or otherwise sanction drug companies for running misleading ads. Drug companies begin to advertise to public.
1998 Traditional/fee-for-service plans drop to 14% of the health insurance market. HMO enrollment reaches 79 million (35%) of over 227 million insured (see 1988 and 1992). Demand for HMOs rises as traditional insurance enrolllment drops
1999 Medicare covers 39.5 million people (14.5% of population). Medicaid covers 37.5 million (13.8%) (see 1966). Medicare/Medicaid enrollment rises
2000 Life expectancy in the United States: 77 years. Population Statistic
Health care spending reaches $1.2 trillion, 14% of the GDP Health care spending rises
Medicare and Medicaid account for 32% of all health care spending. Medicare/Medicaid 1/3 of health spending
2002 National healthcare spending is $5,267 per person, $1,821 more than Switzerland, the next runner-up. Health care spending
New variation of HSAs arises: Health Reimbursement Arrangements, reincarnated in 2003 as HSAs and signed into law. Beginning of HSAs
2002-2003 Nearly 82 million young and middle-aged Americans are uninsured for some portion each year, including workers, the temporarily unemployed, and children. Population Statistic
2003 President G. W. Bush signs Medicare Prescription Drug, Improvement, and Modernization Act.

  • offers prescription drug coverage to seniors and people with disabilities, starting in 2006;
  • relies on insurance companies to deliver the benefit to those on Medicare and over 6 million low-income elderly Medicaid subscribers without federal supervision;

Department of Health and Human Services is not allowed to negotiate prescription drug prices.Act also creates Medicare Advantage, which allows for HSAs and increases subsidies to insurers who offer private Medicare plans, currently 5.3 million people (across 285 contracts).

Government, Insurance Companies, Drug

Companies, AARP: Government passes Medicare prescription drug coverage and privatization

legislation, drug prices and spending rise

Maine passes the “Dirigo Health Reform Act” to establish a five-year plan to achieve universal coverage by 2009 via an expansion of public and private coverage. State government attempt at statewide health coverage
Study finds more care does not necessarily lead to better health; 1/3 of medical treatments provide no apparent benefit. Medical Research
2003-2004 California passes a “pay or play” employer mandate for businesses with 50 or more employees requiring them to either “pay” into a fund to provide coverage for uninsured state residents or “play” by providing coverage for their employees -repealed a year later by a ballot initiative sponsored by big businesses. State government attempt at statewide health coverage
2004 GM cost for employee health benefits is about $5 billion/year, $1400 per vehicle manufactured (profit per vehicle is $178); Chrysler and Ford lose money on every car produced. Health Care spending eats into manufacturing profits
Small businesses report health care costs as #1 problem. Health Care spending rises
National Coalition on Health Care, an alliance of 100 of the country’s largest businesses, unions, health care groups and insurers, and grassroots groups, chaired by former Presidents Ford, Carter, and Bush, call for health care price controls and national health insurance. Employers, Unions, Providers and

American Public unite for Health Care reform

HMO enrollment is down 12% from 1998 to 70 million. PPOs and other types of managed care cover most of working America and their families. Traditional / fee-for-service plans account for less than 5% of employer-sponsored health insurance. Demand for HMOs shrinks though majority

still have managed care

Bush argues for a cap of $250,000 for the pain and suffering portions of medical malpractice awards to help hold down health-care costs though critics predict this will in fact increase spending. President seeks cap on malpractice



Health care spending nears $2 trillion, more than 16% of GDP. Health Care spending rises
Since 2000:

  • Health care costs are up 73%: average annual premium for family policy is close to $11,000 (25% of median annual salary); 2/3 of all families struggling to pay medical bills have insurance.
  • The number of uninsured is up more than 6 million, though 1 in 3 uninsured households have an annual salary of more than $40,000.
  • 59% of companies with less than 200 employees offer health benefits, down from 68% (and compared with 60% of companies overall); more than 1/3 of these workers receive no health care cost contribution from employer.
More people lack health insurance as fewer businesses offer it or contribute to

costs, and at the same time, the insured struggle to deal with medical bills

The portion of Americans working for an employer that sponsors a health plan is 81% though only 74% of workers are eligible and only 62% participate, the lowest numbers since 1988. The reasons for this decline are that the majority has coverage through a spouse or other job, and an increasing number of employees cite the offered plan as too costly. Fewer employees participate in their

employer’s health plans due to other

coverage or increased costs

Only 57.5% of children have health insurance through their guardian’s employer. Children are often uninsured or reliant on government programs
Insurance companies merge and privatize, resulting in 3 for-profit and 2 non-profit plans controlling 90% of the market. Control of the health-care market.
2006 Rep. John Conyers [D-MI] introduces the Expanded and Improved Medicare for All Act (HR 676) to provide for comprehensive health insurance coverage for all United States residents. 9th attempt at national health reform (see 1993): universal single-payer coverage
Medicare Prescription Plan (Part D) goes into effect. Two weeks into the year, states panic as low-income seniors complain of having lost their free Medicaid coverage and of facing problems at pharmacy counters. Medicare Prescription Plan begins
Maryland passes Public-Private Partnership for Health Care for All. State Government attempt at statewide health coverage
Massachusetts becomes the first state in which a Democratic legislature and a Republican governor agree on the need for universal healthcare, passing a reform package with both employer and individual mandates. State Government attempt at statewide

health coverage

Vermont passes the “Health Care Affordability Act of 2006” covering most of the state’s uninsured. State Government attempt at statewide

health coverage

GOP legislation to create Association Health Plans, federally regulated Small Business Heath Plans, reaches Senate debate after 11 years of efforts. Bill is filibustered by Democrats who fear the measure would allow insurers and small businesses to bypass state-mandated protections, and increase costs for firms with one or more sicker workers. Congress fights over creation of health

plans for small businesses

Nearly 4.3 million births in the U.S. are reported, the largest number recorded since 1961. Population statistic
2007 In State of the Union address, President Bush proposes citizens pay taxes on their employer-provided health care benefits, presumably paving the way for increased demand for tax-protected Health Savings Accounts with high insurance deductibles. 10th attempt at national health reform (see 2006): complete privatization of health care through HSAs.
California and Illinois are considering universal health care proposals while Pennsylvania and other state governors are seeking ways to increase health care access and limit costs. State Governments attempt at statewide

health coverage

Congressional Budget Office estimates that Medicare could save $40 billion over next 10 years if subsidies to Medicare Advantage insurers for doctor and hospital reimbursements were limited to levels of the rest of the program (or save $54 billion in 5 years if eliminated altogether). About 1/5 of elderly Medicare enrollees are in private plans – 8.3 million across 604 contracts (see 2003). Medicare privatization expands
2011 First baby boomers reach 65 years of age. Population Statistic
2020 PriceWaterhouseCoopers predicts health care spending will reach 21% of GDP. Health Care spending rises
Beginning-1909 | 1910-1929 | 1930-1949| 1950-1969 | 1970-1989 | 1990-Future| Sources