Until the late 1920s, health insurance wasn't really a thing because health care wasn't really a thing. You got cholera and you couldn't cross the river and you died. Here's where it went from there...
A group of schoolteachers in Dallas, TX sign up for health insurance from a local hospital. For a small amount every month, they get all the health care they need. The plan's called Blue Cross. Sound familiar? Within a decade, basic insurance plans like this one are becoming more popular around the US.
Blue Shield is started by groups of doctors, although it isn't officially called this until later. Just like how the hospitals set up Blue Cross, the doctors offer access to health care for a small payment every month. Eventually they join forces, and voila: Blue Cross Blue Shield.
It's WWII time. Since a lot of men are at war, there aren't as many workers in the job market. The feds decide that companies can attract in-demand workers by offering to pay for health insurance as a tax-free benefit. Employer-sponsored health care becomes the status quo.
President Harry Truman gets involved. He pushes Congress to go for a single-payer healthcare system, which his predecessor FDR had wanted. Psst...single-payer is a public system that makes sure everyone gets insurance. It's what your British friends have. This would have helped retirees and the unemployed get care. Doctors, hospitals, and unions – which are all now benefiting from the status quo of employer-sponsored care – organize against the idea, and lobby lawmakers to their side. The idea gets tossed. More and more people get private insurance.
LBJ steps in. At this point employer-sponsored insurance is all the rage. And older retirees are high and dry. Enter: Medicare. That's the government-run insurance program for everyone over 65 years old. Also enter: Medicaid. That's the one that offers health care for low-income people. Today, President Johnson's twin programs cover more than a third of Americans.
President Bill Clinton taps FLOTUS Hillary Clinton to overhaul the US healthcare system. Say hi to Hillarycare. Her goal was health care for everyone. The plan required all companies to pay most of their employee insurance costs. It aimed to set up state insurance purchasing groups that would collect the monthly bills owed by consumers and businesses. These groups would also guarantee health coverage for everyone living in the state. The feds would monitor insurance costs including drug prices. If you don't follow, it's OK. Neither did a lot of people. Meanwhile, doctors, hospitals, and unions countered with a simple message: ‘let's keep the government out of our health care, shall we?' Voters – and lawmakers – agreed. No deal.
The Big D. President George W Bush wants to do something about the rising costs of prescription drugs for seniors. Enter: Medicare Part D. The good news? It extends prescription drug coverage for people on Medicare. The not-so-good news? Lobbyists convinced lawmakers to add a clause preventing the feds from negotiating discounts with drug companies. So nothing is really done to address rising costs...this just shifts who's footing the bill.
Heeeeere comes Mittens. Then-Massachusetts Gov. Mitt Romney (R) decides to come up with a state health care law to insure more people in his state and drive down costs. Here's what he and his advisors come up with: everyone has to buy health insurance. Those who can't afford it will get an assist from the state government. Those who can't get coverage where they work get it from a state exchange. If this sounds vaguely familiar, that's because it is. Go on…
Sen. Max Baucus (D, MT), who's been cooking up a bipartisan healthcare reform bill for months, organizes a summit on Capitol Hill. It's like one big therapy session for lawmakers, their staff, lobbyists, policy makers, etc. The goal: talk out how American health care got so effing expensive, and figure out what to do about it. Lawmakers on both sides of the aisle agree it's time for an overhaul.
Barack Obama gets a new job. And – even though the American economy has the flu – the president-elect also decides to make healthcare reform a top priority. After taking office, he gives the green light to Congress to continue working on a bipartisan bill.
TIME OUT: By this point, more than 43 million Americans don't have health coverage. And many more are losing their plans with thanks to the financial crisis. People with pre-existing conditions like diabetes and asthma are getting priced out of the market since very few insurance companies want to pay for their care. People paying for the cheapest plans realize that they're barely covered for anything at all. Tl;dr: it's a hot mess.
Sips tea. A lot of people felt shut out by the secrecy of the administration's writing process. Critics say Obama is planning a new, expensive, government-run entitlement system like Medicare and Medicaid. More government intervention is NOT popular, just months after taxpayers bailouts due to the financial crisis. So when Obama's team kicked off a yearlong process of hearings and debates, lots of people showed up angry. Which got broadcast all over cable TV. Cue HUGE Tea Party rallies pushing back against Big Government.
The Patient Protection and Affordable Care Act – aka Obamacare – passes Congress. Obama signs on the dotted line. The final law borrowed heavily from Mitt Romney's plan for Massachusetts…
• Obamacare expands Medicaid funding to states to cover more low-income Americans.
• It creates insurance exchanges where Americans can shop for health care plans.
• And it requires basically all Americans to have health insurance or pay a fine – aka the 'individual mandate'.
Republicans take control of the House of Representatives in the midterm elections, in big part thanks to promises to repeal and replace Obamacare.
The Supreme Court rules on a case questioning whether Obamacare's "individual mandate" – requiring you to get insurance or pay a fine – is constitutional. The entire law hinges on this mandate, since healthy and sick people all need to be buying into the system for it to function. The Supremes give the thumbs up to the mandate, and Obamacare supporters exhale loudly.
Healthcare.gov – aka the federal exchange where ‘Murica can shop for health care – says ‘helloooo world.' And promptly falls on its face. Tech glitches prevent lots of people from signing up for plans. Oh, and around the same time, the government shuts down because Republicans don't want to OK a federal budget that includes funding for Obamacare. Great mood music.
Donald Trump gets a new job. On the campaign trail, he promised to repeal and replace Obamacare with a plan that would provide insurance for all. He also promised that there would be no cuts to Medicare and Medicaid.
House GOP leaders unwrap a plan for repealing and replacing Obamacare. It would get rid of the individual mandate requiring everyone to have insurance. It would help people pay for coverage with age and income-based tax credits, rather than income-based subsidies. And it would pull back on funding for Medicaid. Some GOP lawmakers worry it isn't conservative enough. Others worry about estimates that tens of millions of people would be bounced off their health care plans. A few weeks later, the bill is killed.
Take two. Ever since the House health care reform bill failed, GOP leaders have been tweaking it to get enough Republicans on board for it to pass. And they finally get it over the finish line. It includes...
• Lets states decide whether "essential benefits" required under Obamacare still need to be covered. This could drive down costs for some
• Makes it legal for insurance companies to charge more to people with pre-existing conditions, meaning a health issue you had before getting coverage
• Temporarily withholds Medicaid reimbursement funding for Planned Parenthood services
• Cuts funding for Medicaid – the program that covers low-income people
A few weeks later, the Congressional Budget Office estimated that the new bill will still leave tens of millions of people without coverage.
Senate GOP leaders give it a go. Their version was supposed to be a total 180 from the House plan...but not so much. Plus it was crafted mostly behind closed doors. Leading some to say, 'hypocritical much?' since that was a big GOP criticism of Obama's process. Here are the highlights of the bill:
• Cuts the 'individual mandate.' But makes people who go without health insurance for nearly two months wait another six months for their insurance to work once they opt back in
• Caps funding for Medicaid. And phases out how much the gov will pay states that extended Medicaid coverage
• Ties tax credits – the ones that help people pay for coverage – to income instead of just age. But fewer people would be eligible to get them
• Cuts taxes on high-income Americans that help pay for Obamacare
• Keeps the Obamacare rule that insurance companies can't charge people more if they have pre-existing conditions. But includes waivers that would let insurance providers offer plans that don't cover essential benefits (think: maternity care, emergency services)
The Senate GOP failed to approve the House's plan. And they've been trying to pass something of their own ever since. There was the 'repeal and replace in two years' plan. There was the 'Skinny Repeal' plan. Now, there's the Graham-Cassidy plan. TBD on whether anything will stick.
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