Timeline: History of Health Reform in the U.S

VIEW:

Timeline: History of Health Reform in the U.S.Early 1900's 1930 – 1934 1935 – 1939 1940 - 1945 1945 - 1949 1950 - 1954 1955 - 1959 1960 – 1964 1965 – 1969

1970 - 1974 1975 – 1979 1980 - 1984 1985 - 1989 1990 – 1994 1995 - 1999 2000 – 2004 2005 – 2009 2010

1912Teddy Roosevelt and hisProgressive party endorsesocial insurance as part oftheir platform, including healthinsurance.

1912National Convention of Insurance Commissionersdevelops first model of state law for regulating healthinsurance.

1915The American Association for Labor Legislation(AALL) publishes a draft bill for compulsory healthinsurance and promotes campaigns in several states.A few states show interest, but fail to enact as U.S.enters into World War I. The idea draws initialsupport from the AMA, but by 1920 AMA reversestheir position.

1921Women reformers persuade Congress to pass theSheppard-Towner Act, which provided matchingfunds to states for prenatal and child health centers.Act expires in 1929 and is not reauthorized.

1927Committee on the Costsof Medical Care forms tostudy the economicorganization of medicalcare. Group is comprisedof economists,physicians, public healthspecialists, and other

major interest groups. Recommendations werecompleted by 1932. While some members would notsupport the recommendation for medical grouppractice, the majority did endorse the idea, alongwith voluntary health insurance.

1929Baylor Hospital introducesa pre-paid hospitalinsurance plan for agroup of school teachers,which is considered theforerunner of futurenonprofit Blue Crossplans.

1929Great Depression years begin.

Early 1900's

1930 – 1934National Health Insurance and the New DealHard economic times called for social policies to secure employment, retirement, and medical care. PresidentRoosevelt appointed a committee to work on all these issues, but in the end did not risk the passage of theSocial Security Act to advance national health reform.

1929-39The Great Depression spans a decade, with 1933-34being the worst years.

1934FDR creates Committee on Economic Security toaddress old-age and unemployment issues, as wellas medical care and insurance.

For an overview on National Health Insurance and the New Deal, please see p. 2 of National HealthInsurance: A Brief History Of Reform Efforts In The U.S.

1935Committee on Economic Security issues finalrecommendations, none of which explicitly addressnational health insurance; however principles ofhealth reform are outlined. Committee later issuesunpublished report "Risks to Economic SecurityArising Out of Illness."

1935Social Security Actpassed by Congress. TheAct includes grants forMaternal and ChildHealth. These grantsrestored many of theprograms establishedunder the Sheppard-

Towner Act and extended the role of the Children’sBureau to include not only maternal and child healthservices, but other child welfare services as well.

1935FDR forms Interdepartmental Committee toCoordinate Health and Welfare Activities.

Learn more about the InterdepartmentalCommittee.

1935-36National Health Survey conducted under the auspicesof the U.S. Public Health Service to assess thenation's health and the underlying social andeconomic factors affecting health – the forerunner tothe National Health Interview Survey of today.

1937Technical Committee on Medical Care establishedunder Interdepartmental Committee to CoordinateHealth and Welfare Activities; publishes its report, ANational Health Program in 1938.

1938National Health Conference convened in Washington,D.C.

1939Sen. Wagner introduces National Health Billincorporating recommendations from the NationalHealth Conference. Proposal dies in committee.

1935 – 1939National Health Insurance and the New DealPresident Roosevelt continued to support national health reform throughout his terms. His second push fornational health insurance came after the Social Security Act passed. However, the momentum from FDR’sTechnical Committee on Medical Care and a National Health Conference were not enough to overcome aCongress that was no longer supportive of further government expansions.

For an overview on National Health Insurance and the New Deal, please see p. 2 of National HealthInsurance: A Brief History Of Reform Efforts In The U.S.

1939Physicians start to organize the first Blue Shield plansto cover the costs of physician care.

1939Department of Health and Human Services born asthe Federal Security Agency bringing together federalagencies concerned with health, welfare, and socialinsurance.

1943War Labor Board rules wage freeze does not apply tofringe benefits, including health insurance benefits.

1943Senators Wagner and Murray, along withRepresentative Dingell introduce legislation as part ofbroader vision to operate health insurance as part ofsocial security. Wagner-Murray-Dingell bill includesprovisions for universal comprehensive healthinsurance along with other changes to social securitymeant to move toward system of "cradle to grave"social insurance.

1944FDR outlines 'economic bill of rights' including rightto adequate medical care and the opportunity toachieve and enjoy good health in his State of theUnion address.

Access the text of FDR's 1944 State of the Unionaddress.

1944Social Security Board calls for compulsory nationalhealth insurance as part of the Social Securitysystem.

1940 - 1945

1946Truman sends health message to Congress. RevisedWagner-Murray-Dingell bill introduced to Congressagain. An alternative Senate bill (Taft-Smith-Ball bill)authorizes grants to states for medical care of thepoor. Neither bill gains traction.

1946Hill-Burton Act (Hospital Survey and ConstructionAct) to fund the construction of hospitals passes. Italso prohibits discrimination on the basis of race,religion, or national origin in the provision of hospitalservices, but allowed for "separate but equal"facilities. The statute also required hospitals toprovide a "reasonable volume" of charitable care.

1947Truman, in another special message to Congresscalls for a National Health Program. Wagner-Murray-Dingell bill and Taft bill both reintroduced.

1948National Health Assembly convened in Washington,D.C., by the Federal Security Agency. Final reportendorses voluntary health insurance, but reiteratedneed for universal coverage.

1948AMA launches a national campaign against nationalhealth insurance proposals.

1949Supreme Court upholds National Labor RelationsBoard ruling that employee benefits can be includedin collective bargaining.

1945 - 1949National Health Insurance and the Fair DealPresident Truman picked up the mantle for a national health program just months after the end of World WarII. His election in 1948 appeared to be a mandate for national health insurance, but the opposition, using fearof socialism, coupled with the power of southern Democrats who believed a federal role in health care mightrequire desegregation, effectively blocked all proposals.

For an overview on National Health Insurance and the Fair Deal, please see p. 3 of National HealthInsurance: A Brief History Of Reform Efforts In The U.S.

1950National Conference on Aging is convened by FederalSecurity Agency.

1951Joint Commission on the Accreditation of Hospitals(JCAH) formed to improve the quality of hospital carethrough the voluntary accreditation of hospitals.

1952Federal Security Agency proposes enactment ofhealth insurance for Social Security beneficiaries.

1953Federal Security Agency made a cabinet level agency,renamed Department of Health Education andWelfare (DHEW).

1954President Eisenhower proposes a federal reinsurancefund to enable private insurers to broaden thegroups of people they would cover.

1954Revenue Act of 1954 excludes employers'contributions to employee's health plans from taxableincome.

1956Military "medicare" program enacted, providinggovernment health insurance for dependents ofthose in the Armed Forces.

1956Legislation introduced in the House (the Forand bill)to provide health insurance for social securitybeneficiaries; reintroduced again in 1959.

1957AFL-CIO decides to support government healthinsurance, while the AMA reiterates opposition tonational health insurance.

1957First year that the National Health Interview Surveywas conducted; survey has been continuously fieldedever since.

1950 - 1954

1955 - 1959

1960 – 1964The Great Society – Medicare and MedicaidThe groundwork for the enactment of Medicare and Medicaid began in the late 1950s and early 1960s. Asemployer-based health coverage grew, private plans began to set premiums based on their experience withhealth costs and the retired and disabled found it harder to get affordable coverage. Health reformersrefocused their efforts toward the elderly.

For an overview of this era in health reform history, please see p. 4-5 of National Health Insurance: ABrief History Of Reform Efforts In The U.S.

1960Federal Employees Health Benefit Plan (FEHBP)initiated to provide health insurance coverage tofederal workers.

1960Kerr-Mills Act passes, using federal funds to supportstate programs providing medical care to the poorand elderly; a precursor to the Medicaid program.

1961White House Conference on Aging is held inWashington, D.C. Presidential task force recommendshealth insurance for the elderly under Social Securityand President Kennedy sends special message toCongress on health. Rep. King and Sen. Andersonintroduce a bill to create a government healthinsurance program for the aged; King-Anderson billdraws support from organized labor, intenseopposition from the AMA and commercial healthinsurance carriers.

1962President Kennedy addresses the nation on Medicarethat is televised from Madison Square Garden. AMAissues televised rebuttal.

Read text of President Kennedy's address atMadison Square Garden.

1963Kennedy sends special message to Congress onneeds of the elderly. King-Anderson billre-introduced.

1964President Johnson advocates for Medicare in aspecial message to Congress.

1964Civil Rights Act passes.

19651965 TheMedicare andMedicaidprograms aresigned into law.Medicare Part A isto pay forhospital care and

limited skilled nursing and home health care.Optional Medicare Part B is to help pay for physiciancare. Medicaid is a separate program to assist statesin covering not only long-term care for the poor butalso to provide health insurance coverage for certainclasses of the poor and disabled.

Learn more about the history of the Medicareprogram.

Access the transcript of President Johnson'sremarks at his signing of Medicare and Medicaid.

For other historical materials visit the Foundation'sMedicare and Medicaid at 40.

1965Neighborhood health centers (precursors to FederallyQualified Health Centers or FQHCs) are establishedas part of the Office on Economic Opportunity toprovide health and social services to poor andmedically underserved communities.

Access an overview of the role of communityhealth centers.

1967Social Security amendments pass, adding optionalMedicaid categories to insure others who are notreceiving cash assistance. Early and PeriodicScreening and Diagnostic Testing (EPSDT) benefitsare also added to Medicaid.

Access the Foundation's fact sheet on the EPSDTbenefit.

1965 – 1969The Great Society – Medicare and MedicaidMedicare and Medicaid were incorporated under the Social Security Act and signed by President Johnson in1965 with Truman by his side. The combination of Johnson’s political skills, a large Congressional Democraticmajority, public approval, the support of the hospital and insurance industries, and the fact that no governmentcost controls or physician fee schedules were enacted contributed to the passage of the most significant healthreform of the century.


1970 - 1974

1971Wage and price freezes begin, with medical caresingled out for specific limits on annual increases inphysician and hospital charges. Medical care limitsare not lifted until 1974, over a year after othercontrols had ended.

1972Supplemental Security Income (SSI) program beginsproviding cash assistance to elderly and disabled.States are required to cover SSI recipients or applytheir 1972 Medicaid eligibility standards for the twogroups for coverage under Medicaid.

1972Social Security amendments pass allowing peopleunder age 65 with long-term disabilities and endstage renal disease (ESRD) to qualify for Medicarecoverage. Those with long-term disabilities must waitfor two years before qualifying for Medicare.

1974Hawaii Prepaid Health Care Act passes requiringemployers to cover any employee working more than20 hours/week. In 1989 Hawaii added their StateHealth Insurance Program to cover "the gap group":those not eligible for Medicaid or employer-basedinsurance.

1974Employee Retirement Income Security Act (ERISA)exempts self-insured employers from state healthinsurance regulations. Hawaii's new employermandate is given an exemption from ERISA.

1974Enactment of Health Planning ResourcesDevelopment Act, mandating states to develophealth planning programs to prevent duplication ofservices. Results in the widespread adoption ofCertificate of Need programs.

Competing National Health Insurance ProposalsGeneral inflation and unchecked health care costs were a growing concern by the early 1970s. Sen. Kennedy’sproposal for national health insurance was countered by President Nixon’s own Comprehensive HealthInsurance Plan (CHIP). Other Congressmen wrote more incremental plans, all of which splintered support forany one reform. Action on national health insurance was eventually overshadowed by the Watergate hearingsand Nixon’s resignation. While President Ford supported national reform in 1974 and Rep. Mills drafted yetanother compromise bill, its progress stalled without Mills' leadership following a personal scandal.


Access the transcript and audio recording of President Nixon's radio address concerning CHIP.

1977Health Care Financing Administration (HCFA)established within Department of Health, Education,and Welfare (HEW).

Interview with Secretary Califano on theestablishment of HCFA Watch Video

1977President Carter proposes Medicaid expansion(Children's Health Assessment Program) for poorchildren under age 6; proposal fails to come to avote in Congress.

1977National Medical Care Expenditure Surveys (NMCES)conducted surveying households, their physicians,and health insurers – provides first detailed data onindividuals' health care costs.

1975 – 1979Cost-Containment Trumps National Health InsuranceIn the face of stagflation and rapidly rising health care costs, President Carter prioritizes health care costcontainment over expanding coverage. Sen. Kennedy, however, drafts another national health insuranceproposal, which is then followed by Carter's own plan that would delay implementation until 1983. Nationalhealth reform efforts were completely stalled in the face of an economic recession and uncontrollable healthcare costs.


1980Department of Health, Education, and Welfarerenamed the Department of Health and HumanServices (DHHS).

1981Federal budget reconciliation (OBRA 81) requiresstates to make additional Medicaid payments tohospitals who serve a disproportionate share ofMedicaid and low-income patients. It also repeals therequirement that state Medicaid programs payhospital rates equivalent to those paid by theMedicare program. Requires states to pay nursinghomes at rates that are "reasonable and adequate"under the Boren Amendment (applied to hospitalsthe following year).

1981Two types of Medicaid waivers are established undera budget reconciliation act (OBRA 81) allowing statesto mandate managed care enrollment of certainMedicaid groups and to cover home andcommunity-based long-term care for those at risk ofbeing institutionalized.

1982States allowed to expand Medicaid to children withdisabilities who require institutional care but can becared for at home and would not otherwise qualifyfor Medicaid if not institutionalized; popularlyreferred to as the Katie Beckett option for thedisabled child who garnered national attention on theissue.

1983Medicare introduces Diagnostic Related Groups(DRGs) as a prospective payment system for hospitalpayment.

1980 - 1984

1986Emergency Medical Treatment and Active Labor Act(EMTALA) requires hospitals participating in Medicareto screen and stabilize all persons who use theiremergency rooms regardless of ability to pay.

1986COBRA (Consolidated Omnibus Budget ReconciliationAct) contains specific regulations that allowemployees who lose their jobs to continue with theirhealth plan for 18 months.

1986Federal budget reconciliation (OBRA 86) gives statesMedicaid option to cover infants, young children andpregnant women up to 100% of the poverty levelregardless of whether they receive public assistance.Raised to 185% of the poverty level in legislation forinfants and pregnant women the following year.OBRA 86 also allowed state Medicaid programs topay Medicare premiums and cost sharing for qualifiedMedicare beneficiaries under 100% of poverty(QMBs). (This was later required in 1989 andincreased to certain Medicaid beneficiaries at 120%of poverty in 1990).

1987Census Bureau begins annual estimate of healthinsurance coverage in the United States with itsCurrent Population Survey finds 31 million uninsured(13% of the population) in 1987.

1987National Medical Expenditure Survey (NMES), builton the NMCES 1977, is conducted with householdinformation supplemented by surveys of medical andhealth insurance providers used by respondents.

1988Medicare Catastrophic Coverage Act (MCCA) expandsMedicare coverage to include prescription drugs anda cap on beneficiaries' out-of-pocket expenses.However, many believed the costs that were to beborn by the elderly outweighed the benefits.Responding to the ground swell of negative reaction,the MCCA is repealed the following year, retractingthese major provisions. However, the requirementthat states pay Medicare premiums and cost-sharingamounts for poor beneficiaries through Medicaid ismaintained.

Learn more on the repeal of MCCA.

1988The Family Support Act requires states to extend 12months of transitional Medicaid coverage to familiesleaving welfare due to earnings from work.

1989Federal budget reconciliation (OBRA 89) mandatescoverage for pregnant women and children underage 6, at 133% of the federal poverty level.

1985 - 1989

1990 – 1994The Health Security ActMaking national health reform a priority early in his Presidency, Clinton proposed a "managed competition"approach, sending a detailed plan to Congress in 1993. It called for universal coverage, employer andindividual mandates, competition between insurers, with government regulation to control costs. Support fromkey stakeholders was often limited and conditional. The opposition was led largely by two groups: the HealthInsurance Association of America and the National Federation of Independent Businesses, both believingreform would create hardship for their smaller members. Congressional Democrats were divided in theirsupport, and further splintered by a variety of alternative proposals that were then generated all of whichblocked progress on the President's plan.

1990Federal budget reconciliation (OBRA 90) legislationmandates Medicaid coverage of children age 6-18under poverty level, phased in one year at a timeuntil 2002.

1990National Committee on Quality Assurance (NCQA)forms to accredit managed care health plans.

1993Within his first week in office President Clintonconvenes White House Task Force on Health Reform,and appoints First Lady Hillary Clinton as chair.

1993President Clinton's proposal, named the HealthSecurity Act, is introduced in both houses ofCongress in November, but gains little support. EveryAmerican would have a "Health Security Card" toensure access to care.

1993The Clinton Administration begins approvingMedicaid waivers allowing more statewide expansiondemonstrations. Many states turned to managed carefor delivery of services and used savings to expandto previously uninsured groups.

1993The Vaccines for Children program providing federallypurchased vaccines to states is established.

1993Health Insurance Association of America beginsairing "Harry and Louise" television advertisementsportraying a middle-class couple worried abouthealth care under the Clinton health plan.

1993Other national health reform proposals areintroduced in Congress, but also fail to garnersufficient support for passage -- theMcDermott/Wellstone single payer health insuranceproposal and Cooper's proposal for managedcompetition without a guarantee of universalcoverage. By mid-1994 even a bipartisan bill toexpand coverage without comprehensive reform isunable to pass.


1996Health Insurance Portability and Accountability Act(HIPAA) restricts use of pre-existing conditions inhealth insurance coverage determinations, setsstandards for medical records privacy, andestablishes tax-favored treatment of long-term careinsurance.

1996Personal Responsibility and Work Opportunity Actdelinks Medicaid and cash assistance eligibility andallows states to cover parents and children at currentAid to Families with Dependent Children (AFDC)levels and higher. Bans Medicaid coverage of legalimmigrants within their first five years in the country,except for emergency care.

Access resources on Welfare, Work, andHealth Care.

1996Mental Health Parity Act enacted that prohibits grouphealth plans from having lower annual or lifetimedollar limits for mental health benefits than medicalor surgical benefits (except substance abuse andchemical dependency).

1996Medical Expenditure Panel Survey (MEPS) isconducted. Unlike its survey predecessors, the 1977NMCES and 1987 NMES, MEPS is designed to beongoing, providing annual updates on healthinsurance coverage, access to care, utilization ofhealth services and their costs.

1997Census Bureau's Current Population Survey estimates42.4 million (15.7% of the population) uninsured inthe United States.

Balanced Budget Act includes many changes inprovider payments to slow the growth in Medicarespending. It establishes the Medicare + Choiceprogram, a new structure for Medicare HMOs andother private plans offered to beneficiaries, laterre-named Medicare Advantage in 2003.

1997Also part of the Balanced Budget Act (BBA), theState Children's Health Insurance Program (S-CHIP)is enacted. Provides block grants to states allowingfor coverage of low-income children above Medicaideligibility levels. BBA also allows states to coverworking disabled with incomes up to 250% ofpoverty, permits mandatory Medicaid enrollment inmanaged care and repeals the Boren amendment.

1999Ticket to Work and Work Incentives ImprovementAct of 1999 allows states to cover working disabledwith incomes above 250% of poverty and imposeincome-related premiums.

1995 - 1999

2000Breast and Cervical Cancer Treatment and PreventionAct of 2000 allows states to provide Medicaidcoverage to uninsured women for treatment ofbreast or cervical cancer if they have been diagnosedthrough a CDC screening program, regardless ofincome or resources.

2002President Bush launches Health Center GrowthInitiative significantly expanding the number ofcommunity health centers serving the medicallyunderserved.

Learn more about the role of community healthcenters in communities..

2003Maine passes the Dirigo Health Reform Act, acomprehensive health care reform plan, that createsthe DirigoChoice health plan, providing subsidizedcoverage to individuals and small employers,expands Medicaid, and creates the Maine QualityForum.

2003Medicare Drug, Improvement, and Modernization Act(MMA) passes, creating a voluntary, subsidizedprescription drug benefit under Medicare,administered exclusively through private plans, bothstand-along prescription drug plans and MedicareAdvantage plans.

2003Medicare legislation creates Health Savings Accountswhich allow individuals to set aside pre-tax dollars topay for current and future medical expenses. Theplans must be used in conjunction with a highdeductible health plan.

2000 – 2004

2005Deficit Reduction Act of 2005 makes significantchanges to Medicaid related to premiums and costsharing, benefits, and asset transfers.

2006Medicare Part D Drug benefit goes into effect inJanuary.

2006Massachusetts passes and implements legislation toprovide health care coverage to nearly all stateresidents. Legislation requires residents to obtainhealth insurance coverage and calls for sharedresponsibility among individuals, employers, and thegovernment in financing the expanded coverage.Within two years of implementation the state'suninsured rate is cut in half.

Learn more about Massachusetts health reform:Fact Sheet

News Clips

2006One month following Massachusetts, Vermont passescomprehensive health care reform also aiming fornear-universal coverage. In addition to creating theCatamount Health Plan for uninsured residents, theplan focuses on improving overall quality of care andthe management of chronic conditions through theBlueprint for Health.

Learn more about Vermont's health reform.

2006City of San Francisco creates the Healthy SanFrancisco program, providing universal access tohealth services in the city for residents. Acontroversial provision requiring city employers tospend a minimum amount per hour on healthcare fortheir employees is challenged in court. In September2008, the U.S. Ninth Circuit Court of Appeals upholdsthe employer requirement saying it does not violatethe Employee Retirement and Income Security Act of1974 (ERISA).

Learn more about San Francisco's plan.

2007Senators Wyden and Bennett introduce the HealthyAmericans Act. Proposal would require individuals toobtain private health insurance coverage throughstate health insurance purchasing pools. Thelong-standing favorable tax treatment of employer-sponsored insurance premiums would be eliminated.Legislation gains some bipartisan support.

2005 – 2009

2007Census Bureau estimates 45.6 million uninsured(15.3% of the population) in 2007. Surveyinstrument undergoes periodic design improvementsover the years that confound trend analyses, yetremains the most widely used estimate of healthinsurance coverage.

For more on the nation's uninsured see theFoundation's fact sheet and primer on theuninsured.

President Bush announces health reform plan thatwould replace the current tax preference foremployer-sponsored insurance with a standardhealth care deduction. Proposal is not acted upon byCongress.

2007Congress passes two versions of a bill to reauthorizethe State Children’s Health Insurance Program withbi-partisan support, but President Bush vetoes bothbills and Congress cannot override the veto. Atemporary extension of the program is passed inDecember 2007.

2007California fails in its attempt to pass a health reformplan with an individual mandate and sharedresponsibility for financing the costs. Compromiselegislation supported by the Governor passes theAssembly, but falls short in the Senate.

2008Mental Health Parity Act amended to require fullparity. Insurance companies must treat mental healthconditions, including substance abuse disorders, onan equal basis with physical conditions when healthpolicies cover both.

2008Presidential campaign focuses early on nationalhealth reform, overshadowed later by housing crisisand economic downturn, yet remains a keypocketbook issue throughout the campaign. Bothmajor party candidates announce comprehensivehealth reform proposals.

2008Sen. Baucus, Chairman of the Senate FinanceCommittee, releases White Paper on health reformoutlining a national health reform plan based on theMassachusetts model.

2009President Obama establishes Office of Health Reformto coordinate administrative efforts on nationalhealth reform.

2009The Children's Health Insurance Program (CHIP) isreauthorized, providing states with additionalfunding, new tools land fiscal incentives to helpreach and estimated 4.1 million children throughMedicaid and CHIP who otherwise would have beenuninsured by 2013.

Learn more about the program's reauthorizationhistory.

Learn more about the role Medicaid and SCHIP play

2009The American Reinvestment and Recovery Act(ARRA) makes substantial investments to helpdevelop health information technology, expand theprimary care workforce and conduct research oncomparative effectiveness for health care treatmentoptions.

2009White House holds a Health Reform Summit with key

in covering low-income children: EnrollingUninsured Low-Income Children in Medicaidand SCHIP andHealth Coverage of Children: The Role ofMedicaid and SCHIP

stakeholders.

2009President Obama releases FY 2010 budget whichoutlines eight principles for health reform andproposes a set aside of 634 billion in a health reformreserve fund.

2009Congress continues to deliberate national healthreform options.

February 22, 2010The White House releases President Obama'sproposal for health care reform that bridgeselements of the House and Senate bills passed in thelast months of 2009.

February 25, 2010President Obama hosts a second Health CareSummit at Blair House. Little consensus achievedbetween the Democrats and Republicans

March 3, 2010In a White House speech President Obama laysout his proposal and provides legislative directionindicating that if need be, the reconciliation process(requiring a Senate majority vote vs. 60 votes topass) should be used to pass major health reformlegislation.

March 21, 2010The House of Representatives passes the Senate bill,the Patient Protection and Affordable Care Act(voting 219-212) and sends it to the President forsignature.

House also passes the Health Care and EducationReconciliation Act of 2010 that amends the Senatebill to reflect House and Senate negotiations and alsoincludes reform of the nation's student loan system.The reconciliation bill is sent to the Senate for a finalvote.

Official summary of the Senate bill.

An official summary of the reconciliation bil

March 23, 2010

President Obama signs the landmark legislation, thePatient Protection and Affordable Care Act (P.L.111-148) at the White House, surrounded bylegislative leaders and invited guests, including somewho have suffered from lack of health coverage.

The historic health reform legislation requires that allindividuals have health insurance beginning in 2014.

The poorest will be covered under aMedicaid expansion.Those with low and middle incomes who donot have access to affordable coveragethrough their jobs will be able to purchasecoverage with federal subsidies through new"American Health Benefit Exchanges."Employers are not mandated to providehealth benefits, however large businesseswhose employees receive insurancesubsidies will pay penalties. Small businesseswill be able to access more plans through aseparate Exchange.Health plans will not be allowed to deny

2010

National Health Reform Enacted

coverage to people for any reason, includingtheir health status, nor can they chargemore because of a person's health or gender.Young adults will now have the option ofbeing covered under their parents' plan up toage 26.

President Obama's speech at the signing

March 25, 2010Senate passes final version of the Health Care andEducation Reconciliation Act of 2010 with twoeducation-related changes to the House bill (voting56-43). House votes on the bill as amended by theSenate (voting 220-207).

March 30, 2010President Obama signs the Health Care andEducation Reconciliation Act of 2010 (becoming P.L.111-152) at the Northern Virginia CommunityCollege amending P.L. 111-148.

For a summary of the key provisions:www.kff.org/healthreform/upload/8023-R.pdf

Check out our implementation timeline, aninteractive tool designed to explain how and whenthe provisions of the health reform law will beimplemented over the next several years.

Documents

Timeline: History of Health Reform in the U.S