Trump hasn't specified what the Affordable Care Act would be replaced with, however. And the challenge will be to improve options and costs while keeping as many Americans as possible signed up.
In 2013, before Obamacare took effect, roughly 17 percent of Americans had no health insurance, according to Gallup. As of 2016, at the end of President Barack Obama's term, that was down to 11 percent.
In a Rasmussen Reports survey released in January, 56 percent of Americans said that Congress and the president should "go through the law piece by piece and improve it." Only 30 percent favored total repeal.
For more than a century, presidents and presidential candidates have discussed and debated proposals aimed at making health care affordable and accessible. Here is an update of an article we ran in 2015 on presidents and the history of health care reform:
Theodore Roosevelt (president, 1901-1909)
Roosevelt is often cited for his ideas on everything from a robust foreign policy to environmental preservation. His term ended in 1909, but in 1912, he again ran for office as a Progressive Party candidate. Here are two lines from his platform: “The supreme duty of the nation is the conservation of human resources through an enlightened measure of social and industrial justice. We pledge ourselves to work unceasingly in State and Nation for: … The protection of home life against the hazards of sickness, irregular employment and old age through the adoption of a system of social insurance adapted to American use. …” Roosevelt lost the election.
President Franklin D. Roosevelt (president, 1933-1945)
The Social Security Act of 1935 contained old-age insurance, unemployment compensation and maternal and child health -- but not health insurance, according to Centers for Medicare and Medicaid Services. Some officials in FDR's administration wanted to include health insurance, but Roosevelt thought that would be too controversial, according to the centers.
This is not to say Roosevelt forgot about it. Four years later, in 1939, Roosevelt gave a message to Congress spelling out his vision for health care. And on Jan. 11, 1944, during his State of the Union address, he proposed "a second Bill of Rights" that included, "The right to adequate medical care and the opportunity to achieve and enjoy good health." He died April 12, 1945.
"The health of American children, like their education, should be recognized as a definite public responsibility," Truman said in a message to Congress in 1945. But not everyone agreed, and the ensuing political donnybrook quickly turned nasty, according to the website for the Harry S. Truman Library and Museum. Truman's proposal included a national health insurance plan. The American Medical Association attacked the bill, characterizing it as socialized medicine and “called Truman White House staffers ‘followers of the Moscow party line,’” the website recounted. It added that while Truman was unsuccessful, he managed to publicize the issue.
The following year, the Hill-Burton Act funded construction of rural hospitals. The act was named for its sponsors in the U.S. Senate, Lister Hill, a Democrat from Alabama, whose physician father was the first American to suture a human heart, and Harold Burton, a republican from Ohio, according to the Center on Congress at Indiana University. Facilities getting federal money were to provide medical services free or at a reduced rate for those unable to pay.
Lyndon B. Johnson (president, 1963-1969)
Fifty years ago, July 30, 1965, President Lyndon Johnson signed Social Security amendments establishing Medicare and Medicaid. [See an account at the Lyndon B. Johnson Library website.] Medicaid is a “joint federal and state program that helps with medical costs for some people with limited income and resources,” according to the Medicare.gov website. Medicare is the “federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease."
In an effort to reduce health care costs, Nixon signed the Health Maintenance Organization Act. "Expanding the geographic distribution of health maintenance organizations is an integral part of the National Health Strategy that I first proposed nearly three years ago," he said, when signing the act in 1973. The act was "somewhat broader than the administration's proposal, but it nevertheless contains the essential concepts and principles that I support. It will provide initial federal development assistance for a limited number of demonstration projects, with the intention that they become self-sufficient within fixed periods."
Nixon recognized that it wasn't a total fix: "The major task of providing financial access to health services should be addressed in the next session of this Congress with the enactment of an appropriate and responsive national health insurance act."
But Nixon's energies were consumed by the Watergate scandal.
Ronald Reagan (president, 1981-1989)
The Consolidated Omnibus Budget Reconciliation Act of 1985 contained a provision that continued health coverage temporarily for people who became unemployed. Known as COBRA, its provisions mandate that the former employee pick up the tab. Here is an explanation from the U.S. Department of Labor's website: "Your group health plan can require you to pay for COBRA continuation coverage. The amount charged to qualified beneficiaries cannot exceed 102 percent of the cost to the plan for similarly situated individuals covered under the plan who have not incurred a qualifying event. In determining COBRA premiums, the plan can include the costs paid by employees and the employer, plus an additional 2 percent for administrative costs."
Bill Clinton (president, 1993-2001)
Clinton put his wife, Hillary, in charge of a task force to reform health care. “This had been a major campaign promise,” wrote William A. DeGregorio and Sandra Lee Stuart in The Complete Book of Presidents (Barricade Books; 2013). “The plan, when finally presented, was criticized by Democrats as well as Republicans and was quickly killed in Congress.”
In 1997, The State Children's Health Insurance Program (SCHIP), a partnership between the federal and state governments, was approved as part of the Balanced Budget Act. It provided health coverage for children whose families earned too much to qualify for Medicaid, but too little to afford private coverage, according to the U.S. Department of Health and Human Services.
In 2003, Bush signed Medicare reform legislation that included prescription drug benefits. The Medicare Prescription Drug, Improvement and Modernization Act of 2003 changed the Medicare program, notably to encompass an outpatient prescription drug benefit, recounts the Centers for Medicare and Medicaid services. Administration officials predicted a price tag of $400 billion to $500 billion over a 10-year period. Two years later, The Washington Post reported that the benefit would cost more than $1.2 trillion in the decade to come.
President Barack Obama (president, 2009-2017)
After he took office in 2009, Obama pursued health care legislation modeled after a Massachusetts plan put into effect under Mitt Romney, a Republican who served as the state's governor. The plan uses health care exchanges set up in each state, along with subsidies for people who could not afford insurance. Those with pre-existing conditions are insured, and anyone under the age of 26 can remain insured through a parent's plan.
In 2015, a U.S. Supreme Court decision upheld government subsidies considered the linchpin of the program championed by Obama.
In a 6-3 decision, Chief Justice John Roberts wrote that Congress “passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.”
The act, passed in 2010, remains the signature achievement of Obama, who tweeted that since the act was approved, 16 million Americans have gained health coverage.
Obama also noted the history of health reform in remarks delivered after the Supreme Court decision was handed down June 25: “Five years ago, after nearly a century of talk, decades of trying, a year of bipartisan debate, we finally declared that in America, health care is not a privilege for a few but a right for all.”
Sources:
- U.S. Supreme Court opinions: King V. Burwell.
- WhiteHouse.gov: The President speaks on the Supreme Court's ruling on the Affordable Care Act.
- PBS, The American Experience: Progressive Party Platform, 1912.
- Centers for Medicare and Medicaid Services: Tracing the History of CMS Programs.
- The Presidency Project, University of California, Santa Barbara: Franklin D. Roosevelt, Message to Congress on the National Health Program, Jan. 23, 1939.
- The Presidency Project, University of California, Santa Barbara: State of the Union Message to Congress, Jan. 11, 1944.
- Truman Library: President Truman's Proposed Health Program.
- AnnenbergClassroom.org, the Leonore Annenberg Institute for Civics: Health Care Timeline.
- The Center on Congress at Indiana University: The Hill-Burton Act
- LBJ Presidential Library: The 1965 Medicare Amendment to the Social Security Act.
- The Presidency Project, University of California, Santa Barbara: Richard Nixon, Statement on Signing the Health Maintenance Organization Act of 1973.
- The Complete Book of Presidents, By William A. DeGregorio and Sandra Lee Stuart, (Barricade Books; 2013).
- U.S. Department of Labor: FAQs about COBRA Continuation Health Coverage
- U.S. Department of Health and Human Services: State Children's Health Insurance Program.
- The Washington Post: Medicare Drug Benefit May Cost More Than Reported.
Related:
Quick Study: Who was the youngest president?
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