Legislative History of Universal Health Care Coverage

Written by Adam Knopsnyder

Achieving universal health care coverage in the United States of America has consisted of a long history of public policy initiatives starting just after World War II and continuing through to the 21st Century. Along with the goal of providing universal coverage, there has been a great deal of thought put into the idea of either enacting a true single payer healthcare system in the US or at least providing a government-run public option for individuals who are unable to afford private medical insurance.

While Franklin D. Roosevelt originally wanted to include a single payer system in the New Deal during the Great Depression, the first legislative action took place in 1943 when three Democratic members of Congress introduced a bill to create a national health insurance program for all Americans through the newly implemented Social Security system (Oberlander, 2019). However, the bill was very unpopular at the time, its critics labeling the idea as “socialized medicine,” so it was unable to go any farther in the legislative process. Then, after the end of World War II, President Harry Truman became the first US president to formally endorse the idea of a single payer healthcare system and advocated for the implementation of such a system in the US, but yet again, the policy proposal failed to be passed by Congress (Oberlander, 2019). Even though President Truman was unable to enact a single payer system, in 1951, he was able to pass a policy that gave federal hospital insurance to elderly citizens who were Social Security beneficiaries for a period of 60 days (Oberlander, 2019). This Truman administration policy was the original blueprint for what was to become Medicare and Medicaid 14 years later.

With the passing of Medicare and Medicaid into law in 1965, a whole new era of healthcare policy formed in the United States. It was the first time that the US federal government offered a health insurance plan to individuals who were unable to obtain private health insurance on their own. Medicare provided citizens 65 years and older with a relatively inexpensive health care plan, while Medicaid offered a cheaper health insurance option to those Americans with substantially low incomes. From the 1970s to the 1990s, there were quite a few Congressional bills that passed which expanded coverage to a number of people, including: expanding coverage to those under 65 year of age and suffering from long-term disabilities and end stage renal disease; expanding hospice services for the terminally ill; and providing care for pregnant women and infants (Anderson, 2019). Then, in the late 1990s, the Clinton Administration worked to expand Medicaid coverage, buy enacting the Children’s Health Insurance Program, also known as CHIP, in 1997 which provided children with government-sponsored health care to families that made too much money to qualify for Medicaid as a whole, but were unable to afford the high prices of private insurance (Program History | Medicaid, n.d.). Lastly, in 2010, President Barack Obama enacted the Affordable Care Act which furthered expanded both Medicare and Medicaid, as well as created the Basic Health Program which further increased the number of individuals being covered by a government financed health care program (Program History | Medicaid, n.d.). Currently, the Affordable Care Act is the most recent healthcare policy that has been successfully signed into law and implemented, providing most of the public with access to a public option that is somewhat affordable.


Anderson, S. (2019, September 1). A brief history of Medicare in America. Medicareresources.Org. https://www.medicareresources.org/basic-medicare-information/brief-history-of-medicare/

Program History | Medicaid. (n.d.). Retrieved October 19, 2020, from https://www.medicaid.gov/about-us/program-history/index.html

Oberlander, J. (2019). Lessons From the Long and Winding Road to Medicare for All. American Journal of Public Health, 109(11), 1497–1500. https://doi.org/10.2105/AJPH.2019.305295

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: