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Should everyone have the right to healthcare, or is it a privilege? How has the idea of healthcare in the US evolved over the years?
The top cause of bankruptcy in the US is healthcare-related debt. According to a KFF survey, most US adults worry about paying for health care, whether they’re financially comfortable or struggling.
Here’s what the healthcare system looked like in the past and a glimpse of what might come in the future.
A History of US Healthcare
The idea of healthcare as a right in the US traces back to the early 20th century. In 1912, Theodore Roosevelt and the Progressive Party endorsed social insurance, including health insurance, as part of their platform.
In 1944, President Franklin D. Roosevelt included the right to adequate medical care in his proposed Economic Bill of Rights, laying the groundwork for future discussions on the fundamental right to healthcare.
Post-World War II Changes
In 1945, President Harry S. Truman proposed a national health program to Congress. Though the American Medical Association (AMA) denounced it as “Communist,” his effort paved the way for future healthcare initiatives.
Medicare and Medicaid
A breakthrough came in 1965 when President Lyndon B. Johnson signed the Medicare and Medicaid Act. This legislation provided healthcare coverage to the elderly and those with low incomes.
Recent Developments
In 1971, Senator Ted Kennedy introduced the Health Security Act, calling for healthcare coverage for all US citizens and documented permanent residents. While this bill didn’t pass, it fueled ongoing discussions about healthcare as a right.
In 2010, Congress passed the Patient Protection and Affordable Care Act (ACA). Though it didn’t establish healthcare as an explicit right, the ACA greatly expanded Americans’ access to health insurance.
Key changes since then include:
1. Implementation of healthcare provisions in President Biden’s Inflation Reduction Act:
- Negotiation of some Medicare drug prices.
- A $35 monthly cap on insulin costs for Medicare beneficiaries.
- A requirement that drug manufacturers pay rebates if their prices exceed inflation.
2. Expansion of Telehealth by extending Covid-19 pandemic telehealth flexibilities through 2024, loosening some requirements, and pausing some reimbursement prohibitions.
What a Second Trump Administration Might Mean
Trump’s administration is expected to push for market-driven policies that could further significantly change healthcare access, costs, and coverage, particularly for those relying on public health insurance programs (Medicare and Medicaid) and ACA marketplace plans. Major proposals include:
1. Medicare Changes
- Making Medicare Advantage plans the default enrollment option for Medicare recipients
- Scaling back or repealing Medicare’s drug price negotiation program established by the Inflation Reduction Act
- Changes in physician fee payment
2. Affordable Care Act (ACA) Modifications
- Allowing the enhanced ACA premium subsidies to expire at the end of 2025
- Expanding Health Savings Account flexibilities and alternative health coverage options like Short-Term Limited Duration Insurance plans
- Reducing funding to help people enroll in healthcare plans and allowing “noncompliant” plans
3. Medicaid Overhaul
- Implementing work requirements for Medicaid recipients
- Considering block grants or per-capita caps for Medicaid funding to states
- Establishing lifetime caps or time limits on receiving Medicaid benefits
- Implementing stricter eligibility determinations for Medicaid
A Glimpse of the Future
In any case, Gallup expects healthcare to remain a key issue, predicting in its Trends to Watch in 2025 preview that the murder of UHC’s CEO will continue to fuel debate over healthcare access and costs. The firm plans to release a “Mood of the Nation” poll on American satisfaction with healthcare availability and affordability in January, plus further detail in 2025 on consumers’ views on the healthcare industry and ratings on healthcare coverage and quality.
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