Peer Reviewed Policy

What You Should Know About the ACA and the History of Health Insurance in the US

Everything you should know about health insurance history and the ACA


How will repealing the ACA affect your state?


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Spending cut and coverage loss numbers are from Linda Blumberg, Matthew Buettgens, and John Holahan, Implications of Partial Repeal of the ACA through Reconciliation, Urban Institute, 2016. The job loss analysis is from Josh Bivens, Repealing the Affordable Health Care Act would cost jobs in every state, Economic Policy Institute, 2017.


“At present, the United States has the unenviable distinction of being the only great industrial nation without compulsory health insurance,” the Yale economist Irving Fisher said in a speech in December.

December of 1916 that is.”

Our journey began in 1912.  Apparently, we’re bad at this whole health policy business. In the beginning, Southern politicians decried the involvement of the government in healthcare. Industrial workers in America faced the “problem of sickness,” missing work because of illness, no doubt related to toxic chemical exposures and unsafe work environments.

Image for postChemist and Druggist 6 January 1923.

Image for postChemist and Druggist supplement: 6 January 1923



How could industry keep loyal a politician in-office without meeting the public’s healthcare demands?

Change the demand.
The easiest solution: Convince the public, they don’t want universally accessible healthcare. Campaigns warned about “socialized medicine, rationing of family doctors and of freedoms Americans held so dear.”

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“Still Just as Hard to Swallow” is a cartoon included in a pamphlet created by the National Physicians’ Committee titled Showdown on Political Medicine, ca. 1946.

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Americans Spend More Than Any Other Wealth Country

At present Americans pay more for the same level of care or worse:

  • 87% more than Canada
  • 102% more than France
  • 182% more than Japan (which has one of the highest life expectancies)
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Source: Roosa Tikkanen and Melinda K. Abrams, U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? (Commonwealth Fund, Jan. 2020).


“…there are likely to be policies out there that could save a lot more lives than RomneyCare does per dollar spent.”


Indeed, there were other policies and the relatively small population in MA likely contributed to some lackluster fiscal reward. Large populations are essential for making the policy work. People who stay healthy longer, generate GDP, and cost the government much less. They catch cancer early and live. Insured people may have more money to invest in their children, thus paying out in future generations. The scenario in the early 1900s also suggested that it could help with poverty, but that was still a theory.


Grim realities born of the inequities began to appear

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The U.S. Has the Lowest Life Expectancy among these countries. Among all countries, it ranks 46th.

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Some expansion or public option is wildly popular with the public but continues to be ignored by politicians




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Senator McCain delivers surprise no to repeat ACA.