Filed Under:Health Insurance, Individual Health

PPACA: A history

Health Care Finance Wars Didn't Start in 1992

The U.S. Supreme Court. (AP Photo/Dana Verkouteren)
The U.S. Supreme Court. (AP Photo/Dana Verkouteren)

The battle over whether the Patient Protection and Affordable Care Act of 2010 (PPACA) is constitutional, unconstitutional, or something more complicated is just one new attention-getting chapter in the long history of health care finance.

We prepared a history of the topic to try to give you, our readers, the background you need to come up with your own response to PPACA, Supreme Court action on PPACA, and all of the other legislative, regulatory, enforcement, medical community, corporate, scholarly, consumer and patient activity revolving around health care finance.

Health care finance unplugged

No one knows how the first medicine men (and women) billed the first patients. Maybe those patients paid for care with polished shells entirely out of their own leather pouches, or with promises to turn over a portion of the berries they gathered over the next few months. 

Historians tell us that the civilizations with written records that we know how to read have been struggling with health care finance since they developed health care.

U.S. health finance battles: The early years

Franklin Pierce

Franklin Pierce (National Archives)

The struggle over health care finance continued in the New World.

Germany makes waves


C.D. Babcock (National Underwriter file photo)

The German empire influenced policymakers throughout the world, including the United States, by implementing a sickness-related income protection program Jan. 1, 1891, and a sickness program that paid for people to get care through local “clubs” in 1893.

The age of HIPAA

Hillary Clinton (AP Photo/Louis Lanzano)

Health maintenance organizations (HMOs) temporarily calmed fears about rising health care costs by successfully holding down the price of care. HMOs then faced a backlash when patients argued that HMOs were skimping on obviously necessary care. Group medical practices rebelled when they discovered that the "capitated," flat-fee-per-patient contracts they had negotiated with the HMOs were bankrupting them. 

How PPACA came to be

Sen. Ted Kennedy, D-Mass. (AP Photo/Toby Jorrin)

In 2008, the three most successful Democratic presidential primary challengers – Barack Obama, Hillary Clinton and John Edwards – each agreed that they would support a “universal health insurance” bill.

Implementing PPACA

Kathleen Sebelius

Kathleen Sebelius (AP Photo/Carolyn Kaster, File)

Since President Obama signed PPACA into law March 23, 2010, federal agencies, state regulatory agencies and groups such as the National Association of Insurance Commissioners (NAIC), Kansas City, Mo., have been developing rulemaking notices, white papers, regulations, batches of guidance helping the public interpret regulations, procedures, forms, bid documents, and the other documents, processes and programs needed to implement the law.

Can Congress require consumers to buy insurance?

Protesters gathered in Washington March 28 (AP Photo/Carolyn Kaster)

The U.S. Supreme Court heard oral arguments on several sets of legal challenges to PPACA in March.

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Nichole Morford

Nichole Morford
Managing Editor

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