Debating U.S. Healthcare: The Affordable Care Act in Historical Perspective

Session Abstract

On 1 January 2014, key provisions of The Affordable Care Act (ACA), one of the most important and hard-fought pieces of legislation of recent American history, will go into effect. To its proponents, the ACA, which was signed into law in March 2010, marks a major step forward in American social policy; for the first time, the government will help ensure that the broad majority of U.S. citizens will have access to health insurance. To its detractors, the new law represents a major overstepping in federal authority and an invasive encroachment on individual rights and freedoms. This panel will put the ACA, and the vitriolic debates surrounding its passage, in historical context.

While examining the deep historical roots of the ACA, the scholars in this session will elucidate the ways in which the new legislation is at once consistent with, and a remarkable departure from, principles embodied by past social policies. Michael Gusmano will open the panel with a paper that documents the similarities and differences between the debate over the ACA and health reform discussions and disagreements that have taken place since 1910. His paper will explore how the prospect of federal involvement in any aspect of individuals’ medical care consistently spurred tension throughout the twentieth century. Jessica Adler and Tamara Mann will follow with an examination of governmental efforts to ensure access to health care for two distinct populations: veterans and the elderly. Their analysis will look closely at the logic behind providing for particularly “needy” or “worthy” groups and conclude with an explanation of the ACA’s departure from this tradition. Christy Ford Chapin’s paper will then offer a detailed account of the long partnership between the federal government and private insurance companies, which continues to inform the ACA. Her paper will describe how federal policies throughout the twentieth century propelled insurance companies to the center of the U.S. health care system. Jonathan Engel’s concluding presentation will offer a recent history of the ACA, the legislative process that produced the law, and the ways in which its implementation has altered American health policy. Session Chair and Commentator, Rosemary Stevens, who has written extensively on the history of U.S. health policies, will offer insights on panel papers and foster discussion among attendees on the larger implications and potential of undertaking historical studies of the U.S. health care system.

By exploring a long tradition of “Disagreement, Debate, and Discussion” in American health policy, this panel will stimulate an informed and context driven conversation about the Affordable Care Act.