The 1935 National Labor Relations Act (NLRA) was the first political act that had an impact on healthcare, establishing bargaining rights for employees and ultimately leading to the provision of health insurance via third-party nonprofit entities in the form of Blue Cross and Blue Shield. Two significant changes occurred after World War II: (1) for-profit insurance companies were given openings by state legislative and regulatory action to sell health insurance and provide competition to Blue Cross and Blue Shield and (2) as a result of tax law changes, major companies began providing health insurance to employees. In the late 1950s and early 1960s, concerns about healthcare for the elderly and poor led to the enactment of Medicare and Medicaid under President Johnson in 1965, marking the first time the federal government was directly involved in the US healthcare system. The programs left the determination of medical necessity and delivery of services with physicians and hospitals and the payment process with insurance companies. The chapters ahead demonstrate how the makeup of Congress and the presidency, along with the political climate among the American electorate, shaped healthcare policy decisions.
KeywordsNLRB Blue Cross Blue Shield President Johnson Medicare Medicaid
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