Journal of the American Medical Association   |  June 24, 2010

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IN A HISTORIC CEREMONY ON MARCH 23, 2010, PRESIdent Obama signed into law the first US comprehensive health care reform bill, the Patient Protection and
Affordable Care Act (PPACA). For almost a century, presidents have tried and failed to pass national health insurance—ranging from President Franklin Roosevelt’s exclusion of national insurance from the Social Security Act to the failure of President Nixon’s and President Clinton’s health care plans.1 Previously, health care reform passed incrementally with a uniquely US blend of public and private
coverage. The War Labor Board’s exclusion of employer-based health insurance from wage and price controls significantly increased coverage. By 1954, Congress exempted employee benefits from income tax, creating powerful incentives. The enactment of Medicaid and Medicare in 1965 expanded public coverage, followed by President Clinton’s State Children’s Health Insurance Program and President Bush’s Medicare Part D Prescription Drug coverage.

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