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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

From Teddy Roosevelt to Donald Trump, the Executive Office has long used Congressional addresses as a venue for proposing how to improve the nation's health and access to healthcare.

Here's a look at those proposals as told through State of the Union or other addresses to Congress.

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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

Theodore Roosevelt

In a 1907 address to Congress, President Roosevelt urged an expansion of federal public health efforts: "At last the public mind is awake to the fact that many diseases, notably tuberculosis, are national scourges. The work of the State and city boards of health should be supplemented by a constantly increasing interest on the part of the national government. The Congress has already provided a bureau of public health and has provided for a hygienic laboratory. There are other valuable laws relating to the public health connected with the various departments. This whole branch of the Government should be strengthened and aided in every way."

One year earlier, President Roosevelt signed the Pure Food and Drug Act, which prevented the manufacture, sale, or transportation of adulterated or misbranded foods, drugs, medicines, and liquors.

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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

Franklin D. Roosevelt

Public health had been a major federal effort since Theodore Roosevelt's administration, but in his 1944 State of the Union address, FDR became the first president to explicitly state that medical care was a right for each US citizen and should be addressed by the federal government.

In this address, President Roosevelt called for "…a second Bill of Rights under which a new basis of security and prosperity can be established for all regardless of station, race or creed." Among these rights he included employment, housing, and a good education. He also spoke of "the right to adequate medical care and the opportunity to achieve and enjoy good health."

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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

Harry Truman

During his administration, President Truman consistently advocated a national healthcare system, and it was during his time in office that Congress enacted new programs to improve mental health, the health of mothers and children, and the construction of hospitals. In his 1948 State of the Union address, Truman said, "We are rightly proud of the high standards of medical care we know how to provide in the United States. The fact is, however, that most of our people cannot afford to pay for the care they need."

Truman proposed a voluntary insurance plan in which participants would pay monthly fees and the government would pay for the cost of services rendered by any doctor who chose to join the program. A bill that would have created a national health insurance program funded by payroll taxes was never passed, however, and the plan was derided by the American Medical Association as "socialist medicine."

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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

Dwight Eisenhower

In 1953, President Eisenhower signed legislation that created the Department of Health, Education, and Welfare and he then continued to advocate for a more comprehensive national plan for health. In his 1956 State of the Union address, he said, "We must aid in cushioning the heavy and rising costs of illness and hospitalization to individuals and families. Provision should be made, by Federal reinsurance or otherwise, to foster extension of voluntary health insurance coverage to many more persons, especially older persons and those in rural areas." Although such efforts failed to materialize over the course of Eisenhower's time in office, he strengthened the US Food and Drug Administration and increased funds for medical research.

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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

John F. Kennedy

In his 1961 State of the Union address, President Kennedy said, "Medical research has achieved new wonders—but these wonders are too often beyond the reach of too many people, owing to a lack of income (particularly among the aged), a lack of hospital beds, a lack of nursing homes and a lack of doctors and dentists. Measures to provide healthcare for the aged under Social Security, and to increase the supply of both facilities and personnel, must be undertaken…"

JFK ultimately failed in garnering support for a 1962 bill that essentially would have created a Medicare-type program.

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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

Lyndon Johnson

It was in 1965, under President Johnson's administration, that Social Security Act amendments were passed which resulted in the creation of the Medicare and Medicaid programs. Johnson made a case for health reform in his 1967 State of the Union address: "We have brought medical care to older people who were unable to afford it. Three and one-half million Americans have already received treatment under Medicare since July."

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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

Richard Nixon

In his 1971 State of the Union address, President Nixon proposed major reforms that are echoed in the Affordable Care Act, including a program to ensure that no American family would be prevented from obtaining basic medical care by inability to pay; incentives to improve the delivery of health services, particularly in low-resource areas; new programs to encourage better preventive medicine; and incentives to doctors "to keep people well rather than just to treat them when they are sick."

During his address he asserted, "America has long been the wealthiest nation in the world. Now it is time we became the healthiest nation in the world."

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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

Gerald Ford

In his 1976 State of the Union address, President Ford proposed "catastrophic health insurance for everybody covered by Medicare." To finance it, he suggested raising fees for short-term care and lowering costs for senior citizens: "[N]obody after reaching age 65 will have to pay more than $500 a year for covered hospital or nursing home care, nor more than $250 for 1 year's doctor bills." But Ford also made clear in his speech that he did not support a national healthcare program, although he suggested that "we combine 16 existing Federal programs, including Medicaid, into a single $10 billion Federal grant. Funds would be divided among States under a new formula which provides a larger share of Federal money to those States that have a larger share of low-income families."

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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

Jimmy Carter

In his 1981 State of the Union address, President Carter pushed even harder than his predecessors "to reach the goal of comprehensive, universal healthcare coverage." He proposed, for example, fully subsidized and comprehensive coverage for 15 million additional poor persons, prenatal and delivery services for all pregnant women, and coverage for all acute care for infants in their first year of life, with a limit of $1250 on annual out-of-pocket medical expenses and no limits on hospital coverage for the elderly and disabled. His plan also mandated employer coverage of health insurance for all full-time employees.

President Carter's proposals for healthcare cost control included voluntary hospital cost guidelines and moving away from the fee-for-service payment model "toward a system of prospective reimbursement, under which healthcare providers would operate within predetermined budgets."

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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

Ronald Reagan

President Reagan raised the issue of healthcare in three of his eight addresses, but only briefly, and mostly focused on cost cutting. His 1982 speech urged a need to reduce Medicare and Medicaid costs specifically by weeding out fraud. He also said, "I signed a bill to reduce the growth of these programs by $44 billion over the next 3 years while at the same time preserving essential services for the truly needy." In his 1986 speech, he directed the Secretary of Health and Human Services to recommend how the private sector and government could work together to address the problems of affordable insurance for those threatened with financially catastrophic illness.

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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

George H. W. Bush

President Bush mentioned the healthcare issue in two of his early speeches, and he tackled it in more detail in his last address in 1992. Recognizing the need for reform, he said that there were two options: implementing a national healthcare system, which he opposed, or providing insurance security for everyone while preserving choice. To accomplish this, he proposed making basic health insurance affordable for all low-income persons who were not currently covered by providing a health insurance tax credit of up to $3750 for each family. By doing this, he said, the United States would ensure that all US citizens had access to basic health insurance even if they changed jobs or developed serious health problems.

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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

Bill Clinton

President Clinton proposed significant changes to the healthcare system in every one of his presidential addresses. Despite his failure to achieve consensus on a healthcare plan, Clinton pushed on. In his 1995 address, he said, "[L]ast year we almost came to blows over healthcare, but we didn't do anything…Let's do whatever we have to do to get something done. Let's at least pass meaningful insurance reform." Congress did extend health coverage to 5 million children, and Clinton ended his administration with a budget surplus, which he said he hoped would ensure the future of big entitlement programs like Social Security.

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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

George W. Bush

President Bush continued the discussion on healthcare in every presidential address with some aggressive proposals. In his 2005 speech, he urged Congress "to move forward on a comprehensive healthcare agenda with tax credits to help low-income workers buy insurance, a community health center in every poor county, improved information technology, association health plans for small businesses and their employees, expanded health savings accounts, and medical liability reform that will reduce healthcare costs and make sure patients have the doctors and care they need."

In 2003, Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act, which included a prescription drug plan for elderly and disabled Americans.

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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

Barack Obama

President Obama signed the Patient Protection and Affordable Care Act into law in March 2010.

In his 2011 State of the Union address, he called for bipartisan support: "Now, I have heard rumors that a few of you still have concerns about our new healthcare law. So let me be the first to say that anything can be improved. If you have ideas about how to improve this law by making care better or more affordable, I am eager to work with you…What I'm not willing to do is go back to the days when insurance companies could deny someone coverage because of a preexisting condition…So I say to this Chamber tonight: Instead of refighting the battles of the last 2 years, let's fix what needs fixing, and let's move forward."

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A History of Presidential Healthcare Proposals, From Teddy Roosevelt to Trump

Carol Peckham; Stephanie Cajigal | March 1, 2017 | Contributor Information

Donald Trump

In his first address to Congress on February 28, President Trump called for repealing Obamacare and replacing it with policies that make health insurance more affordable. These policies would include offering US citizens tax credits and expanded health savings accounts, and would also make it possible for them to purchase health insurance across state lines. He also called for giving "state governors the resources and flexibility they need with Medicaid to make sure no one is left out," as well as implementing "legal reforms that protect patients and doctors from unnecessary costs that drive up the price of insurance, and work to bring down the artificially high price of drugs—and bring them down immediately."

He prefaced his remarks by saying that the government should ensure that people with preexisting conditions aren't denied coverage and that people currently enrolled in ACA plans don't see a disruption in coverage.

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