If our U.S. Congress passes, or fails to pass, healthcare reform legislation this year, one thing is for sure: either way, a lot of us will be upset. There will be few happy campers.
We will be upset because it will either cost too much or cover too few of the millions of uninsured Americans, compete too much or too little with private health insurance, undermine or encourage high-benefit health insurances gained by labor unions, restrict too much or too little federal funding for abortion, expand Medicaid coverage for too many or too few poor people, upset us for reasons of our own, & or, all of the above.
If healthcare reform legislation is passed by Congress and signed by the president, it will probably get amended many times.
The Social Security Act of 1935 was comparably complex legislation and it was amended many times. Originally it covered only workers in commercial and industrial occupations. It also provided for federal grants to assist the states with programs for the disabled, the aged, child welfare services, public health services, and vocational rehabilitation.
Amendments to the Social Security Act, in the year —
- 1939, added benefits for seamen, and for dependents and survivors of workers;
- 1950, broadened the coverage to include full-time farm and domestic workers, many self-employed persons, employees of state and local governments, and employees of non-profit organizations;
- 1951, added railroad workers to those covered;
- 1956, extended coverage to members of the armed forces and self-employed professionals;
- 1956, provided benefits to workers 50 years of age and older who became permanently and totally disabled;
- 1962, lowered the age of eligibility for retirement benefits from 65 to 62, but with lower benefits for persons retiring before 65;
- 1965, provided Medicare for persons over the age of 65, and an accompanying Medicaid program for the indigent regardless of age;
- 1965, added divorcees over age 65, who had been married for at least 20 years, remained unmarried, and were dependent on their ex-husbands;
- 1972, transferred administration of Supplemental Security Income (SSI) from the states to the federal government;
- 1972, tied increases in Social Security retirement to increases in the Consumer Price Index;
- 1972, established a minimum benefit;
- 1972, increased benefits through Delayed Retirement Credit for those who delayed retirement past age 65;
- 1977, recalculated the procedure for adjusting price and wage increases as the basis for cost of living adjustments (COLA), giving rise to Notch beneficiaries;
- 1983, allowed partial taxation of benefits for upper-income recipients;
- 1983, included federal employees under Social Security;
- 1996, excluded eligibility of applicants for Social Security or SSI disability benefits if drug addiction or alcoholism is a material factor in their disability;
- 1996, ended by welfare reform legislation the categorical entitlement to Aid to Families with Dependent Children, by implementing time-limited benefits with a work requirement;
- 1996, terminated SSI eligibility for most non-citizens;
- 1996, ordered all federal payments to be made electronically, i.e., no more paper checks;
- 1999, set payroll deductions at 6.2% of annual wages below $72,600, and payroll deductions for Medicare at 1.45% of all annual wages, with employers contributing matching amounts;
- 1999, enabled disability beneficiaries to obtain a ticket for vocational rehabilitation, employment, and other support services from a network of their choice;
- 2000, eliminated the earnings limitation for beneficiaries above 65.
(Reference: A History of Social Security by Larry DeWitt, of the SSA Historian s Office, available with a helpful bibliography @SocialSecurityOnline.)
Healthcare reform legislation, or its absence, will be a major influence in the lives of millions of Americans for decades to come. Only the delusional would call this legislation ideal. Its evolution reflects our contentious American politics. It is political sausage making at its worst or at its best, depending on one s point of view.
If this legislation is enacted into law, the United States will join all other 17 most industrialized nations of the world in having some system of national healthcare insurance.
Joseph A. Gagnon Marysville, Michigan