Keenan Blog

The goal of the Keenan Blog is to provide a forum where we can come together to discuss issues and cultivate the solutions that will have a meaningful impact on your organization.

Did Health Care Reform Begin in the John Adams Administration?


Here’s a brief American history lesson on health care regulation. In 1798, Congress became concerned about the welfare of the sailors of the Merchant Marine, as maritime trade was essential to the economic development of the young nation. Not only were there sick and disabled sailors who had no resources for medical care, the bustling port cities of the east coast, with Boston and Baltimore as leaders, were places where diseases and epidemics could be imported from other countries.

To protect both the sailors and the public, Congress passed “An Act for the Relief of Sick and Disabled Seamen,” which created Marine Hospitals at the harbors of the major port cities and worked to control infectious diseases. Over the years, their scope of activities expanded to quarantine authority and medical inspection of arriving immigrants. Eventually, the Marine Hospital Service evolved into the Public Health Service (PHS), a uniformed corps of medical professionals with a mission to “protect, promote and advance the health and safety of the United States.” And no, branding the program “Adamscare,” after the second president, did not catch on.

john_adams_blog_2In 1944, the Public Health Service Act (PHSA) consolidated all existing legislation related to the PHS, and since then its duties have been substantially expanded. Under the jurisdiction of the Department of Health and Human Services (HHS), the PHS is now the largest public health program in the world, and its agencies include the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA) and the National Institutes of Health (NIH).

The Surgeon General commands the more than 6,000 members of the PHS Commissioned Corps who deliver public health programs, conduct biomedical research, respond to infectious disease outbreaks, and provide medical assistance in the aftermath of natural disasters and terrorist attacks. The Surgeon General also reports on major threats to public health such as tobacco use or HIV.

So, an interesting bit of history, but what does all of this have to do with your health plan? The individual states regulate insured health plans within their borders and are responsible for monitoring consumer protection and insurer solvency. However, the need for protection of private health information, preventive testing and treatment, and access to health care in the U.S. has been deemed a public health issue.

Whenever the various PHS agencies report potential threats to public health and safety, Congress has the authority through the PHSA to mandate coverage for prevention and mitigation of health problems by all health plans across all states, regardless of whether they are governmental or church plans or privately sponsored plans. For this reason, the PHSA has been amended in recent years to apply such laws as COBRA, HIPAA and ACA across the board to every plan that delivers health care in the U.S.

While we have heard so much about health care reform over the last ten years, the federal government has actually put in more than two hundred and ten years of effort trying to reform the system!