ABSTRACT
As the quote opening of this chapter suggests, the 1980s saw tremendous change in the health policy area as did the subsequent decades. The development of medical insurance, first through Blue Cross and Blue Shield, later through private insurers, and finally through public insurance programs (Medicare and Medicaid), addressed some of the financial access issues, as did the Affordable Care Act (ACA). The third period of federal health policy focused on cost control. Some of the opposition on the part of medical and hospital groups to national health insurance and to Medicare and Medicaid was precisely on this basis, as was the opposition of the pharmaceutical industry in 1999 and 2000 to including a prescription drug benefit in Medicare. The ACA does increase the role of government, especially the federal government, in the health care system.
