Healthcare & Social Policy – Timeline of Key Acts

Federal healthcare and social policy has developed over nearly a century to provide safety nets, regulate insurance, and expand access to care. This timeline highlights the most impactful laws still shaping U.S. healthcare and social policy.

Social Security Act (1935)

• Created the Social Security system.
• Established unemployment insurance, old-age benefits, and aid to dependent children.
• Still the foundation of U.S. social insurance.

Medicare & Medicaid (1965, amendments to the Social Security Act)

• Created Medicare for seniors (65+) and Medicaid for low-income individuals.
• Codified at 42 U.S.C. §§ 1395 et seq.
• Remain two of the largest federal programs today.

Children’s Health Insurance Program (CHIP, 1997)

• Expanded health coverage for children in low-income families not eligible for Medicaid.
• Joint federal–state program.

Health Insurance Portability and Accountability Act (HIPAA, 1996)

• Guaranteed portability of health insurance between jobs.
• Established health data privacy rules and security standards.
• Codified at 42 U.S.C. §§ 1320d et seq.

Mental Health Parity and Addiction Equity Act (MHPAEA, 2008)

• Required group health plans to provide equal coverage for mental health and substance use disorders as for medical/surgical benefits.
• Strengthened by later amendments under the Affordable Care Act.

Affordable Care Act (ACA, 2010)

• Expanded health insurance coverage through subsidies and Medicaid expansion.
• Prohibited denial of coverage for preexisting conditions.
• Established insurance marketplaces and mandated essential health benefits.

21st Century Cures Act (2016)

• Increased funding for medical research.
• Streamlined FDA approval processes.
• Expanded access to mental health and opioid treatment.

CARES Act (2020)

• COVID-19 emergency relief act.
• Provided direct payments, expanded unemployment insurance, and allocated billions for hospitals and testing.

American Rescue Plan Act (2021)

• Expanded ACA subsidies.
• Extended unemployment benefits and child tax credits.
• Provided significant funding for COVID-19 response and healthcare systems.

Why It Matters Today

These laws collectively:

Social Security Act (1935)

1) Link to the Text of the Act
Read the statute (42 U.S.C. § 301 et seq.)

2) Why It Was Done
Enacted during the Great Depression to provide a federal safety net for the elderly, unemployed, and disadvantaged. It created programs for old-age pensions, unemployment insurance, and welfare benefits.

3) Pre-existing Law or Constitutional Rights
Before 1935, social welfare programs were largely state or local. The Act marked a major expansion of federal responsibility for economic security.

Medicare & Medicaid Act (1965)

1) Link to the Text of the Act
Read historical signing statement and statute (SSA.gov)

2) Why It Was Done
The Act was passed to provide health insurance for two vulnerable groups:

• Medicare (Title XVIII): Seniors (65+) and certain disabled individuals.
• Medicaid (Title XIX): Low-income individuals and families.

It was part of President Lyndon B. Johnson’s Great Society programs.

3) Pre-existing Law or Constitutional Rights
Before 1965, older and low-income Americans often had little or no access to affordable healthcare. Employer-based insurance and charity care dominated, leaving many uninsured.

Emergency Medical Treatment and Labor Act (EMTALA, 1986)

1) Link to the Text of the Act
Read the statute (42 U.S.C. § 1395dd)

2) Why It Was Done
EMTALA was enacted to prevent “patient dumping,” where hospitals refused to treat or transferred patients unable to pay. It requires hospitals to provide emergency medical screening and stabilization regardless of insurance or ability to pay.

3) Pre-existing Law or Constitutional Rights
Before EMTALA, hospitals often turned away indigent or uninsured patients. While some state laws existed, no comprehensive federal law guaranteed emergency care.

Health Insurance Portability and Accountability Act (HIPAA) (1996)

1) Link to the Text of the Act
Read the statute (42 U.S.C. § 1320d et seq.)

2) Why It Was Done
HIPAA was enacted to improve portability and continuity of health insurance coverage, combat waste and fraud, and protect the privacy and security of patients’ medical information.

3) Pre-existing Law or Constitutional Rights
Before HIPAA, there was no comprehensive federal protection for patient health data. Privacy of medical information was governed by a patchwork of state laws and professional ethics standards.

Children’s Health Insurance Program (CHIP, 1997)

1) Link to the Text of the Act
Read the statute (42 U.S.C. § 1397aa et seq.)

2) Why It Was Done
CHIP was created to expand health insurance coverage for children in families with incomes too high for Medicaid eligibility but too low to afford private insurance.

3) Pre-existing Law or Constitutional Rights
Medicaid (1965) covered many low-income families, but left gaps for near-poor children. CHIP filled this gap as a joint federal–state program.

Mental Health Parity and Addiction Equity Act (MHPAEA, 2008)

1) Link to the Text of the Act
Read the statute (29 U.S.C. § 1185a; 42 U.S.C. § 300gg-26)

2) Why It Was Done
The MHPAEA was enacted to require health insurance plans that offer mental health or substance use disorder benefits to provide them at parity with medical and surgical benefits—meaning no stricter limits or higher costs.

3) Pre-existing Law or Constitutional Rights
The Mental Health Parity Act of 1996 prohibited annual and lifetime dollar limits on mental health benefits but had major loopholes. MHPAEA strengthened and expanded these protections, especially for addiction services.

Patient Protection and Affordable Care Act (ACA) (2010)

1) Link to the Text of the Act
Read the statute (42 U.S.C. § 18001 et seq.)

2) Why It Was Done
The ACA was enacted to expand access to affordable health insurance, improve quality of care, and reduce healthcare costs. It created health insurance marketplaces, expanded Medicaid, and prohibited insurers from denying coverage for preexisting conditions.

3) Pre-existing Law or Constitutional Rights
Built upon the Social Security Act (Medicare and Medicaid provisions) and existing insurance regulations, but established the first nationwide mandate for health coverage and sweeping insurance reforms.

National Federation of Independent Business v. Sebelius (2012)

1) Link to the Actual Opinion
Read the U.S. Reports opinion (PDF)

2) Summary of the Opinion
The Affordable Care Act (ACA) required most Americans to purchase health insurance or pay a penalty. Opponents argued it exceeded Congress’s power under the Commerce Clause. The Supreme Court ruled that the mandate was unconstitutional under the Commerce Clause but upheld it as a valid exercise of Congress’s taxing power. The Court also struck down the mandatory expansion of Medicaid as coercive, making it optional for states.

Inflation Reduction Act (IRA, 2022)

1) Link to the Text of the Act
Read the statute (Public Law 117–169)

2) Why It Was Done
The IRA was passed to lower prescription drug costs, invest in clean energy, reduce the federal deficit, and address inflation concerns. It represented one of the largest climate and energy investments in U.S. history.

3) Pre-existing Law or Constitutional Rights
Built on provisions from the Affordable Care Act (2010) (health subsidies) and prior clean energy tax credits. Expanded tax code authorities rather than creating new constitutional frameworks.

FDA v. Alliance for Hippocratic Medicine (2024)

1) Link to the Actual Opinion
Read the Supreme Court opinion (PDF)

2) Summary of the Opinion
Anti-abortion medical groups challenged the FDA’s approval and regulation of mifepristone, a medication used in medication abortions. The Supreme Court unanimously ruled that the challengers lacked standing, meaning they had no legal right to sue because they were not directly injured by the FDA’s actions.

3) Why It Mattered
The decision preserved access to mifepristone by dismissing the challenge on procedural grounds. It sidestepped broader questions about the FDA’s authority but underscored limits on who can bring cases in federal court.

Medina v. Planned Parenthood South Atlantic (2025)

1) Link to the Actual Opinion
Read the Supreme Court opinion (PDF)

2) Summary of the Opinion
The case asked whether Medicaid recipients have a private right to sue under §1396a(a)(23)(A) of the Medicaid Act (the “free choice of provider” provision). The Supreme Court ruled that the Act does not unambiguously create an enforceable right for individuals to choose specific providers in federal court.