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Education Higher Education

Health Care Reform and History

About the Module


Beatrix Hoffman, Professor of History at Northern Illinois University, is a historian of the U.S. health care system, health reform, and social movements. She is the author of The Wages of Sickness: The Politics of Health Insurance in Progressive America (University of North Carolina, 2001) and Health Care for Some: Rights and Rationing in the United States since 1930 (University of Chicago Press, 2012), and coeditor of Patients as Policy Actors (Rutgers, 2011). Her work has been supported by awards from the Robert Wood Johnson Foundation, the National Endowment for the Humanities, and the American Council of Learned Societies. Currently, she is working on a study of immigration and the right to health care.

Suggested Use

The Health Care Reform and History higher education module allows instructors to integrate the story of health care reform into U.S. history, or to add historical analysis to the study of health policy. The six classes focus on the major reform attempts of the past century, beginning with Progressive health insurance proposals in the 1910s and ending with the 2010 Affordable Care Act. The module allows students to analyze the political and social forces that shaped the U.S. health care system, including presidential politics, organized physicians, workers and women suffragists, civil rights activism, the media, and special interest lobbying. It looks at health care reform within the historical contexts of industrialization, medical advances, the Great Depression and New Deal, World War II, and the transformation of the economy since the 1970s. In studying health care politics, students will also learn about how reform attempts and failures led to many unique features of the U.S. health care system: employer-based health coverage, Medicare and Medicaid, the private insurance industry, rapid cost inflation, and high numbers of uninsured people.

Each of the six classes includes 2–3 primary sources and 1–2 excerpts from secondary sources. The primary sources include articles, speeches, and political cartoons illustrating different perspectives in reform debates. Secondary sources are excerpts from works by prominent scholars of health care reform history and have been selected for their accessibility to undergraduate readers. Discussion questions for each class encourage students to make connections between the sources. The module is suitable for use in courses on U.S. history, American studies, the history of medicine, public policy, U.S. politics, and public health. It may also be used in conjunction with the online exhibition, For All the People: A Century of Citizen Action in Health Care Reform, in courses that examine the relationship between social movements and political change.


After completing this higher education module, students are expected to demonstrate a basic understanding of:

  • the structure and organization of the U.S. health system, its benefits and drawbacks, and the historical forces behind its development
  • the main actors and organizations in the history of U.S. health care reform in the 20th and 21st century
  • how to use primary and secondary historical sources to discuss and analyze the history of health reform
  • the main provisions of the Affordable Care Act and arguments of supporters and opponents
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