Since the early 1930s, Harmony has worked to keep IHA members up to date and informed on health care issues in Indiana and across the country. The Harmony archives provide a glimpse of those issues and how they affected Indiana hospitals. IHA and our members have withstood tremendous change, overcome challenges and adapted together to continue to provide the best possible care for the citizens of Indiana, and Harmony has documented our journey every step of the way.

The Great Depression
As the country struggled under the burden of the Great Depression, the U.S. shifted its attention toward providing relief for the poor and the elderly. In 1932, the findings of the Federal Committee on the Costs of Medical Care were published. The report raised concerns about the cost and accessibility of health care. In 1935, President Franklin Delano Roosevelt signed the Social Security Act into law. The bill provided pensions and other benefits to the elderly. However, national health insurance was omitted from the final bill. The American Medical Association strongly opposed national health insurance because they believed it would limit doctors’ freedom and complicate doctor-patient relationships.

War Years
The outbreak of war with Japan and Germany in 1941 presented Indiana hospitals with a new set of challenges. As the war effort demanded more resources, hospitals were required to make do with less. Hospitals all over Indiana faced shortages of food, rubber, fuel and medical instruments. One issue of Harmony asked hospitals to “make one tool do what two used to.” Hospitals also faced severe manpower shortages, as many doctors and nurses left to serve their country overseas. In 1943, the National War Labor Board declared employer contributions for health insurance “tax free.” This encouraged hospitals to compete for an increasingly scarce workforce by offering health benefits. In 1944, enrollment in the Indiana Blue Cross plan began. Two years later, the passing of the Hill-Burton Act paid for the construction of hospitals across the country, especially in rural areas. It also prohibited hospitals from discriminating on the basis of race, religion or national origin.

The 50’s
In 1949, IHA officially came out against “compulsory health insurance,” a stance it would maintain as debate over national health insurance continued throughout the 1950s. By September of 1950, Indiana led the nation in a number of resolutions against socialized medicine. With the outbreak of the Korean War, the nation’s attention shifted away from health care reform. Hospitals were once again burdened with personnel shortages and were forced to ration valuable resources. Throughout the decade, enrollment in private insurance plans increased drastically. Several different approaches to national insurance made their way onto the legislative agenda, but none became law.

Medicare & Medicaid
By the 1960s, hospital costs had risen dramatically. In 1965, President Lyndon B. Johnson signed into law legislation creating the Medicaid and Medicare programs, providing comprehensive health care coverage for people 65 and older, as well as the poor and the disabled. A continued shortage of doctors and nurses led to federal measures to expand education in health care professions.

Payment Caps
With millions more Americans insured under Medicare and Medicaid, health spending and health care costs both increased. Much like today, the cost of health care became a hot-button political issue. Facing economic government regulations, IHA worked with the American Hospital Association to fight President Gerald Ford’s proposed cap on Medicare payments to hospitals, believing they would force hospitals to cut services. In addition to the struggling economy, the energy crisis forced Indiana hospitals to operate with limited access to resources such as gas.

The 80’s and AIDS
The 1980s saw a change in the landscape of the health care industry. Corporations began integrating into hospitals and other health care fields. By 1985, more than 130 business and health coalitions had formed nationwide, marking an overall shift toward the privatization of hospitals and health care. As this shift took place, new threats from infectious diseases such as AIDS also began to surface. By the end of the decade, over 100,000 people in the U.S. had HIV/AIDS, with a 60 percent mortality rate. This new threat meant hospitals had to make unprecedented adjustments to the way they dealt with patient safety and confidentiality, staff safety and public relations.

Clinton’s Initiative
In the 1990s, organizations merged and consolidated more rapidly than at any other time in the nation’s history up to that time. Technological advances provided hospitals with new opportunities and methods for providing quality care. President Bill Clinton made health care reform a major part of his campaign and presidency. The 1993 Clinton health plan required every U.S. citizen to enroll in a qualified health plan and allowed people under a certain income level to pay nothing. However, the plan was not enacted into law.

The New Millennium
The 9/11 terrorist attacks changed national priorities and hospitals were placed on the backburner as attention shifted from health care legislation to homeland defense. However, with health care costs rapidly rising and the world’s economy in recession, it was not long before health care again became the nation’s primary focus.

The Affordable Care Act
Decades of debate over universal health insurance and health care reform came to a head in March 2010 when President Obama signed the Affordable Care Act—the most significant overhaul of the health care system since the passage of Medicare and Medicaid—into law.

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