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  Evolutionary TimeLine   
  TimeLine 1917-1945  
1917  1917: Western Clinic in Tacoma provides prepaid physician services for the lumber industry (3)  
1929  1929: Dr. Justin Ford Kimball at Baylor Hospital in Texas establishes The Baylor Plan, a prepaid hospitalization plan that first uses the Blue Cross logo (3)
Ross-Loss prepaid medical clinic started by Drs. Donald Ross and H. Clifford Loos under contract with Los Angeles Dept. of Water and Power for its employees (1)
Rural Farmers' Cooperative Health Plan started by Michael Shadid in Elk City, OK (1)
1933  1933: Sidney Garfield MD establishes prepaid plan to fund care for his Contractors General Hospital and clinic providing care to workers on Los Angeles Aqueduct (2)  
1937  1937: Group Health Association (GHA) started in Washington, DC to serve employees of Federal Home Loan Bank (1)  
1938  1938: Henry J Kaiser recruits Dr. Garfield to establish prepaid clinic and hospital care for his Grand Coulee Dam project in Washington (2)  
1939  1939: Blue Shield program adopted for participating prepaid physician plans (3)  
1942  1942: At the request of Henry Kaiser, Dr. Garfield expands program to Kaiser-managed shipyards and Kaiser steel mill (2)  
1945  1945: Group Health Cooperative of Puget Sound established in Seattle, WA (1)
Permanente Health Plans opens to the public in California, in addition to serving Kaiser employees (2)

  TimeLine 1947 - 1963  
1947  1947: American Medical Association (AMA) indicated and convicted of antitrust violations due to organized efforts to curb physician participation with Group Health Plans (1)
Health Insurance Plan (HIP) of Greater NY established to serve NY city employees (1)
1949  1949: 81 Blue Cross hospital Plans and 44 Blue Shield medical Plans cover 24 million Americans (3)  
1952  1952: Permanente Health Plans changes name to Kaiser, while medical group retains Permanente name. Kaiser membership at 250,000 (2)    
1954  1954: First IPA formed, the San Joaquin Medical Foundation, in California (1)  
1955  1955: Kaiser expands to Oregon and total membership reaches 500,000 (2)    
1958  1958: Kaiser expands to Hawaii (2)    
1959  1959: Blue Cross Companies cover 52 million and Blue Shield Plans cover 40 million Americans (3)  
1963  1963: Kaiser membership reaches 1 million (2)  
  TimeLine 1968 - 1982  
1968  1968: Kaiser expands to Colorado and Ohio (2)  
1970  1970: Paul Ellwood coins the term "Health Maintenance Organization" (1)  
1973  1973: HMO Act of 1973 signed into law by President Nixon, using federal funds and policy to promote HMOs (1)  
1976  1976: Kaiser membership reaches 3 million (2)  
1979  1979: Blue Cross Blue Shield collectively covers 87.4 million Americans (3)  
1980  1980: Kaiser expands to Mid-Atlantic region (2)  
1981  1981: Kaiser membership reaches 4 million (2)     
1982  1982: California legislation enacted allowing selective contracting for Medicaid and private insurance, paving the way for other states to enact similar laws facilitating Preferred Provider Organizations (PPOs) (5)
The Tax Equity and Fiscal Responsibility Act (TEFRA) made it easier and more attractive for HMOs to contract with the Medicare program. (4)    
  TimeLine 1985 - 2000  
1985  1985: National total HMO enrollment reaches 19.1 million (6)  
1990  1990: National total HMO enrollment reaches 33.3 million (6)
National PPO enrollment surpasses HMO enrollment with 38.1 million members (6)
NCQA established (7)
1991  1991: HEDIS 1.0 released (7)  
1994  1994: Blue Cross Blue Shield Association eliminates requirement that all Member Plans must maintain not-for-profit status (3)  
1995  1995: National total HMO enrollment reaches 50.6 million (6)  
1996  1996: Health Insurance Portability & Accountability Act of 1996 (HIPAA) includes patient privacy compliance and health plan portability provisions (4)  
1999  1999: NCQA initiates accreditation of PPOs, which now cover 89 million Americans (7)  
2000  2000: National total HMO enrollment is 80.9 million, declining for the first time from the previous year's level (81.3 million in 1999) (6)       

  TimeLine 20032014  
2003  2003: Medicare Modernization Act establishes Part D drug benefit, establishes HSAs and HDHPs, renames Medicare+Choice program to Medicare Advantage and increases payment rates to Medicare Advantage plans (4)  
2010  2010: Patient Protection and Affordable Care Act is adopted, implementing widespread insurance market reforms, health insurance exchanges, coverage mandates, expanding Medicaid coverage and other provisions, to be phased in over a number of years. (8)  
2013  2013: National total HMO enrollment is 80.5, and national PPO enrollment is 181.7 million (including POS and HDHP enrollment) (6)  
2014  2014: Health Insurance Exchanges open nationally, with 8 million enrolling after the close of open enrollments (9)  
2015  2015: National total HMO enrollment is 90.4, and national PPO enrollment is 156.4 million (6) The Medicare Access and CHIP Reauthorization Act of 2015 is adopted, which includes expansion of Medicare value based programs through the Quality Payment program with two tracks (MIPS and APM) to take effect in subsequent years.   
2017  2017: Trump Administration begins dismantling specific enforcement and other provisions of the Patient Protection and Affordable Care Act. The tax penalty for individuals not having health insurance coverage was repealed starting in 2019 under the Tax Cuts and Jobs Act of 2017.   
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(1) Tufts Managed Care Institute, "A Brief History of Managed Care" 
(2) Kaiser Permanente "History of Kaiser Permanente" 
(3) Blue Cross Blue Shield Association "Blues History" 
(4) Centers for Medicare and Medicaid Services "Key Milestones in CMS Programs" 
(5) CHCF "Making Sense of Managed Care Regulations in California" 
(6) MCOL Managed Care Fact Sheets
(7) NCQA Timelines
HHS.Gov/Healthcare About the Law
Press Release, The White House

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