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After much secrecy and no public deliberation, Senate Republicans finally released their “draft” repeal and replace bill for the Affordable Care Act on June 22. Unquestionably, the released “draft” will not be the final version.

The U.S. has rarely taken back benefits once they have been bestowed on its citizenry.

Amendments and a potential, albeit not necessary, conference committee are likely to make some adjustments. However, both the House version—American Health Care Act—and the Senate’s Better Care Reconciliation Act will significantly reduce coverage for millions of Americans and reshape insurance for virtually everyone. The Congressional Budget Office is expected to provide final numbers early next week.

If successful, the repeal and replacement of the Affordable Care Act would be in rare company. Even though the U.S. has been , the U.S. has rarely taken back benefits once they have been bestowed on its citizenry. Indeed, only a small number of significant cases come to mind.

My academic work has analyzed the including those rare instances. I believe historical precedents can provide insights for the current debate.

Providing help to mothers and infants

The first major federal grant program for health purposes was also the first one to be quickly eliminated. The program was authorized under the of 1921. It provided the equivalent of $20 million a year in today’s dollars to states in order to pay for the needs of women and young children.

Sheppard-Towner, which provided funding to improve health care services for mothers and infants, was enacted after a amid accusations of socialism and promiscuity. Interestingly enough, the act may have passed only due to .

The act may have passed only due to pressure from newly voting-eligible women.

Overall, the for more than 3 million home visits, close to 200,000 child health conferences, and more than 22 million pieces of health education literature distributed. It to establish 3,000 permanent health clinics serving 700,000 expectant mothers and more than 4 million babies.

The , when Congress, under pressure from the American Medical Association, the Catholic Church, and the Daughters of the American Revolution, terminated the program. Without federal support, a majority of states either eliminated the programs or only provided nominal funding. Fortunately for America’s children and mothers, the much of the original funding and expanded it over time.

Helping America’s farmers during the New Deal

America’s next major program confronted a similar fate. To address the challenges of rural America during the Great Depression, the federal government developed a variety of insurance and health care programs that offered extensive and comprehensive services to millions of farm workers, migrants, and farmers.

Some of these programs provided subsidies to farmers to form more than 1,200 insurance cooperatives nationwide. At times, provided extensive services directly to migrant farmworkers through medical assistance on agricultural trains, mobile and roving clinics, migratory labor camps that included health centers staffed with qualified providers, full-service hospitals, and Agricultural Workers Health Associations.

In all cases, services were generally comprehensive and included ordinary medical care, emergency surgery and hospitalization, maternal and infant care, prescription drugs, and dental care.

Although accepting the program during wartime, the American Medical Association and the Farm Bureau opposed it, which ultimately led to the demise of these programs shortly after World War II, and millions of farmers lost their insurance.

Medicaid in the 1980s

Perhaps the most indicative of what will happen if congressional Republicans are able to pass their proposal comes from the Medicaid program itself.

In the early 1980s, leading to the first contracting in the program’s history. These involved both a reduction in federal funding and in eligibility, and an increase in state flexibility to run the program, as do the Republican proposals in Congress.

The cuts pale in comparison to those currently proposed by both the Senate and House. Nonetheless, the results were the . However, this came at a steep cost for many Americans in the form of a .

Protecting America’s seniors

The 1980s also saw the creation and quick demise of another health care program. The sought to fill in the gaps of the original Medicare program for America’s seniors. Specifically, it sought to provide them with protection from major medical costs and offer them a prescription drug benefit for the first time.

Only limited steps have been taken to protect seniors from major medical losses.

Like the Affordable Care Act, the law had a by requiring richer seniors to contribute more than poorer individuals. It also phased in benefits over a period of time.

Congress, confronted by affluent seniors who would have shouldered much of the financial burden of the program, quickly repealed much of the law before its provisions came into effect.

It took more than a decade to provide America’s seniors with a prescription drug benefit through Medicare Part D, while only limited steps have been taken to protect seniors from major medical losses.

A serious setback looming?

While a latecomer, the United States has to the development of a comprehensive welfare state when it comes to health care. While the development has been incomplete, health benefits, once granted,

The proposed changes are unprecedented.

The . States were unable to continue the program without federal support or offer a valid replacement. Indeed, the programs quickly faded away. With them, millions of Americans lost access to health care.

In all three previous cases, the federal government . However, at times it took time for a replacement program to emerge.

The current changes proposed by congressional Republicans, particularly to the , are tremendously more consequential than anything we have previously experienced.

Indeed, in scale and extent, the proposed changes are unprecedented and would significantly roll back, likely for the foreseeable future, America’s safety net. 

This article was originally published on . It has been edited by ¾«¶«Ó°Òµ Magazine.