On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (Affordable Care Act). The measure became law when, on March 30, 2000, he also signed the Health Care and Education Reconciliation Act of 2010 which had been passed by both the House and the Senate. By many accounts, the resulting law is one of the most sweeping and far-reaching national reform acts since the Civil Rights Act of 1964. Indeed, it promises to reform the national health care system in a variety of ways that will impact virtually every member of American society -- personally, financially and/or professionally.

Although the Affordable Care Act marks an important time in American politics, national health care reform is not a modern concept. Rather, it is an idea that finds its roots in models that European countries first used in the late 1800’s and has been a consistent piece of the American political dialogue since the early 1900’s. Understanding the prior efforts at – and obstacles to – national health care reform therefore is essential to understanding how the Affordable Care Act became law. It also provides an important context that should prove useful when trying to forecast exactly how the Affordable Care Act will shape the future of American society.