<P> A Johns Hopkins Hospital study found that heart transplant complications occurred most often amongst the uninsured, and that patients who had private health plans fared better than those covered by Medicaid or Medicare . Gallup issued a report in July 2014 stating that the uninsured rate for adults 18 and over declined from 18% in 2013 to 13.4% by in 2014, largely because there were new coverage options and market reforms under the Affordable Care Act . Rand Corporation had similar findings . </P> <P> The Affordable Care Act of 2010 was designed primarily to extend health coverage to those without it by expanding Medicaid, creating financial incentives for employers to offer coverage, and requiring those without employer or public coverage to purchase insurance in newly created health insurance exchanges . The CBO has estimated that roughly 33 million who would have otherwise been uninsured will receive coverage because of the act by 2022 . </P> <P> Accident insurance was first offered in the United States by the Franklin Health Assurance Company of Massachusetts . This firm, founded in 1850, offered insurance against injuries arising from railroad and steamboat accidents . Sixty organizations were offering accident insurance in the US by 1866, but the industry consolidated rapidly soon thereafter . While there were earlier experiments, sickness coverage in the US effectively dates from 1890 . The first employer - sponsored group disability policy was issued in 1911, but this plan's primary purpose was replacing wages lost because the worker was unable to work, not medical expenses . </P> <P> Before the development of medical expense insurance, patients were expected to pay all other health care costs out of their own pockets, under what is known as the fee - for - service business model . During the middle to late 20th century, traditional disability insurance evolved into modern health insurance programs . Today, most comprehensive private health insurance programs cover the cost of routine, preventive, and emergency health care procedures, and also most prescription drugs, but this was not always the case . The rise of private insurance was accompanied by the gradual expansion of public insurance programs for those who could not acquire coverage through the market . </P>

When did health insurance start in the united states