<P> Persistent lack of insurance among many working Americans continued to create pressure for a comprehensive national health insurance system . In the early 1970s, there was fierce debate between two alternative models for universal coverage . Senator Ted Kennedy proposed a universal single - payer system, while President Nixon countered with his own proposal based on mandates and incentives for employers to provide coverage while expanding publicly run coverage for low - wage workers and the unemployed . Compromise was never reached, and Nixon's resignation and a series of economic problems later in the decade diverted Congress's attention away from health reform . </P> <P> Shortly after his inauguration, President Clinton offered a new proposal for a universal health insurance system . Like Nixon's plan, Clinton's relied on mandates, both for individuals and for insurers, along with subsidies for people who could not afford insurance . The bill would have also created "health - purchasing alliances" to pool risk among multiple businesses and large groups of individuals . The plan was staunchly opposed by the insurance industry and employers' groups and received only mild support from liberal groups, particularly unions, which preferred a single payer system . Ultimately it failed after the Republican takeover of Congress in 1994 . </P> <P> Finally achieving universal health coverage remained a top priority among Democrats, and passing a health reform bill was one of the Obama Administration's top priorities . The Patient Protection and Affordable Care Act was similar to the Nixon and Clinton plans, mandating coverage, penalizing employers who failed to provide it, and creating mechanisms for people to pool risk and buy insurance collectively . Earlier versions of the bill included a publicly run insurer that could compete to cover those without employer sponsored coverage (the so - called public option), but this was ultimately stripped to secure the support of moderates . The bill passed the Senate in December 2009 with all Democrats voting in favor and the House in March 2010 with the support of most Democrats . Not a single Republican voted in favor of it either time . </P> <P> Public programs provide the primary source of coverage for most seniors and also low - income children and families who meet certain eligibility requirements . The primary public programs are Medicare, a federal social insurance program for seniors (generally persons aged 65 and over) and certain disabled individuals; Medicaid, funded jointly by the federal government and states but administered at the state level, which covers certain very low income children and their families; and CHIP, also a federal - state partnership that serves certain children and families who do not qualify for Medicaid but who cannot afford private coverage . Other public programs include military health benefits provided through TRICARE and the Veterans Health Administration and benefits provided through the Indian Health Service . Some states have additional programs for low - income individuals . In 2011, approximately 60 percent of stays were billed to Medicare and Medicaid--up from 52 percent in 1997 . </P>

Which act established provisions that require u.s. citizens to obtain health​ insurance