<P> The Congressional Act of 1798 was signed into law by President John Adams . It created a tax of 20 cents each month to be withheld from seamen's wages for support of marine hospitals . The money was paid to the U.S. Collector of Customs . This was the first example of pre-paid health insurance in U.S. history . The Act was expanded in 1799 to include all "officers, seamen and marines of the navy of the United States" </P> <P> In 1801, the first marine hospital owned by the Federal government was located at Washington Point in Virginia . Other early marine hospitals were established in the port cities of Boston, Massachusetts; Newport, Rhode Island; New Orleans, Louisiana; Mobile, Alabama; and Charleston, South Carolina . </P> <P> The first permanent Marine hospital was authorized to be built in Boston, Massachusetts . </P> <P> Kentucky Senator Henry Clay sponsored legislation for the U.S. Marine Hospital to be built in Louisville, "for the of sick seamen, boatmen, and other navigators on the western rivers and lakes ." </P>

Founded in 1798 the marine hospital service has since evolved into which of the following agencies