1/ The Social Security Act dates back to 1935 when Franklin D. Roosevelt was President. It was amended under the government of President Johnson.
It was the time of the Great Depression, when so many people were ruined after Black Tuesday.
Black Tuesday took place on October 29th 1929. The Dow Jones, which had reached the figure of 369 on September 19th 1929, had fallen to 173 on November 11th 1930 and to 53 on March 4th 1933, the day of Franklin D. Roosevelt’s election.
The former President Herbert Hoover  - 10/08/1874 -  20/10/1964  (president 1929-1933) was a Republican. He was an orphan and a self made man. He did not know very much about economy. 
 He used to repeat, during his presidency, in the years 1929, 1930, 1931, 1932, year after year "Next year things will get better". As you can imagine he was not reelected.
At that time the economists made mistakes, like raising the discount rate of the banks. People got frantic  and withdrew their money from the banks. There was no more credit, no more money for firms.  Many companies had to shut down, causing unemployment and ensuing poverty.
Unemployment  went  sky high (more than 25 % of the US population)  and there were more than 2 million  homeless.  Many people lived  in shanty towns nicknamed "Hooverville"
Franklin D. Roosevelt made some reforms, but the US economy  did not recover until after WW II.  The Dow Jones regained its value of 360 on October 10th 1954 -  The value in January  2014 is : 16500. 
Back to our subject : the Social Security Act, a law passed in 1935 and signed by President Franklin D. Roosevelt encompassed several social welfare and social insurance programs 
•	Federal Old-Age, Survivors and Disability Insurance
•	Unemployment benefits
•	Temporary Assistance for Needy Families
•	 Health Insurance for the Aged and the Disabled (Medicare)
•	 Grants to States for Medical Assistance Programs (Medicaid)
•	 State Children’s Health Insurance Program
•	 Supplemental Security Income

It was funded through taxes, but its privatization and reduction have been a major political issue for the last three decades. Each state had its own particular level of social welfare and medical insurance.

2/ In the list there is no mention of medical insurance for the general population.
In fact, medical insurance for the general population has so far been based on private insurance which is profit-making. 
Most people in employment, at least those who work for large companies, have medical insurance. But with the economic crisis many people have lost their jobs and at the same time their  health insurance.
In 2010, nearly 50 million Americans still did not have  access  to medical care just because they could not afford it, and many families have gone bankrupt after financing medical treatment for one of their members.
So there are big discrepancies among the American population based on age, employment or fortune :  hence the maxim :  “Our current national health care system is simple “Don’t get sick”
Till now the aim of the US government has been to maintain economic growth, so as to avoid unemployment and keep people in work by every possible means so that they can pay for their health insurance.
But this has changed with the economic crisis, and the cost of medical care that has gone sky high, increasing sevenfold in the past three decades.
3/ The US healthcare system has many attractive features. A large part of the population has access to high standards of medical care which are continuously enhanced through cutting edge technological innovation. 
Nevertheless, the overall health status of the US population as reflected in variables such as life expectancy and potential years of life lost, appears to rank among the lower third of OECD countries, despite much higher expenditure per capita than any other country i.e. 17% of the US GNP  (France 11%, and UK 8%)
The idea is “that there were substantial opportunities for reforms that would reduce costs and increase access, enhance quality and improve the health of the Americans.”
4/ Seizing these opportunities would thus contribute to the achievement of the main objectives of the US Department of Health and Human Services : namely to reduce and ultimately eliminate health inequalities among various segments of the US population including those concerning gender, ethnic, socioeconomic and geographic groups and to increase life expectancy and the quality of life among Americans of all ages.
All the candidates, McCain, Obama and Hillary Clinton had proposals to reform the healthcare system but Obama said he would introduce a bill.
5/ The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Obama on March 23rd 2010.
Speaker Nancy Pelosi was instrumental in the passage of the  Patient Protection and Affordable Care Act of 2010. Pelosi was a key figure in convincing President Obama to continue pushing for health care reform after the election of the Massachusetts Republican Senator Scott Brown in a January special election, (GB : a bye-election) a defeat that was seen as potentially fatal to Democratic reform efforts. 
After delivering 219 votes in the House for Obama’s signature health care package, Pelosi was both praised and heckled as she made her way to Capitol Hill.
The Tea Party movement organized protests and many conservative groups voiced their opposition to the reform bill, with Sarah Palin as one of their leaders. 
The bill contained provisions that would go into effect immediately : in June  2010 and September 2010 ; and other provisions that will come into effect in 2014.
The funding is based on taxes. Small businesses will have to buy insurance for their employees or pay a fine, and uninsured people will be allowed to buy insurance at competitive prices. 
Illegal immigrants are excluded from the reform. It is estimated that 32 million  Americans will now have access to medical insurance.
Nevertheless health insurance remains under private management : there is nothing like the French Sécurité Sociale. I didn’t find anything about sick pay (or ‘sickness benefits’).
6/ So the law was passed in spring 2010 but came up against a strong protest movement: the Tea Party, which enabled the Republicans, the GOP, to regain a majority in  the House of Representatives.
The idea of the GOP representatives was to make the President derail and modify the Healthcare Reform. So they tried to blackmail the President and they bided their time.
7/ October 1st marks the start of a new fiscal year. Under the US Constitution, Congress must pass laws to spend money. When Congress cannot agree on a spending bill called an appropriation, the government does not have the legal authority to spend money and must cease all non-essential operations.
The House and Senate were unable to come to an agreement after months of negotiations. The main source of contention was funding for the implementation of the Affordable Care Act (ACA) also known as Obamacare. Republicans wanted to cut spending and avoid raising taxes, while Democrats sought a combination of spending cuts and tax increases. President Obama threatened to veto legislation that would defund  the ACA.
So, from the first of October all non important parts of the administration were shut down, including Medicaid and Medicare. Many public service employees were furloughed (GB =  laid off temporarily). The deadline was Wednesday October 16th at midnight, when the US Government had to settle its debt.
The melodrama lasted until the final hours but in the end the law was voted by the two Chambers and  signed by President Obama.
Under this agreement, the Government would be financed through (GB = until) January 15th 2014  and the Treasury would have borrowing powers until  February 7th. But the story is not finished yet. In the first quarter of 2014, the country will again hit "the debt ceiling" and encounter the same problems.
8/ How does the ACA work ?
Health Insurance remains private. 
People are required to have insurance either individually or through their  jobs,  otherwise they will have a tax penalty.

So there is a link between healthcare and taxes. Many people will be eligible for a tax credit if the annual family income is between 100 and 400% of the Federal Poverty Level which stands at 11,490 US $ per year per person.

The tax credit will lower the insurance premiums for the general population, but  high earners will pay more taxes.

The ACA has set up  an organization "the Health Insurance Marketplace" also called " Health Exchange" to facilitate the purchase of health insurance in every state of the US, in accordance with the law. 

Marketplaces provide a set of government-regulated and standardised  health care plans from which individuals  or small businesses may purchase  health insurance eligible for federal subsidies.

Exchanges are not themselves insurers, they do not bear risks themselves but they do determine the insurance companies that are allowed to participate.

So they help to spread the risk, to ensure that the costs associated with expensive medical treatment are shared more broadly across large groups of the population rather than spread over just a few beneficiaries.

To receive a tax credit people must apply  by phone or through the internet on  the website healthcare.gov which is working well now after some glitches during the first few weeks. 

The applicants must create a Marketplace account, choose the State and the County they live in, indicate the number of people in their family and their age, and choose the plan they want to pay for, bronze, silver, gold or platinum.
Each plan has its monthly premium, its deductible  and out-of-pocket maximum per year. 

Insurers are prohibited from discriminating against any individual by charging higher rates based on pre-existing medical conditions or gender.
On 3rd January 2014, 2 million people had already applied.

In conclusion  : I hope that this presentation has shown you how Politics and Economy  interfere with Healthcare.

Health Insurance Companies :
CIGNA
BLUE CROSSO BLUE SHIELD
AETNA INC
HUMANA INC
UNITEDHEALTH GROUP Incorporated
WELLPOINT
HEALTH NET INC.