Thursday, September 18, 2014
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Government-sponsored health care's success (in World War II)

The Emergency Maternity and Infant Care Act, attacked as socialized medicine, turned out to be a roaring success for the wives of servicemen at war.

Government-sponsored health care's success (in World War II)

A GI and his family seeking assistance through EMIC during World War II. (National Archives)
A GI and his family seeking assistance through EMIC during World War II. (National Archives)

In 1943, the United States government began paying for medical, nursing, and hospital maternity and infant care provided to the wives of enlisted men in the lowest four military pay grades. The Emergency Maternity and Infant Care Act, known as EMIC, funded the care of about 1-1/2 million women and infants from 1943 to 1949. Although opponents questioned whether EMIC was a dangerous form of “socialized medicine,” patriotism—and the fact that this was presented as an emergency measure—overrode their opposition. There was widespread legislative support.

EMIC answered a demonstrated need. After the attack on Pearl Harbor and the United States’ entrance into World War II, the size of the military expanded rapidly. Over 16 million Americans saw service during the war. The wives of soldiers and sailors moved with them to military bases and lived far from home and family on low pay. Men in grade 7, for example, the lowest pay grade, earned only $50 a month, although base pay increased annually. Lacking the means to pay for medical care during and after their pregnancies or to cover the costs when their babies fell ill and needed services, families turned to state programs supported by the Social Security Administration and to local charities, but these did not underwrite the full costs of charitable care.

EMIC was the answer. Created and run by the United States Children’s Bureau, the program sent funds to the states to pay physicians and hospitals for the services provided. Reimbursement for complete maternity services—at least five prenatal visits, delivery, care of the newborn, and postpartum examinations—ranged from $35 to a maximum of $50 depending on the state reimbursement rate. Cesaerean deliveries were paid at the same rate and there were no co-pays for any EMIC-supported services! Hospital stays—a minimum of 10 days after delivery—averaged $5.38 per day in 1944 and rose to $6.58 by 1946, again with variations by state. When the figures were tallied at the close of the program, families' cost for maternity care (including doctor and hospital) averaged $92.49.

Like any new form of social welfare, the EMIC program had its detractors, its administrative difficulties, its challenges in defining the scope of coverage, and its concerns about growing costs. The program was not means-tested in the sense that it served all those who qualified according to their husband’s pay grade. But the wives of those in the top three pay grades were not eligible. Unlike modern medical forms, enrollment in EMIC was simple. A one-page form (on page 189, if you're curious) asked only the patient's name, address, husband's name, his branch of service, his rank or rating, and his service mailing address.

Martha May Eliot, a physician and associate chief of the United States Children’s Bureau, developed and administered the EMIC program. Eliot later served as chief of the Children’s Bureau, president of the American Public Health Association, and assistant general director of the World Health Organization, and in many other distinguished leadership posts.

From our vantage point we can look back on EMIC as a successful program in terms of the care that it delivered—but as an ultimate failure precisely because it met its goals. Eliot and others viewed EMIC as the first step on the way to a broader national program underwriting infant and child health. It was a successful demonstration of how to efficiently deliver medical care. Families that could not afford but wanted hospital deliveries had access to them. For the wives of African American servicemen in particular, the EMIC program brought vastly improved access to medical services.

Yet the EMIC program's success in limiting costs by setting fees for physicians and hospitals roused opposition. Legislation to support an expanded program met with a barrage of opposition from organization medicine. Cries of “socialized medicine” rose—and, in peacetime, they drowned out the voices of health care supporters on Capitol Hill. Organized medical groups continued to fight efforts to expand access to coverage through federally funded plans. As a result, no new federal programs to underwrite medical care would begin until the legislation creating Medicare and Medicaid programs passed in 1965. By then, the first EMIC babies had reached voting age.


Read more about The Public's Health.

Janet Golden, PhD Professor of history, Rutgers University-Camden
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Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

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Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, DrPH, MSc Assistant Professor, Drexel University School of Public Health
Janet Golden, PhD Professor of history, Rutgers University-Camden
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