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One of the joys of being in this space since 2018 is watching more and more voices grow public awareness of health policy.
https://joehoft.com/a-brief-history-of-health-insurance-regulation-death/
A Brief History of Health Insurance: Regulation = Death
Joe Hoft /Guest post by Rolf Lindgren | December 1, 2025
In the U.S. Constitution ratified in 1788, there is no federal power to regulate insurance. The states regulated insurance. This was a great system because if the laws in one state were bad, you could move to another state. It prevented a cartel of massive insurance corporations from taking over the entire nation. Insurance lobbyists had to go to each state separately to try to rig the system, which was impractical.
So in 1869, the national insurance lobby brought a case to the US Supreme Court. This case, called Paul vs. Virginia (1869) was remarkable for three reasons:
1) The insurance companies WANTED to be regulated by the federal government.
And the Supreme Court decided…
2) Corporations are NOT people.
3) Insurance is NOT commerce!
The insurance lobby lost the case. It was a unanimous decision authored by fabled pro-capitalism Justice Stephen J. Field.
So America continued to enjoy insurance freedom for another 75 years as it turned out, during which time the American economy grew to the largest in the world, by far.
But the bad news is that in 1944, Paul vs. Virginia was overturned.
The Supreme Court suddenly decided that insurance was commerce and soon the President, US Congress, and national insurance lobby thought it was a good idea to federally regulate insurance.
One area ripe for regulation was employee-paid health insurance. Since wage freezes were enacted during WWII, employers offered free health insurance to compensate. The federal government quickly moved in to regulate this practice. So began the cycle of fixing one insurance regulation with new regulations.
Here is a quick summary of major post-WWII health insurance regulations, all of which would have been unconstitutional under Paul vs. Virginia:
The Hill-Burton Act of 1946 – Regulated the addition of hospital construction costs into health insurance costs
The Revenue Act of 1954 – Excluded health benefits from taxable income, thereby ingraining the employee-paid healthcare system
Military Medicare Act of 1956 – Medicare for military family members only
Medicare and Medicaid 1965 – Medicare for everyone, plus Medicaid for low-income people
Employee Retirement Income Security Act (ERISA) of 1974 – Massive regulation of all facets of health insurance
Mental Health Parity Act of 1996 – Requires quasi-scientific mental healthcare to be treated the same as medicine based upon hard science.
And we all know about Obamacare 2010 – Obamacare also would have been unconstitutional under Paul vs. Virginia. In a remarkable fact, not long after the Supreme Court upheld Obamacare in 2012, the six largest health insurance companies merged into only three!
Another remarkable fact is that Obamacare was labeled a “a government takeover of insurance.” But had the Republicans held Congress at the time, the insurance lobbyists were prepared to have it called “a corporate takeover of insurance” for almost the exact same law! Either way, it’s both socialism (redistribution of wealth) and fascism (partnership of big government and big business).
The three most heavily regulated industries in the US are healthcare, education, and nuclear reactors. All of them have unsustainable cost explosions.
Today, we face a health insurance and healthcare crisis, accompanied by a vast array of laws and regulations. We don’t have cost transparency. This didn’t exist prior to 1944. In those days, you could call your family doctor over for a visit and pay out of pocket. The improvements we do have since 1944 derive from advances in science & technology, not from regulations. Today, health insurance isn’t affordable, and pretty soon, healthcare costs may swallow up most of our Gross National Product.
Frightening Final Thought
Imagine for a moment if a serious world war began. Suppose this war involved the United States, China, Russia, India and/or Europe. Suppose our government needed every resource available for the military to fight the war. What would happen to all the people getting government healthcare benefits? Chances are, they would be left on their own until the world war was over, and millions of people would die.
Our healthcare system must be fixed now. Restore Paul vs. Virgina!
How do we restore Paul V Virginia? Another lawsuit?
@pattie such a good question. The best I've got is that people controlling their own money are more free than those who don't.
What we have with federal insurance law is one knotty mess, I just wish I knew the correct thread to pull to undo it!
@pattie Justia records Paul v. Virginia's opinions and final decision. Fascinating stuff! I'm posting just the syllabus here.
Trigger any ideas?
https://supreme.justia.com/cases/federal/us/75/168/
U.S. Supreme Court
Paul v. Virginia, 75 U.S. 7 Wall. 168 168 (1869)Syllabus
1. A state statute which enacts that no insurance company not incorporated under the laws of the State passing the statute shall carry on its business within the State without previously obtaining a license for that purpose, and that it shall not receive such license until it has deposited with the Treasurer of the State bonds of a specified character to an amount varying from thirty to fifty thousand dollars, according to the extent of the capital employed, is not in conflict with that clause of the Constitution of the United States which declares that "the citizens of each State shall be entitled to all the privileges and immunities of citizens in the several States," nor with the clause which declares that Congress shall have power "to regulate commerce with foreign nations and among the several States."
2. Corporations are not citizens within the meaning of the first of these clauses. They are creatures of local law, and have not even an absolute right of recognition in other States, but depend for that and for the enforcement of their contracts upon the assent of those States, which may be given accordingly on such terms as they please.
3. The privileges and immunities secured to citizens of each State in the several States by this clause are those privileges and immunities which are common to the citizens in the latter States under their constitution and laws by virtue of their being citizens. Special privileges enjoyed by citizens in their own States are not secured by it in other States.
4. The issuing of a policy of insurance is not a transaction of commerce within the meaning of the latter of the two clauses, even though the parties be domiciled in different States, but is a simple contract of indemnity against loss.
The case was thus:
An act of the legislature of Virginia, passed on the 3d of February, 1866, provided that no insurance company not incorporated under the laws of the State should carry on its business within the State without previously obtaining a license for that purpose, and that it should not receive such license until it had deposited with the treasurer of the State bonds of a specified character, to an amount varying from thirty to fifty thousand dollars, according to the extent of the capital employed. The bonds to be deposited were to consist of six percent bonds of the State, or other bonds of public corporations guaranteed by the State, or bonds of individuals, residents of the State, executed for money lent or debts contracted after the passage of the act, bearing not less than six percent per annum interest.
A subsequent act passed during the same month declared that no person should, "without a license authorized by law, act as agent for any foreign insurance company" under a penalty of not less than $50 nor exceeding $500 for each offence; and that every person offering to issue, or making any contract or policy of insurance for any company created or incorporated elsewhere than in the State should be regarded as an agent of a foreign insurance company.
In May, 1866, Samuel Paul, a resident of the State of Virginia, was appointed the agent of several insurance companies, incorporated in the State of New York, to carry on the general business of insurance against fire, and, in pursuance of the law of Virginia, he filed with the auditor of public accounts of the State his authority from the companies to act as their agent. He then applied to the proper officer of the district for a license to act as such agent within the State, offering at the time to comply with all the requirements of the statute respecting foreign insurance companies, including a tender of the license tax, excepting the provisions requiring a deposit of bonds with the treasurer of the State, and the production to the officer of the treasurer's receipt. With these provisions neither he nor the companies represented by him complied, and, on that ground alone, the license was refused. Notwithstanding this refusal, he undertook to act in the State as agent for the New York companies without any license, and offered to issue policies of insurance in their behalf, and in one instance did issue a policy in their name to a citizen of Virginia. For this violation of the statute, he was indicted, and convicted in the Circuit Court of the City of Petersburg, and was sentenced to pay a fine of fifty dollars. On error to the Supreme Court of Appeals of the State, this judgment was affirmed, and the case was brought to this Court under the 25th section of the Judiciary Act, the ground of the writ of error being that the judgment below was against a right set up under that clause of the Constitution of the United States [Footnote 1] which provides that "the citizens of each State shall be entitled to all the privileges and immunities of citizens in the several States," and that clause [Footnote 2] giving to Congress power "to regulate commerce with foreign nations, and among the several States."
The corporators of the several insurance companies were at the time, and still are, citizens of New York, or of some one of the States of the Union other than Virginia. And the business of insurance was then, and still is, a lawful business in Virginia, and might then, and still may, be carried on by all resident citizens of the State, and by insurance companies incorporated by the State, without a deposit of bonds, or a deposit of any kind with any officer of the commonwealth.
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