Before 1973, most health insurance in the U.S. was nonprofit. Plans like Blue Cross were founded by hospitals to help patients afford care — everyone paid the same rate regardless of age or health. The focus was on community benefit, not profit margins. ▪️ What changed? The 1973 HMO Act under President Nixon opened the door for for-profit insurers. Rising medical costs, hospital consolidation, and Wall Street investment shifted health coverage from a community service to a commercial product. ▪️