The original intent of the HMO Act of 1973 was to encourage the creation and proliferation of nonprofit operations through federal grants and loans. In 1981, nearly 90 percent of all HMOs were nonprofits (Mahar, 2006). In the late 1990s workers had become increasingly dissatisfied with managed care plans and employers faced mounting pressure to offer plans with fewer restrictions on provider choice and greater access to care ( ), as a result Preferred Provider Organizations (PPOs) emerged as the dominant alternative to HMOs.

In 1993 sectors requiring employees to offer an HMO alternative was repealed, and in 1988 other provisions regarding equal managed care and traditional plan contribution was amended to give companies more flexibility in determining their HMO contributions, and by the late 1990s workers had become increasingly dissatisfied with their managed care plans. Today the government is trying its best to improve the health care system with the passing of the newThe system for delivering health care in the United States is under great stress, and the pressures are mounting. If cost increases continue unabated and employers persist in their attempt to shift more and more of the burden onto the working population, the ranks of the uninsured will continue to expand, health outcomes will worsen, more people will be forced into bankruptcy, families will dissolve, and all of this will dampen economic activity in the rest of the economy.The delivery health care system has been experiencing major changes over the years and many of these changes have brought about much stress one of which is a result of continued cost increases.

If this continues and employers continue with their goal of shifting more and more of the burden of health care cost on the working population the number of uninsured will continue to escalate, more individuals will be forced into bankruptcy, along with dampening the economy. References Mahar, Maggie. 2006. Money-Driven Medicine: The Real Reason Health Care Costs So Much. New York: Harper Collins.