07/03/2012 10:24 pm ET Updated Sep 02, 2012

July 4th and the Roots of Obamacare

Many historians have called the Emancipation Proclamation the Second Declaration of Independence, since it legally freed over four million people from chattel slavery at the height of the American Civil War on January 1, 1863. When the Continental Congress announced on July 4, 1776 that "all men were created equal" in the Declaration of Independence, black men and women remained enslaved. The Emancipation Proclamation attempted to correct this exclusion by defining enslaved people in the Confederacy as free and independent.

Yet a closer examination of the Emancipation Proclamation reveals that while enslaved people gained their freedom, it was not granted with the revolutionary fervor of the Declaration of Independence, but instead developed out of military necessity. The Union Army depended on the labor power of formerly enslaved people to support the Union cause. Formerly enslaved men enlisted as soldiers and worked as laborers, while freedwomen worked as cooks and laundresses.

Further, the Emancipation Proclamation made no accessions or plans for how freed slaves were to survive the war. When freed slaves escaped from Southern plantations, they entered an environment in which more soldiers died from disease than from battle. Freed slaves quickly became exposed to outbreaks of smallpox, yellow fever, and typhus; without clean clothing, shelter, and food, many also suffered from exposure and starvation. The war that liberated slaves ironically and unexpectedly led to the death of hundreds of thousands of freedpeople.

In response to the high mortality and sickness that plagued emancipated slaves, federal officials, in an unprecedented move, established the first-ever system of national health care. Under the aegis of the War Department, Congress created the Medical Division of the Freedmen's Bureau, which established 40 hospitals, employed 120 doctors, and treated over one million sick and suffering former slaves in the postwar South.

Because the Emancipation Proclamation didn't provide protection against the deadly consequences of war, federal officials in 1865 needed to expand their authority in order to respond to this medical crisis. Congressmen realized that independence was an empty promise without access to some form of health care, which in the 19th century ranged from basic medical treatment to food, clothing, and shelter.

This history provides an important context to consider the Affordable Care Act (nicknamed Obamacare) and the recent Supreme Court's ruling on it. In the 19th century, the federal government expanded its power and provided medical relief for its soon-to-be citizens as a result of the medical crises that they faced. Today, in response to a health crisis in which American citizens cannot afford medical care, the federal government once again has intervened. What prompted the federal government both then and now has been a crisis. In both the 19th century and now today, the federal government realizes that the rights of citizenship mean very little without access to medical support.

Just like freed slaves could not celebrate emancipation without access to basic medical support, what does celebrating freedom and independence on July 4 mean if American citizens are not in good health?

Jim Downs is the author of 'Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction' (Oxford University Press, 2012). He is an associate professor of history at Connecticut College.