Facing resistance from the American Medical Association (AMA) against government-funded insurance, physician pressure leads to the establishment of new private insurance companies during the late 1920s through 1940s, including Blue Cross for hospital insurance, Blue Shield for physician insurance, and Kaiser Permanente as an independent consumer cooperative.

Blue Cross begins in Texas in 1929 as a plan for teachers to be able to better afford healthcare. They create the first prepaid plans, which means that consumers can pay money at the front end of the year to receive specific kinds of care throughout the year.