The history of water quality policy in the US is characterized by incremental changes in policy instruments over time. This chapter traces the origins of water quality policy in the US through the lens of a policy streams model. Beginning with the Refuse Act of 1899, the chapter traces the antecedents of the landmark Federal Water Pollution Control Act of 1948, and discusses the development of the expanding federal role in water pollution policy through the 1950s and 1960. The chapter discusses both the political forces that drove policy development, as well as the larger social and economic context that created a growing demand for national policy.