Fifty years ago today, President Lyndon B. Johnson signed into law the landmark amendments to the Social Security Act that created the Medicare and Medicaid programs. In his comments at the signing, President Johnson made explicit the connection between the right to health care, and the financial security of older Americans and families of all ages. In the half century since, these two life-changing programs have indeed provided that security to tens of millions of adults over age 65, people with disabilities, children and families, pregnant women, and low-income Americans.
At the time of enactment, roughly half of all older adults in the United States had no health insurance. Today, Medicare and Medicaid cover nearly 1 out of every 3 Americans – more than 100 million people. But there are still millions more without coverage of any kind, or with coverage, but inadequate access to care and services they vitally need.
While a pause for celebration is in order today, complacency is not.
The United States continues to spend almost twice as much per capita on health care as any other western democracy, with far less “bang for our buck,” in terms of health status and outcomes to show for it. Significant health disparities and unequal access to quality care continue to be hallmarks of our health system. These issues pose a threat to the sustainability of Medicare and Medicaid, as well as new programs established under the Affordable Care Act.
The ACA was carefully crafted to build upon – and improve – the solid footings Medicaid and Medicare provide for the health care of vulnerable populations, even as it created a new pathway to coverage for millions more through the insurance Marketplaces.
Beyond establishing the Marketplaces, the ACA has many other provisions that are already changing the health care landscape in dramatic ways:
- First and foremost, the provision insuring more people through Medcaid was envisioned to take effect in every state, to dovetail with the eligibility guidelines of the Marketplaces. Advocates are working tirelessly in those states which have yet to close the coverage gap to make that promise a reality in all 50 states.
- The Medicare-Medicaid Coordination Office, created under the ACA, is overseeing financial alignment demonstration projects in a dozen states to address the very real difficulties that people eligible for both Medicare and Medicaid confront daily due to the different rules and benefit guidelines, and often fragmented and uncoordinated care they produce. Our Voices for Better Health Project is working with state partners and geriatric provider experts to help implement these demonstrations to provide the best integration and coordination of care possible, while protecting consumers and helping them make their voices heard in the process.
- The Center for Medicare and Medicaid Innovation (“The Innovation Center”) is another creation of the ACA. This center is working to seek out, evaluate and pilot new payment and service delivery models that aim to achieve better care for patients, better health for communities, and lower costs through improvement of the health care system.
There is much more advocacy needed to expand the reach, quality, equity and cost effectiveness of both Medicare and Medicaid in the decades ahead. Community Catalyst and our state partners are committed to working together to transform our health care system into one that operates effectively and efficiently to ensure all people get the care they need and that invests in keeping them healthy.
For today, please join us in wishing a Happy 50th Anniversary to Medicare and Medicaid!