An Origin Story: Medicaid

Medicaid (noun): health coverage provided through a joint partnership of the federal and state governments to millions of Americans, including low-income individuals, pregnant women, children, elderly adults, and individuals with disabilities. 

1937: President Franklin D. Roosevelt did not include national health insurance in the New Deal. The rhetoric of this time was similar to the 2008 election and subsequent passage of the Affordable Care Act , painting any potential government-financed health program as a socialized nightmare. Roosevelt responded to complaints from the American Medical Association (AMA) and put the issue to rest: “Attempts have been made in the past to put medicine into politics. Such attempts have failed and always will fail.”

1945: The AMA conducts the most expensive lobbying effort to date against President Truman’s plan for universal health care, calling such a program “un-American,” “socialized medicine,” and “followers of the Moscow party line.”

1960: The Kerr-Mills Act passes, granting medical assistance to the elderly. This predecessor of the Medicaid and Medicare looks nothing like what we have come to expect from the national programs of today. Strict guidelines and poor uptake (only 28 states adopted the program) led to an estimated one percent of the elderly receiving benefits.

1964: The election of President Johnson, coupled with a Democratic majority, presents the perfect opportunity to begin crafting legislation on meaningful health reform.

July 30th 1965:  The Medicare amendment is added to the Social Security Act and an expanded version of Kerr-Mills, known as Medicaid, begins. Together, these programs are called a “three layer cake,” referring to hospital insurance, voluntary physician coverage, and expanded Kerr-Mills.

This story might sound familiar, as it’s incredibly similar to the story of the Affordable Care Act. Decades of opposition and accusations of socialized medicine, a policy window made possible by an election cycle, a trial balloon in the form of smaller, state-level legislation…this is how policy has been built throughout U.S. history. Sweeping legislation and drastic policy change take several years to put forward; rarely is anything so drastic that it plummets the country into demise. That isn’t to say the Medicaid program and its beneficiaries haven’t met its share of challenges since the 1960s. The last 50 years have seen plenty of bumps and bruises that have required hard work at the state, federal, and advocacy levels to iron out.

Image from the LBJ Library.

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