Happy 53rd birthday Medicaid!!! 🎉🎊🎈🎁🎂 
Two days after Congress passed the Medicare Act of 1965, LBJ signed the Social Security Amendments at the Truman Library in Independence, Missouri.
I actually don’t know at what time.
I actually don’t know at what time.
Truman had fought for universal health care and on the day of signing said:
“Mr. President, I am glad to have lived this long and to witness today the signing of the Medicare bill which puts this Nation right where it needs to be, to be right.”
“Mr. President, I am glad to have lived this long and to witness today the signing of the Medicare bill which puts this Nation right where it needs to be, to be right.”
Johnson: Few can see past the speeches & political battles to the doctor over there that is tending the infirm, & to the hospital that is receiving those in anguish, or feel in their heart painful wrath at the injustice which denies the miracle of healing to the old & to the poor
Johnson: “And no longer will this Nation refuse the hand of justice to those who have given a lifetime of service and wisdom and labor to the progress of this progressive country.”
Johnson: “It calls upon us never to be indifferent toward despair. It commands us never to turn away from helplessness. It directs us never to ignore or to spurn those who suffer untended in a land that is bursting with abundance.”
Oh I do know the time! Sorry! It was at 2:55pm. My bad!
In his speech Johnson did four things:
1. Argue for the ideological reason to embrace Medicare
2. Explain the law and how it would work
3. Explain the process of passage including bringing in the AMA
4. Emphasize the bipartisanship of passage.
1. Argue for the ideological reason to embrace Medicare
2. Explain the law and how it would work
3. Explain the process of passage including bringing in the AMA
4. Emphasize the bipartisanship of passage.
Presidents before Johnson had fought for universal health care but JFK spearheaded the concept of Medicare, first running on it then working to introduce it to Congress the day before he died.
The architects of Medicare and Medicaid were two men named Wilbur. Cohen and Mills. Here is a conversation with the two of them and LBJ on March 23, 1965 (45 years to the day before the passage of the ACA). lbjlibrary.org/press/making-h…
Medicare would begin providing benefit 11 months after passage in 1966.
But implementation was not seamless. Seniors would slam the door in the face of volunteers handing out Medicare cards.
Accounting was haphazard and the systems to reimburse for medical expenses were unclear, even before computers, the internet, and technological developments in medicine.
Medicare implementation was a domestic priority of the Johnson administration.
Put in charge was the powerful Social Security Administration.
Medicaid on the other hand was left to the states to implement.
Medicaid was not mentioned in committee or in the news. It was included in a conversation between the two Wilburs on the critique that Medicare was a pathway to compulsory insurance.
Medicaid was not mentioned in committee or in the news. It was included in a conversation between the two Wilburs on the critique that Medicare was a pathway to compulsory insurance.
Wilbur Cohen developed the plan based on previous state based legislation (Kerr-Mills). He saw this as an incremental step to universal coverage
He would eagerly point out that the AMA was opposed to Medicaid like plans (they also opposed desegregation of hospitals at the time).
Medicaid was 22 pages of the 296 page Medicare Act. Wilbur Cohen included a provision that would stop payments of any state that wasn't broadening eligibility and services in the first 10 years.
Gov. Rockefeller of NY repealed this provision as part of some of the first amendments to Medicaid in 1972.
Cohen: "We might have had a more comprehensive “safety net” for the poor if this provision had remained in the law or had been modified to accommodate New York's special problems."
(Cohen with his brother, I assume his feelings about the 1972 repeal of his secret amendment.)
(Cohen with his brother, I assume his feelings about the 1972 repeal of his secret amendment.)
"I am happy to have played a role in bringing these programs into being and giving a challenge to the health delivery sector of our economy to do better for present and future generations. I believe we will build a better program on the basic foundation of Medicare & Medicaid."
Read about the implementation of Medicaid and Medicare in Wilbur Cohen's own words: ncbi.nlm.nih.gov/pmc/articles/P…
#AmericasGreatestBureaucrat
#AmericasGreatestBureaucrat
Cohen was there for everything-
- Implementing Social Security
- Writing the Wagner-Murray-Dingell bill in 1945 (the most comprehensive universal health care bill)
- Kerr Mill implementation
- JFK Campaign
- Medicare/Medicaid passage and implementation
- Implementing Social Security
- Writing the Wagner-Murray-Dingell bill in 1945 (the most comprehensive universal health care bill)
- Kerr Mill implementation
- JFK Campaign
- Medicare/Medicaid passage and implementation
Kerr-Mills*
Also look how adorable he is!
Also look how adorable he is!
Medicare quickly gained champions in Congress but the beginning years were difficult as the program spent more than anticipated. It required Congress to make several amendments early on.
(Congress eating Medi-cake in 1985)
(Congress eating Medi-cake in 1985)
Medicaid implementation varied by state with some states getting started right away and some holding out nearly 20 years (cough ARIZONA cough).
States used a variety of methods to enroll people learning from their Welfare programs. Eligibility levels were originally tied to state Welfare programs and states would make adjustments based off these levels.
The 1965 law required the states to provide 5 services for those covered by Medicaid: physician's services, skilled nursing home services, inpatient hospital services, outpatient hospital services, and other laboratory or x-ray services.
The first years of implementation were characterized by politics of NY and CA with upstate NYers upset by the generosity of eligibility and Reagan pushing to cut benefits.
Thread dropped for some reason- pick it up again here:
Medicaid would see many changes early. Some of these key changes were related to covering more kids, first with EPSDT in 1967 then later with the Katie Beckett provision in 1982.
In 1967, with the adoption of the EPSDT program a bitter battle between Chairmen Mills and Secretary Gardner over whether Medicaid was welfare or a health insurance program came to light.
The argument had to do in part with work requirements and eligibility levels as a percent of AFDC levels. Ultimately, the House wanted eligibility that couldn't exceed 133% AFDC eligibility (does that number sound familiar?). The Senate version at 150% prevailed.
Johnson said at Wilbur Cohen's swearing in: "Wilbur Cohen knows that you cannot move a nation from an ivory tower. But he has also learned that you can't move a nation with a bulldozer."
"Wilbur feels every person in the country who is at home alone, who is sick, is his personal responsibility....Our future is filled with unfinished business, but it is rich with hope and with a great deal of opportunity, too."
Wilbur Cohen famously said "Good policy is 1% inspiration and 99% implementation." July 30, 1965 was just the beginning.
