Medicare and Medicaid: History, Populations, and APRN Roles
This paper provides an overview of Medicare and Medicaid, tracing their political origins from early 20th-century health insurance proposals through the landmark Social Security Amendment of 1965. It examines the populations each program serves, including low-income individuals, the elderly, disabled persons, and children. The paper then analyzes Virginia's Medicaid expansion efforts before considering arguments made by states that resist expansion, including concerns about care quality, cost shifting, and the need for state-level policy flexibility. The paper concludes by reflecting on the role of Advanced Practice Registered Nurses in advocating for equitable, high-quality care within these programs.
- A Brief History of Medicaid and Medicare: Political origins from Roosevelt through Johnson's 1965 law
- Populations These Programs Are Intended to Serve: Elderly, disabled, low-income, children, and pregnant women
- States That Have Expanded Medicaid: Virginia's Medicaid expansion efforts and legislative battles
- Reasons Why States Opt Not to Expand Medicaid: Cost, care quality, and need for state-level flexibility
- The Role of the Advanced Practice Registered Nurse: APRNs advocating for reform and equitable patient care
- References: Cited sources supporting the paper's claims
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What makes this paper effective
- The paper grounds its policy analysis in historical context, tracing the long legislative struggle from Theodore Roosevelt through Lyndon Johnson's 1965 signing — giving readers a clear sense of why these programs exist.
- It balances descriptive content (program history and populations served) with evaluative content (arguments for and against expansion), providing a rounded view of a contested policy issue.
- The personal reflection on the APRN role ties the abstract policy discussion to professional practice, grounding the argument in real-world nursing responsibilities.
Key academic technique demonstrated
The paper uses structured policy analysis: it introduces background, defines beneficiary populations, presents a case study (Virginia), and then systematically addresses counterarguments to expansion. This "claim and counterargument" structure is a useful undergraduate technique for health policy writing, demonstrating that the author understands multiple stakeholder perspectives.
Structure breakdown
The paper is organized into five substantive sections plus a reference list. It opens with historical background, moves to program eligibility, narrows to a state-level case study, examines opposition arguments, and closes with a professional role reflection. Each section builds logically on the last, moving from macro (national history) to micro (individual nursing practice).
A Brief History of Medicaid and Medicare
The idea of a national health insurance plan gained political momentum in the first part of the 20th century. President Theodore Roosevelt was among the pioneers in making health insurance a campaign issue. The Second New Deal, crafted by President Franklin D. Roosevelt, involved incorporating the Social Security program into federal law (Piatak, 2015). The Act aimed to reduce the extent to which factors such as poverty, old age, widowhood, and children without known fathers were treated as societal dangers. The New Deal had a significant portion of its content struck down by the Supreme Court, either on grounds of unconstitutionality or because the provisions fell outside federal jurisdiction. Acts such as the National Industrial Recovery Act and the Agricultural Adjustment Act were among those ordered removed.
The medical insurance scheme drafted by President Roosevelt and his team was similarly invalidated. Later, President Truman attempted to incorporate a social health scheme into his government programs but also failed. Earlier efforts include a 1915 proposal in which the American Association for Labor Legislation presented a health insurance bill before state legislatures — an effort that also failed (Piatak, 2015). Nevertheless, in 1965, the Social Security Amendment Bill was passed under President Lyndon Johnson, clearing both the House and the Senate with 307 and 70 votes respectively. The Act of 1965 had two parts, which were later named Medicaid and Medicare (Piatak, 2015). Johnson was notably modest at the signing ceremony, crediting former President Truman for initiating the process.
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