Medicare and Medicaid: History, Populations, and APRN Roles

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.

Populations These Programs Are Intended to Serve

President Lyndon Johnson formally signed the Medicaid and Medicare implementation bill into law on July 30, 1965. Initially, the Medicare segment comprised Part A, covering hospital insurance, and Part B, covering medical care insurance — together forming what is known as Original Medicare. Both parts were designed to help Americans manage healthcare costs. Over the years, Congress has reviewed and amended the plan to make it accessible to more Americans. Medicare extended its coverage in 1972 to include people with disabilities, patients with end-stage renal disease, and all individuals aged 65 and above (Piatak, 2015).

Medicaid has also made significant strides over time in assisting American citizens in need of healthcare. Initially focused solely on individuals requiring financial assistance, the program has evolved to include people with disabilities, those with low income, pregnant women, and individuals requiring long-term care. In 1997, the Children's Health Insurance Program (CHIP) was established, providing preventive healthcare to approximately 11 million uninsured children. All 50 states, the District of Columbia, and U.S. territories offer CHIP health plans.

The Medicare Modernization Act (MMA) of 2003 represented the most significant change to the Medicare program in nearly four decades. Private-sector health plans approved by Medicare were designated Medicare Advantage, or Part C. Medicare Part D was also added through the MMA as an optional prescription drug benefit. The Affordable Care Act (ACA), enacted in 2010, established the Health Insurance Marketplace — a centralized platform through which consumers could apply for and enroll in private insurance plans across a broad spectrum (Salmond & Echevarria, 2017).

States That Have Expanded Medicaid

Virginia has continued to expand Medicaid in order to make it accessible to more residents. Terry McAuliffe (D), the former governor, was instrumental in advancing Medicaid expansion in the state. However, in June 2014, the state legislature failed to include the expansion program in its budget (Advisory Board, 2018). Subsequently, a number of lawmakers reversed their opposition to the expansion following a significant influx of Democrats in the 2017 midterm elections. They won the governorship and agreed to include a Medicaid work provision as a condition of benefit eligibility.

A state budget bill was passed by the state legislature on May 31st, expanding the program to include up to 400,000 low-income residents. The legislation directed state officials to apply for a federal waiver to either encourage or require some non-disabled beneficiaries to engage in work activities, and to impose premiums on certain beneficiaries (Advisory Board, 2018). The bill was signed into law on June 7th, with Virginia's Medicaid expansion set to begin on January 1, 2019.