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Medicare is federal health insurance for people age 65 or older. It can also provide insurance for those younger than 65 with certain disabilities. The program helps with health care costs, though it doesn’t cover all medical expenses. Medicare differs from Medicaid; Medicaid is a state-run program that provides hospital and medical coverage to people with lower incomes. 

To understand how we got to the system of Medicare, it’s useful to take a look back at the Great Depression, FDR, and the New Deal. President Franklin Roosevelt appointed Frances Perkins as his Secretary of Labor in 1933. When she assumed the role, she became the first woman to serve in a presidential cabinet. She was also, thanks to FDR’s 4 terms, the longest serving person in that cabinet role. Frances came to the role with a number of priorities in mind:

• 40 hour work week

• Minimum wage for workers

• Unemployment compensation

• Worker’s compensation

• Abolition of child labor

• Direct federal aid to states for unemployment relief

• Social Security

• Revitalized federal employment service (ending a system of favoritism and partisanship)

• Universal health insurance

Is that all? Frances was ready to tackle them all, and the President assured her she could. Roosevelt had inherited an economic and social nightmare in the form of the Great Depression. Unemployment hovered around 25% in 1933 and thousands of banks were failing. So he, Frances, and the rest of the Federal Government got to work!

Though Frances Perkins realized almost all of her agenda, she wasn’t able to secure universal health, but not for lack of effort and care. You can read an excellent overview of her work in the administration and her life here: https://exhibitions.library.columbia.edu/exhibits/show/perkins

The Social Security program continued to grow in popularity and use. By the time Lyndon Johnson got into office in 1963, many were pushing for updates and improvements. As the population aged, the lack of health care became a glaring gap in the protections of social insurance. As people age, health care costs and needs typically increase, even as income decreases. Private medical insurance may help, but is often too costly for those on fixed incomes to afford. 

To answer the need, Medicare was established in 1965 as an amendment to the social security program. LBJ signed H.R. 6675 in 1965, which created two health insurance plans for those aged 65 and over:

• A hospital insurance plan to provide protection against the costs of hospitals and hospital related care

• A supplementary medical insurance plan covering payments for doctors and other medical and health services

To read more about the creation of the plans, you can click here to read the history from the Social Security Administration: https://www.ssa.gov/history/ssa/lbjmedicare1.html

When Medicare began in 1966 under Johnson, there were 19.1 million adults over the age of 65 who enrolled in the program. Those adults represented 9.7% of the entire U.S. population. But the program has grown by leaps and bounds as the population ages and retires. By 1994, there were 32.4 million enrollees, making up 12.4% of the population! Check out the chart below to see just how quickly the program has grown, even from 1966 to 1994:

Part of the reason for growth has been an increased life expectancy, which is a result of improved coverage and care. Between 1900 and 1994, the average life expectancy for Americans increased from 41 to 76 years! And much of that gain is seen in the later years; a person who reached the age of 65 in the year 1900 might expect another 12 years of life. But in 1994, someone reaching 65 could expect an additional 17 years! 

Today, Medicare continues to expand (as well as face challenges). Here are some ‘fast facts’ about the program today:

• Approximately 67.3 million people were enrolled in Medicare as of April of this year (2024)

• Nearly ⅕ of the entire US population was enrolled in Medicare in 2022

• 80.4% of beneficiaries are enrolled in Part D, which is the prescription drug coverage 

• California reported the most Medicare enrollees in 2021 (6.5 million), which is reflective of the population

To read even more facts and statistics about the current face of Medicare, you can click here: https://www.forbes.com/health/medicare/medicare-statistics/

As with any government program, it takes a lot of work, rules, and detail to run a program that serves millions of people. Unfortunately, that sometimes means that things change over time and it’s important to remain current to know what your rights and benefits are. To read more about Medicare and the current rules, you can check out this 20 page explainer directly from the Social Security Administration here: https://www.ssa.gov/pubs/EN-05-10043.pdf

That is an especially useful overview of the basics, and if you have questions from there, you can ask them during class!

https://www.ssa.gov/pubs/EN-05-10043.pdf

https://www.kff.org/medicare/video/the-story-of-medicare-a-timeline/

https://pmc.ncbi.nlm.nih.gov/articles/PMC4193632/