On July 30, 1965, President Lyndon B. Johnson signed Medicare and Medicaid into law. This crowning achievement was both the culmination of a decades-long effort to attain guaranteed universal health insurance and the first step in the quest for Medicare for All.
In the 55 years since the legislation was signed into law, both programs have proven their worth. Before Medicare, about half of seniors lacked health insurance. They were an illness away from bankruptcy. Today, 99.1 percent of Americans 65 and older are insured, thanks to Medicare. Nine million people with disabilities who are under age 65 also have health insurance coverage through Medicare.
More than 65 million Americans have health insurance coverage through Medicaid. Medicaid ensures that poor families have access to health care. It means that seniors and people with disabilities have access to long-term care. Together, Medicare and Medicaid cover more than one-third of the people in our country.
Seniors and people with disabilities have, on average, the highest medical costs. Administering a means-tested program like Medicaid presents administrative challenges. That is why it is so striking that Medicare and Medicaid are more efficient and more cost-effective than private health insurance. It would save money to expand Medicare to cover everyone.
Now, as the COVID-19 pandemic rages across our country, it’s long past time to improve Medicare and expand its coverage to everyone. Imagine how much worse off we would be right now if Medicare and Medicaid did not exist. And imagine how much better off and better prepared to cope with the pandemic we would be if everyone were covered automatically by an improved Medicare—if people knew that if they felt sick, they could get checked without any copays or deductibles. Imagine if losing employment did not also mean losing health care.
Unfortunately, Republicans, aided by a small fringe group of Democrats, want to go in the opposite direction. The latest Republican COVID-19 proposal, the so-called HEALS Act, includes a bill called the TRUST Act.
The TRUST Act is a devious ploy to dismantle Medicare as we know it, by creating a closed-door process to fast-track benefit cuts. Using the COVID-19 crisis to sneak it through is the worst possible way to say “happy birthday” to Medicare and Medicaid.
Fortunately, Democratic leaders like Sen. Ron Wyden, Rep. Richard Neal, and Rep. John Larson have been outspoken in their opposition to the bill. So have advocates for seniors, including AARP, which rightfully calls the TRUST Act “a bill that is unrelated to the crisis and that wrongly targets Social Security and Medicare to reduce deficits that have expanded because of needed pandemic relief.”
Congressional leaders must heed these wise words and throw the TRUST Act in the scrap heap where it belongs. Then, they must build on the foundation LBJ signed into law 55 years ago by expanding Medicare and Medicaid instead of cutting them.
During a pandemic that is disproportionately threatening people of color, expanding these programs would be a powerful force for racial justice—just as their creation was. Medicare and Medicaid became law the year after the enactment of the Civil Rights Act of 1964. Hospitals were only allowed to participate in Medicare if they complied with the Civil Rights Act. This led to the desegregation of hospitals throughout the South, improving the quality of care available to people of color.
This was a quiet yet profound achievement. Overnight integration of hospitals, where patients and health care providers interact in the most personal of ways, was a revolution for racial justice. Extending health insurance to low-income Americans, who are disproportionately people of color, was an important step for racial economic justice.
Among the responses demanded by a life-threatening pandemic and the righteous pronouncement that Black Lives Matter should be the expansion of Medicare and Medicaid to a universal program without premiums, co-pays or deductibles.
As a first step, Congress should pass the Health Care Emergency Guarantee Act, which Senator Bernie Sanders (I-VT) and Congresswoman Pramila Jayapal (D-WA) introduced in response to the pandemic. It would guarantee health care (with no out-of-pocket costs) to all Americans for the duration of the pandemic. This is a commonsense public health measure. The last thing we want during a pandemic is for anyone to forgo needed care due to cost concerns.
Congress should then make the guaranteed health care permanent, enacting Medicare for All. As an incremental step, Congress could help struggling families by passing MediKids to provide health care for all children, as the architects of Medicare envisioned as the next step on the road to Medicare for All. They could lower the Medicare age to 55, which would be essential for older workers who lost their jobs due to the pandemic and may never return to the workforce.
In addition to expanding Medicare and Medicaid to cover more people, Congress should improve the programs for current beneficiaries. The COVID-19 crisis in our nation’s nursing homes reveals the need for the government to cover long-term care in home and community settings, rather than funneling people into institutions. Presumptive Democratic nominee Joe Biden has a plan to do just that. Medicare coverage should also be expanded to include hearing, vision, and dental care.
Medicare and Medicaid are turning 55 amidst some of the most tumultuous times our country has experienced since the Great Depression. Frances Perkins, President Franklin D. Roosevelt’s secretary of labor, astutely recognized, “We must devise plans that will not merely alleviate the ills of today, but will prevent, as far as it is humanly possible to do so, their recurrence in the future.”
Policymakers should heed her words, and take the steps necessary to both alleviate this pandemic and prevent the next one. That includes improving Medicare and Medicaid, and expanding them to cover everyone in America.
