Escalating medical costs gave impetus to initial thrusts of legislation in the late 1950s and early 1960s designed to provide hospitalization and nursing home coverage as well as other forms of health-care insurance for older Americans.
In 1960, the Kerr-Mills Act – aka Medical Assistance for the Aged (MAA) – a precursor to Medicaid, was passed, setting up the disbursement of federal matching funds to states offering financial help to older persons whose medical expenses exceeded their incomes. These funds were allocated for those who did not qualify for Old Age Assistance, or those who did qualify but did not receive enough from OAA to cover their medical expenses. MAA gave tremendous leeway to the 50 states in determining eligibility, benefits and medical services covered, however, resulting in limited, glaringly disparate and often ineffective implementation across the country. (Still, by 1965, the time of Medicaid’s initiation, U.S. nursing home residents had increased by 33 percent, from 400,000 to 600,000 in five short years, with close to half of the residents covered by MAA, Medicaid’s direct predecessor.)
In 1961, prompted by calls for extended medical benefits and “a broad spectrum of institutional and in-home services” for older Americans from the first White House Conference on Aging (and a presidential task force), President John F. Kennedy put the wheels in spin on medical insurance legislation that would become Medicare.
Taking up the flag and seeking to eliminate poverty among those of all ages and ethnic backgrounds for his Great Society programs of the mid-1960s, Kennedy’s successor, President Lyndon Baines Johnson, picked up where Kennedy left off and signed Medicaid, Medicare and the Older Americans Act into law in 1965. These three programs quickly poured millions of dollars into a range of programs for older persons, creating the foundation for what is now known as America’s aging network.
The Older Americans Act (1) sprang, in part, from the same social concerns for older, impoverished persons that spawned Medicare and Medicaid in the same year. All three were initiated, to some extent, in response to a call for a broad range of in-home, community-based and institutional health-care services and coverage from the first White House Conference on Aging; all three were pushed forward by the 1961 Presidential Task Force on the Health and Social Security of the American People; and all three were launched at a time when nearly 30 percent of older Americans lived below the poverty line (2) , compared to about 20 percent for Americans of all ages in the mid-1960s. Notably, the Older Americans Act, Medicare and Medicaid all became law in the same month: first the Older Americans Act on July 14, 1965; then Medicaid and Medicare (3), both signed into law as amendments to the Social Security Act on July 30, 1965 (Medicare as Title XVIII, and Medicaid as Title XIX). President Johnson signed the Medicare bill into law in a special ceremony at the Truman Library in Independence, Missouri, in honor of former President Harry Truman’s attempts to initiate government-sponsored health care almost two decades earlier. Not many recall that former President Truman was presented at the ceremony with our country’s first Medicare beneficiary card (4) .(1) AoA: Older Americans Act: www.aoa.gov/about/legbudg/oaa/legbudg_oaa_faq.asp
(2) (U.S. Bureau of the Census http://www.census.gov/hhes/www/poverty/poverty04/pov04hi.html
(3) Social Security Online: (www.ssa.gov/history/corning.html)
(4) U.S. Dept. of Health and Human Services, Center for Medicare and Medicaid Systems: www.cms.hhs.gov/History)