Then & Now: Medicare and Medicaid turn 50 today

WASHINGTON (AP) – When President Lyndon B. Johnson signed Medicare and Medicaid into law on July 30, 1965, Americans 65 and older were the age group least likely to have health insurance.

“No longer will older Americans be denied the healing miracle of modern medicine,” Johnson said at the signing ceremony. “No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles, and their aunts.”

Fifty years later, virtually all seniors have health insurance, a higher coverage rate than younger people. Presidents and lawmakers of both political parties have collaborated to expand Medicare benefits.

Medicaid, the federal-state program for low-income and disabled people, got off to a slower start, but now covers an estimated 69 million people, making it the largest government health program. It pays for nearly half of U.S. births and a little over half of the nation’s nursing home bill.

But the long-range financial outlook for both programs remains cloudy. A mix of tax increases, benefit cuts, and reductions in payments to service providers will be needed sooner or later, experts say. The longer policymakers wait, the more wrenching the changes.

Here’s a look at Medicare and Medicaid, then and now:

Then: In 1965, life expectancy at age 65 was 13.5 years for men, and 18 years for women. That’s using Social Security data for “cohort life expectancy,” which takes into account improvements in survival during the later years of life. After Medicare’s enactment, Social Security offices around the country signed up 19 million people for coverage effective July 1, 1966.

Now: In 2015, life expectancy at age 65 has risen to 19.3 years for men and 21.6 years for women. Nearly 56 million seniors and disabled people of any age are enrolled in Medicare. Even with the World War II generation passing away, total enrollment is rising by more than 2 million people a year as baby boomers reach 65 and qualify.

Then: Segregated hospitals and nursing homes were common, particularly in the South.

Now: Although racial and ethnic health disparities persist, segregated facilities are unheard of. As a condition of receiving Medicare and Medicaid payments, hospitals and nursing homes have to assure the government that they don’t discriminate, or they can’t be paid. Hospital desegregation proved much less divisive than integration of public schools.

“That’s one of the really important accomplishments of the program that people don’t know about,” said Nancy De Lew, a senior policy expert at the federal Health and Human Services department.

Then: Medicaid eligibility was tied to receiving government welfare checks.

Now: The welfare reform law of the 1990s, and coverage expansions for children that preceded it, broke the link between Medicaid and welfare.

In some states, Medicaid’s coverage for children reaches up into the middle class. About 1 in 3 children, regardless of income, are covered by Medicaid, says the Kaiser Family Foundation. Among poor children, that rises to 3 out of 4.

President Barack Obama’s health care law expanded Medicaid to cover low-income, working-age adults with no children living at home, a major group that had been left out by safety-net programs.