Fifty years ago this week, President Lyndon B. Johnson signed into law the Social Security Act of 1965 establishing the Medicare and Medicaid programs.
Much has been written about the future of Medicare; but Medicaid, now our nation's largest public insurance program, has recently become a lightning rod for debate.
Originally designed as a voluntary social insurance program for low-income families with dependent children and disabled Americans, Medicaid now covers over 70 million people and is the critical component of our national healthcare and long-term care safety net. Along the way it has also become a laboratory for innovation; its flexible federal-state partnership has allowed states to tailor the program to their residents, using emerging models of care delivery to improve quality of care and manage costs.
History shows that the voluntary nature of the program resulted in a 17-year wait for full national implementation. Even then it was done in a very uneven manner. For some, access to benefits from the program was at best illusionary because of the extremely low eligibility levels and the degree of bureaucracy required by some states for both entry into the program and maintenance of eligibility.
The Affordable Care Act altered the paradigm and fundamentally changed the program's potential. Under the law, Medicaid has become much more robust and brought us closer to the goal of providing nationwide coverage to all low-income people up to 138% of the federal poverty level. This is true despite a 2012 U.S. Supreme Court ruling that allowed for states to opt out of expanding their Medicaid programs.