Medicare and Medicaid: Protecting America’s Health

The History of Medicaid and Medicare

The history of Medicare and Medicaid started with debates on the program when President Harry S. Truman was in office. He sent a message to Congress asking for legislation establishing a national health insurance plan. At the time, many opponents were against it, calling it a “socialized medicine” and President Truman had to scale back his plan for it. However, the administrators in the Social Security system and others began to focus on the idea of a program aiming to insure Social Security beneficiaries whose numbers and news were growing.  Fast forward, 1950, the elderly population had increased, and many lived with under $1,000 income and some could not afford health insurance. The need for affordable health care insurance became more urgent. Many debates on the program went back and forth, especially because private health companies saw older adults too risky to cover insurance. However, in 1965, the Social Security Amendment otherwise known as the Medicaid and Medicare Act, was finally passed by President Johnson. 

What is Medicaid and Medicare?

Medicaid is an insurance program that provides free or low cost health coverage to some low income people, families and children, pregnant women, the elderly, and people with disabilities. At first, Medicaid gave medical insurance to people getting cash assistance, now a much larger group is covered. Medicare is a federal health insurance program for people 65 and older and certain younger people with disabilities. It also covers people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant, sometimes called ESRD). The original Medicare program included two parts:

1. Hospital Insurance: This helps cover inpatient care hospitals, skilled nursing facility care, hospice care, and home health care.

2. Medical Insurance: This helps cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and preventive services( screenings, shots, etc.) 

Now, these 2 parts are called “Original Medicare”. Over the years, there have been changes to Medicare made by Congress and it allows more people to be eligible.  Added later on was Medicare part D, which was authorized by “The Medicare Prescription Drug Improvement and Modernization Act of 2003” and went into effect in 2006. This addition made the biggest changes to Medicare in 38 years. What this does is it covers the cost of prescription drugs. 

Although the two may sound the same, there are a few differences between them. Medicare acts as the primary payer for covered services and medicaid serves as the secondary payer, helping with out of pocket costs such as premiums and deductibles. It covers services that Medicare doesn’t. If you have Medicare and qualify for Medicaid coverage, then your state will pay your Medicare Part B monthly premiums and depending on the level of Medicaid you qualify for, the states might pay for your share of medicare costs and Medicare part A premiums. 

Medicare and Medicaid are extremely important, especially, to low income families because they can gain access to health care they could not afford. 

Who is Qualified for Medicaid and Medicare?

To be eligible for Medicaid, it depends on what your state requires. You may be eligible for Medicaid if you are under certain income levels and/or are 65 years or older, a child under the age of 18, pregnant, living with a disability, a parent or adult caring for a child, an adult with a dependent child, and an eligible immigrant.

The eligibility of the Original Medicare Parts A and B is to be 65 years or older, younger than 65 with a qualifying disability, and living with end stage kidney disease. 

Other Acts That Affect Medicaid and Medicare

Other acts that heavily impact Medicaid and Medicare are the Affordable Care Act, Children’s Health Insurance Program, and the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). The Affordable Care Act brought the Health Insurance Marketplace, a single place where consumers can apply and enroll in health insurance plans, and it made new ways for people to design and test how to pay for and deliver health care. The Children’s Health Insurance Program was created in 1997 to give health insurance and preventive care to almost 11 million children. All states in the country and territories have this plan. Lastly, The MMA Act of 2003, created the Medicare Part D program, which provides outpatient prescription drugs to be covered to Medicare beneficiaries. All of these acts strengthen the Medicaid and Medicare programs, expanding coverage, benefits, or access to health care. 

The Issue Right Now

This year, the government had significantly cut down the funding on Medicaid and Medicare making it more difficult for the disabled, elderly, and underprivileged to gain access to affordable healthcare. On July 4, 2025, the Budget Reconciliation Act, had created huge changes to who is eligible for health insurance. The Center on Budget and Policy Priorities estimates that this law will result in up to 15 million more people without health insurance in 2034 and will result in over 1 trillion dollars in spending cuts to health care through 2034. The majority of these cuts affect Medicaid and also changes who is eligible for the two programs and as well as the Affordable Care Act plans. The cuts will reduce the number of people enrolled in Medicaid by work requirements, more frequent eligibility checks, immigration restrictions, and reduced state funding options. 1) Work Requirements: certain adults will need to meet “community engagement” mandates to keep their coverage. 2.) More frequent eligibility checks: States will need to verify people’s eligibility for Medicaid more often. 3.) Immigrant Restrictions: Although undocumented immigrants were already barred from most federal health programs, this new law is now affecting certain groups of lawfully present immigrants who will lose Medicaid eligibility. 4.) Reduce State Funding Options: The law restricts the use of “provider taxes” by state to generate additional money for their Medicaid programs. Although many are losing access to their health care coverage, efforts are being made by going against proposed cuts and expanding coverage for both Medicaid and Medicare primarily through legislation, budget negotiations, and resolutions. 

Works Cited

Bane, Frank. “History.” CMS, 13 August 2025, https://www.cms.gov/about-cms/who-we-are/history. Accessed 5 October 2025.

“Fact Sheet: Medicaid | AHA.” American Hospital Association, 7 February 2025, https://www.aha.org/fact-sheets/2025-02-07-fact-sheet-medicaid. Accessed 5 October 2025.

“Glossary | HealthCare.gov.” the Health Insurance Marketplace, https://www.healthcare.gov/glossary/. Accessed 5 October 2025.

“Home > Medicare and Medicaid Act (1965).” National Archives, 8 February 2022, https://www.archives.gov/milestone-documents/medicare-and-medicaid-act. Accessed 5 October 2025.

“How To Qualify For Medicare and Medicaid.” Humana, https://www.humana.com/medicare/medicare-resources/qualifying-for-medicare-and-medicaid. Accessed 5 October 2025.

“Impact of the “Big Bill” on Medicare.” Center for Medicare Advocacy, 24 July 2025, https://medicareadvocacy.org/impact-of-the-big-bill-on-medicare/. Accessed 20 October 2025.

“Parts of Medicare.” Medicare, https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare. Accessed 5 October 2025.

“Qualifying for Medicaid.” Medicare, https://www.medicare.gov/basics/costs/help/medicaid. Accessed 5 October 2025.

Rosen, Aliza, and Ricky Carioti. “The Changes Coming to the ACA, Medicaid, and Medicare.” Johns Hopkins Bloomberg School of Public Health, 30 July 2025, https://publichealth.jhu.edu/2025/the-changes-coming-to-the-aca-medicaid-and-medicare. Accessed 20 October 2025.