History of Medicare and Medicaid

1
History ofMedicare and Medicaid

• The following chronology is based on a document
  originally prepared by the Social Security
  Administration (SSA).
• Presented by Peter A. Bell, D.O.

2
1937

• The Technical Committee on Medical Care was
  established under the interdepartmental Committee
  to Coordinate Health and Welfare Activities. The
  Technical Committee was composed of staff members
  of the
• Children's Bureau
• U.S. Public Health Service
• Social Security Board

3
February 1938

• The report of the Technical Committee on Medical
  Care,"A National Health Program A Summary," was
  published.

4
July 18-20, 1938

• The National Health Conference was held in
  Washington under the auspices of the
  Interdepartmental Committee to Coordinate Health
  and Welfare Activities, to bring the problems of
  national health and certain recommendations for a
  national health program before professional
  groups and the public.

5
January 23, 1939

• A Health Security Message of the President was
  transmitted to Congress the report and
  recommendations of the Interdepartmental
  Committee to Coordinate Health and Welfare
  Activities.

6
February 1939

• The American Medical Association established a
  "National Physicians Committee for the Extension
  of Medical Services, to fight the anticipated
  Wagner Bill.

7
February 28, 1939

• Senator Robert Wagner introduced S.1620 to create
  the National Health Act of 1939.
• A national compulsory health insurance for almost
  all employees and their dependents was proposed
  by this Bill.

8
February 28, 1939 (cont.)

• Benefits were to include physician's services,
  hospitalization, drugs, and laboratory diagnostic
  services.
• Costs were to be covered through employer and
  employee contributions which were to have been
  deposited in a health insurance fund. The plan
  was to be administered through the States. No
  final action was taken on the Bill--although
  hearings were held April 29-July 13. The Bill
  died in committee.

9
January 11, 1944

• President Roosevelt outlined in his State of the
  Union Message, an "economic Bill of rights,"
  which included "the right to adequate medical
  care and the opportunity to achieve and enjoy
  good health." However, he did not make any
  subsequent proposal for health insurance.

10
January 6, 1945

• President Roosevelt in his State of the Union
  message again made reference to the right to
  "good medical care" but made no specific
  recommendations.

11
November 19, 1945

• In a special message to Congress, President
  Truman proposed a comprehensive, prepaid medical
  insurance plan for all people through the Social
  Security system.

12
November 19, 1945 (cont.)

• The plan would have covered doctors, hospital,
  nursing, laboratory and dental services for
  people covered by the Social Security program
  (medicare) it would also have provided benefits
  financed from Federal Revenues for needy people
  (medicaid).
• A revised Wagner-Murray-Dingell Bill providing
  for National Health Insurance was immediately
  introduced.

13
May 19, 1947

• President Truman, in a special health message to
  Congress, again requested a compulsory national
  health program. Senate Bill 1320 was introduced
  by Senators Wagner and Murray. Senator Taft's
  Bill was also reintroduced.

14
January 5, 1949

• In his State of the Union Message, President
  Truman again called for compulsory national
  health insurance for persons of all ages,
  financed by a Federal payroll tax (medicare tax).

15
December 29, 1951

• President Truman created, by executive order, the
  President's Commission on the Health Needs of the
  Nation.
• The Commission was to determine the Nation's
  total health requirements, both immediate and
  long term, and to recommend courses of action to
  meet those needs.

16
February 26, 1952

• Federal Security Administrator Oscar Ewing
  proposed a substitute health insurance measure
  limited to the payment, through the Social
  Security system, of hospital costs for retired
  beneficiaries and their dependents as a step
  toward a larger goal (medicare part A).

17
September 13, 1960

• The Social Security Amendments of 1960 were
  enacted.
• The new law provided increased Federal grants to
  States for medical care programs for aged people
  getting old-age assistance if the increase was
  spent on vendor medical payments.
  
  
• vs

18
September 13, 1960 (cont.)

• In addition, a new program (commonly referred to
  as "Kerr-Mills") of Federal grants to States for
  vendor medical care programs for aged people not
  on public assistance but unable to pay for needed
  medical services was provided.
• Old-age and survivors' insurance was amended to
  provide disability insurance benefits to disabled
  workers of all ages and to their dependents the
  retirement test was liberalized, as well as were
  eligibility requirements.

19
November 8, 1960

• President-elect Kennedy appointed a "Task Force
  on Health and Social Security for the American
  People", with Wilbur J. Cohen as Chairman.
• The task force was directed to review, from among
  the most pressing and significant health and
  welfare proposals, those which should have
  priority in the initial phase of the new
  administration.

20
January 10, 1961

• The Task Force on Health and Social Security for
  the American People was reported to the
  President. The report made a number of
  recommendations regarding health care, including
  a program of hospital insurance for the aged
  through the Social Security system.

21
February 13, 1961

• H.R. 4222, the Health Insurance Benefits Act of
  1961, proposing a program along the lines set
  forth by the President, was introduced by
  Representative King of California. S. 909, a
  companion Bill, was introduced in the Senate by
  Senator Anderson. The House Bill was referred to
  the Committee on Ways and Means.

22
January 11, 1962

• In his State of the Union Message, President
  Kennedy renewed his 1961 request that the
  old-age, survivors, and disability provisions of
  the Social Security Act be amended to provide
  health insurance for the aged.

23
February 27, 1962

• In his Health Message, President Kennedy renewed
  his 1961 request that the old-age, survivors and
  disability provisions of the Social Security Act
  be amended to provide health insurance protection
  for the aged.

24
July 21,1964

• The Senate Special Aging, Health of the Elderly
  Subcommittee released its report, entitled, "Blue
  Cross and Private Health Insurance Coverage of
  Older Americans.
• It stated that private health insurance was
  unable to provide the large majority of older
  Americans with "adequate hospital protection at
  reasonable premium cost."

25
January 7, 1965

• President Johnson's first legislative message to
  the 89th Congress, Advancing the Nation's Health,
  detailed a program including hospital insurance
  for the aged under Social Security and health
  care for needy children (beginning of SCHIP).

26
March 23, 1965

• The Committee on Ways and Means of the House of
  Representatives approved a Bill to replace the
  Administration's proposal with an unprecedented
  package of health benefits and Social Security
  improvements. (The Mills Bill)

27
March 24, 1965

• H.R. 6675 was introduced by Representative Wilbur
  Mills as the "Social Security Amendments of 1965."

28
April 8, 1965

• The House passed H. R. 6675, the "Mills Bill,"
  without amendment
• Medicare was about to be born

29
July 30,1965

• President Johnson signed H.R. 6675 to provide
  health insurance for the elderly.
• It was signed in Independence, Missouri, in the
  presence of Harry S. Truman who opened the fight
  for such legislation in a message to Congress in
  1945.

30
January 1966

• States were authorized to set up new medical
  assistance and medical assistance to the aged
  programs, with the Federal government to pay from
  50 to 85 of the cost.

31
February 12, 1966

• The Social Security Administration announced the
  selection of 32 Blue Shield organizations, 16
  commercial insurance companies and one private
  insurer to perform the major administrative
  functions of the voluntary part of the Medicare
  program.

32
March 31, 1966

• This was the deadline for Social Security
  beneficiaries to enroll in the voluntary medical
  insurance program for coverage to start on July
  1, 1966.
• All beneficiaries who reached their 65th birthday
  prior to January 1, 1966, were eligible.

33
March 31, 1966 (cont.)

• Persons who reached their 65th birthday after
  that date had to enroll during the three-month
  period before they became 65.
• The medical insurance payment of 3 a month was
  to be taken out of the person's Old-Age,
  Survivors, and Disability Insurance (OASDI)
  check, but his public assistance grants could be
  raised to compensate for the deduction.

34
July 1, 1966

• On this date all persons over 65 were
  automatically covered under all of the hospital
  insurance provisions of the new legislation,
  except for the nursing home provision.
• Public assistance funds were needed to pay the
  deductibles for those who could not afford them.

35
July 1, 1966 (cont.)

• Benefits under the voluntary medical insurance
  program began for OASDI beneficiaries who signed
  up for it earlier and for elderly persons who
  received public assistance payments in States
  that previously entered into an agreement for
  their coverage.

36
January 2, 1968

• President Johnson signed into law the 1967
  Amendments to the Social Security Act. In
  addition to a 13 increase in benefits, the
  measure made changes in the minimum benefit, in
  the retirement test, in disability benefits,
  coverage, hospital and Medicare insurance and
  increased the earnings base from 6,600 to 7,800.

37
January 13, 1969

• The Secretary of the Health, Education and
  Welfare (HEW), sent to the President the report
  of the Task Force on Prescription Drugs as called
  for by the 1967 amendments.

38
January 15, 1969

• President Johnson's budget proposed a minimum 10
  increase in Social Security benefit payments for
  1970.

39
March 4, 1969

• Regulations were issued by HEW to the States to
  ensure efficient and economical use of Medicaid
  services.
• Under the new regulations, States had to include
  in the administration of the Medicaid program
  procedures to review the utilization of health
  care services provided by the program.

40
May 1969

• Secretary Finch released the final report of the
  Task Force on Prescription Drugs. Dr. Philip R.
  Lee headed the Task Force from its inception in
  May 19, 1967.
• The Task Force's charge was to study the
  possibility of adding prescription drug coverage
  to the recently enacted Medicare program.

41
July 1969

• The Bureau of Health Insurance set up a program
  in SRS integrity staff to counter abuses in the
  health insurance program.

42
1969

• HEW Secretary Finch established a Secretary's
  Task Force on Medicaid and Related Programs.
• The President of the National Blue Cross
  Association, Walter J. McNurney, was made
  chairman Arthur Hess was its staff director.

43
October 30, 1972

• President Nixon signed the Social Security
  Amendments of 1972 (PL 92-603).
• The law liberalized several of the cash benefit
  provisions, made substantial changes in Medicare,
  revised the contribution schedule, amended some
  coverage provisions, and established a new
  Federal security income program for the needy
  aged, blind, and disabled (the SSI program).

44
1977

• The Health Care Financing Administration (HCFA)
  was created to administer both the Medicare and
  Medicaid programs.
• About 1,500 employees were transferred to HCFA
  from the Social Security Administration.

45
January 26, 1982

• In his State of the Union Address President
  Reagan called for the transfer of 47 Billion in
  Federal programs to the jurisdiction of State and
  local governments.
• Among other things, the proposal would give the
  States full responsibility for Aid to Families
  with Dependent Children and food stamps and the
  Federal government full responsibility for the
  Medicaid program.

46
August 5, 1997

• President Clinton signed H.R. 2015, the Balanced
  Budget Act of 1997 (BBA), into law.
• The BBA made the most far reaching changes in the
  Medicare program since enactment.

47
August 5, 1997 (cont.)

• It extended the insolvency of the HI trust fund
  to 2010, reduced the rate of increase in payments
  to providers, created several new prospective
  payment systems, added coverage of certain
  preventive benefits, and added the
  MedicareChoice program which allows Medicare
  beneficiaries to choose additional types of
  health plans.

48
August 5, 1997 (cont.)

• The BBA also created the new State Children's
  Health Insurance Program (SCHIP) which is
  designed to assist those working families with
  incomes too high for Medicaid but too low to be
  able to afford private health insurance.

49
November 29, 1999

• President Clinton signed the Medicare, Medicaid,
  and SCHIP Balanced Budget Refinement Act of 1999
  (BBRA).
• It made numerous changes to the Medicare program
  aimed at reducing the impact of the payment
  reductions to providers in the BBA of 1997,
  stabilized the SCHIP allotment formula and
  modified the Medicaid DSH program.

50
November 29, 1999 (cont.)

• On December 17, 1999, President Clinton signed
  the Ticket to Work and Work Incentives
  Improvement Act of 1999 (TWWIIA) which expanded
  the availability of Medicare and Medicaid for
  certain disabled beneficiaries who return to work.

51
December 21, 2000

• President Clinton signed the Benefits Improvement
  and Protection Act of 2000 (BIPA).
• It made numerous changes to the Medicare,
  Medicaid and SCHIP programs.
• Other related legislation improved Medicaid
  coverage of certain women's health services.

52
November 2003

• US Congress in active debates to provide a drug
  prescription benefit to all Medicare recipients.
• Cost appears prohibitive and various formulas are
  offered to reduce federal expense while taking
  into account individual Medicare recipients
  personal wealth.

53
Timeline Summary

• BC Greek City States with health ins.
• 1798 US Gov Marine Hospital ins.
• 1854 Prussian health ins.
• 1883 German health ins.
• 1902 US Workers Comp ins. (unconstitutional)
• 1908 Work Comp. ins. for Fed. Employees
• 1911 British National health ins.
• 1912 T Roosevelt proposes social/health ins.
• 1913-29 Great Debate of social responsibility
• 1933 Blue Cross established
• 1935 First Fed health ins. Epstein bill (failed)

54
Timeline Summary

• 1938 Report, A National Health Program A
  Summary
• 1939 National Health Act
• Comprehensive employee/employer plan
• AMA opposes
• Fails
• 1944-45 Pres Roosevelt calls for health ins. Plan
• 1945 Pres Truman proposes plan thru SS
• 1947 Truman requests a compulsory plan
• 1949 Truman props plan thru Fed payroll tax
• 1951 Truman Commission Health Needs of the
  Nation
• 1952 Proposal SS pay for hospital care

55
Timeline Summary

• 1960 SS Amendments
• Increase Fed grants to states for care to elderly
• Pres Kennedy
• Task Force on Health and SS for American People
• 1961 Health Ins. Benefits Act 61
• died in committee
• 1962 Pres Kennedy request to expand SS Act
• 1964 Senate Subcommittee on Aging/Elderly
• Conclude unable to provide majority of elderly w/
  adequate hospital coverage at reasonable cost

56
Timeline Summary

• 1965 Pres Johnson proposes SS hospital
  coverage plus needy child
• Mills Bill SS Amendments 65 passed
• July 30th Pres Johnson signs bill enacting
  Medicare/Medicaid with former Pres Truman as
  special guest
• 1966 States set up the new programs
• BS and commercial carriers administer
• Persons 65 voluntarily enroll

57
Timeline Summary

• 1968 Pres Johnson expands coverage/benefits
• 1969 Task Force on Medicaid/related prgrms
• 1972 Pres Nixon established SSI
• 1977 HCFA created
• 1982 Pres Reagan
• Transferred and responsibility for Aid to
  Families w/ Dependant Child and Food Stamps to
  States
• Fed government still responsible for Medicaid
• 1997 Pres Clinton Balanced Budget Act 97
• Decrease GME payment schedule
• Decrease provider payment schedule
• Extend insolvency of health ins. Trust to 2010
• Created SCHIP

58
Timeline Summary

• 1999 Pres Clinton Balanced Budget Act 99
• Adjusted payments to providers
• Stabilized SCHIP
• Modified DSH (disproportionate share hospitals)
• Pres Clinton Ticket to Work Incentives
  Improvement Act of 99
• Disabled get health ins. If return to work
• 2000 Pres Clinton Benefits Improvement and
  Protection Act 00
• 2003 Medicare Prescription Benefit