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 Medicare+Choice 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.