The Medicare and Medicaid Act: 60 Years of Expanding Access to Care
- Ryann Hill
- Jul 30
- 4 min read
By Dr. William Knight, PT, DPT, SPH, CSCS and Niyahnee Thomas
On July 30, 1965, President Lyndon B. Johnson signed into law the Social Security Amendments of 1965, establishing two groundbreaking federal programs: Medicare and Medicaid. The legislation created the first broad-based public health insurance programs in U.S. history, dramatically expanding access to care for older adults, people with disabilities, and individuals with low incomes. Today, Medicare and Medicaid remain foundational pillars of the American healthcare system.
A Landmark in Health Policy History
President Johnson signed the Medicare and Medicaid Act in Independence, Missouri, with former President Harry Truman by his side. The moment was both symbolic and transformative. At the time, fewer than half of Americans aged 65 or older had health insurance, leaving them to shoulder the cost of prescriptions and other care services alone. Medical expenses often placed care out of reach for older adults and low-income individuals, making basic medical necessities inaccessible to the people who needed them most. The law was created:
Medicare, a federal health insurance program for people aged 65 and older, was later expanded to include those under 65 with qualifying disabilities and end-stage renal disease
Medicaid, a joint federal and state program that historically only provided health insurance to individuals eligible for Aid to Families with Dependent Children (AFDC) or federal Supplemental Security Income (SSI) and has evolved to provide health coverage for eligible low-income individuals and families, children, and people with disabilities
Decades of Program Expansion and Innovation
Over the past six decades, Medicare and Medicaid have grown to cover more than 150 million Americans. Key milestones include:
Medicare Advantage (Part C), created in 1997 to offer beneficiaries health insurance through private insurance companies approved by Medicare
Children's Health Insurance Program (CHIP), signed into law in 1997 to provide health insurance to children in families with incomes too high to qualify for Medicaid, but can’t afford health insurance
Medicare Part D, introduced in 2003 to provide prescription drug coverage
Medicaid Expansion, enabled by the Affordable Care Act in 2010, which allowed states to cover more low-income adults, improving access to care, especially in underserved communities
Both programs have also become central to long-term services and supports, behavioral health care, maternal health services, and coverage for people living with disabilities.
How the “One Big Beautiful Bill” Is Affecting Medicare and Medicaid
In July 2025, President Donald Trump signed into law the “One Big Beautiful Bill,” a budget and tax package passed through the reconciliation process. Among its many provisions are significant changes to Medicare, Medicaid, and other health and safety net programs. The Act introduces several modifications to Medicare, Medicaid, and various other health safety net initiatives.
Key components of the bill include:
Reductions in Medicaid spending by over $900 billion over ten years, with new work requirements for certain adults, shortened eligibility review timelines, and reduced funding for providers such as Planned Parenthood. Experts have projected that these changes may result in loss of coverage for up to 11 million Medicaid enrollees, with higher loss of eligibility in states that have not expanded Medicaid
Automatic cuts to Medicare under pay-as-you-go rules, potentially totaling 500 billion dollars over the next decade, unless Congress intervenes
Creation of a 50 billion dollar emergency fund to support rural hospitals
Supporters of the bill praise the bill’s aims to reduce federal deficits, strengthen incentives for employment, and eliminate waste in government spending, while critics worry about the impact on vulnerable populations and the long-term viability of the health care safety net. The full impact of the legislation will depend on how states implement new federal guidance and whether additional changes are made in upcoming appropriations bills.
The Rising Cost of Healthcare
Beyond the new legislation, Medicare continues to face long-term financial pressures. According to the Hospital Insurance Trust Fund, Medicare Part A, is projected to become insolvent in the next decade, prompting policy discussions around potential solutions such as drug pricing reform, adjustments to payroll tax caps, and changes to provider payment formulas.
Similarly, states are actively reevaluating Medicaid eligibility in the face of rising healthcare costs, with millions of Americans at risk of losing coverage. Many states are pursuing delivery system reforms to improve outcomes and reduce costs, including value-based payment models, integrated care coordination, and expanded access to community-based services to ensure those insured remain covered.
The Importance of Medicaid and Medicare
Sixty years after their creation, Medicare and Medicaid continue to represent the nation’s commitment to protecting access to care for those most in need. The programs provide coverage to older adults, children, individuals with disabilities, and low income individuals.
As health care costs rise, demographics shift, and political debates intensify, the importance of these programs has only grown. The 60th anniversary is not just a time to look back, but a moment to look forward to protecting and improving these vital programs for future generations.
References
Centers for Medicare & Medicaid Services. (n.d). Centers for Medicare & Medicaid Services Data. https://data.cms.gov/fact-sheet/cms-fast-facts
Congressional Budget Office. (2024). The budget and economic outlook: 2024 to
Kaiser Family Foundation. (2024). 10 things to know about
Kaiser Family Foundation. (2024, May 28). Medicaid 101.
National Archives. (n.d.). Medicare and Medicaid Act
Washington Post. (2025, July 1). What Trump’s “Big Beautiful Bill” means for Medicaid,
Medicare, and the future of American health care. https://www.washingtonpost.com/health/2025/07/01/trump-big-beautiful-bill-health-care-medicaid-impacts/
