Happy birthday, Medicare and Medicaid!

LBJ signing
President Johnson signing the legislation creating the Medicare and Medicaid programs, July 31, 1965

This is an edited and expanded version of a column that ran in the Journal Record.

Until a half-century ago, if you were elderly, poor, or living with a disability in America, chances are you were without health insurance and couldn’t get the medical care you needed. Thanks to Medicare and Medicaid, two landmark public initiatives that were signed into law by President Lyndon Johnson fifty years ago this month, the health and financial security of nearly one in three Americans has forever been improved.

Medicare, which covers almost all seniors and younger people with serious disabilities, pays for a wide range of preventive services, as well as hospital stays, prescription drugs, and critical medical supplies. Before Medicare, almost half of all Americans 65 and older were without health insurance. Today it’s only 2 percent. Between 1970 and 2010, Medicare contributed to a five-year increase in life expectancy at age 65 by providing early access to needed medical care. Medicare recipients are also less likely to miss needed care or have unmanageable medical bills than working-age adults with insurance, as a recent New York Times editorial noted.

Medicaid, the other program signed into law by President Johnson in July 1965,  may forever be Medicare’s less renowned and beloved sibling, but it is an equally important part of the health care safety net. Medicaid provides comprehensive medical coverage primarily to low-income children and pregnant women, while covering premiums, deductibles, and additional services such as long-term care for low-income seniors and people with disabilities who also receive Medicare.

Over 825,000 Oklahomans are currently enrolled in SoonerCare, as Medicaid is known here, and just over one million were enrolled in SoonerCare at some point last year. More than one of every two children in our state are insured through SoonerCare, which means they can get regular vaccinations and screenings, have their medication covered for chronic illnesses like asthma, and get treated when they incur injuries or fall sick. Medicaid provides vital pre-natal care for pregnant women and  pays for close to two-thirds of births in Oklahoma.

SoonerCare now spends over $5 billion annually on medical services for Oklahomans, representing almost 3 percent of the state’s entire GDP (Gross Domestic Product). It provides core funding for hospitals, long-term care facilities, mental health providers, community health centers, home health aides, and other health care providers that are the lifelines of our local communities. For every $1 spent by the state, the federal government contributes an additional $1.78; in total, Medicaid brings over $3 billion in federal dollars back to Oklahoma.

Because Medicaid is a shared state and federal responsibility, it has been vulnerable to our state’s recent budget crunch, which has forced difficult cuts to services and lower payments to health care providers. However, Medicaid continues to prove its worth in Oklahoma:

  • Medicaid has significantly reduced the uninsured rate: Since Medicaid eligibility for children was raised in the late 1990s, the share of Oklahoma kids without insurance has been cut in half, from 16 to 8 percent.
  • Medicaid is efficient: The program costs less than private insurance and its costs have risen at a more modest pace than private insurance.
  • Oklahoma’s Medicaid program has developed high-quality, cost-effective programs. Innovative programs are working to coordinate care and improve health care delivery, especially for those with chronic medical conditions.
  • Medicaid improves health. Research has convincingly established that Medicaid provides wide-ranging benefits in terms of access to care, physical and mental health outcomes, and family financial stability.

The most glaring hole in Oklahoma’s Medicaid program is its failure to cover working-age adults with incomes below the poverty level, almost half of whom are uninsured. Although the federal government will pay the full cost for this population (phasing down to 90 percent by 2020), the Supreme Court left their coverage optional for the states, and so far Oklahoma is among 20 states that has refused to expand coverage. This leaves more than 140,000 adults stuck in a “coverage crater” that leaves billions of Oklahoma taxpayer dollars in Washington and adds to the financial strains on hospitals and other health care providers. SoonerCare, and its sister program Insure Oklahoma, stand ready to serve this population.

There is no question that controlling costs, improving efficiency, and delivering better health outcomes will remain ongoing challenges for Medicare and Medicaid, as they will for other components of the American health system. But as we work to make them even better, let’s celebrate the great achievements of Medicare and Medicaid in ensuring that most Americans now can receive the health care they need. 

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Former Executive Director David Blatt joined OK Policy in 2008 and served as its Executive Director from 2010 to 2019. He previously served as Director of Public Policy for Community Action Project of Tulsa County and as a budget analyst for the Oklahoma State Senate. He has a Ph.D. in political science from Cornell University and a B.A. from the University of Alberta. David has been selected as Political Scientist of the Year by the Oklahoma Political Science Association, Local Social Justice Champion by the Dan Allen Center for Social Justice, and Public Citizen of the Year by the National Association of Social Workers.

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