Happy Birthday, Medicare!

More than 50 years ago, on July 30, 1965, President Lyndon Johnson signed Medicare into law, saying at the time, “I’ll spend the goddamn money,” he said. “I may cut back on tanks – but not on health.”

The story behind Medicare’s birth in Independence, Missouri, detailed here, reveals that LBJ called former President Harry Truman “The real daddy of Medicare.” (LBJ signed Medicare into law in Independence specifically to honor Truman’s effort to create national health insurance.) Truman became the first Medicare enrollee and Truman’s wife Bess got America’s second Medicare card – at the time, the monthly Part B premium was $3.

Quick facts about Medicare

• More than 50 percent of seniors had no health insurance prior to the establishment of Medicare, and 35 percent lived in poverty, according to the Center for Medicare Advocacy.
• Instant success Medicare went into effect in 1966, and more than 19 million people enrolled during its first year, increasing seniors’ access to physician and hospital care by a third.
• A model for universal healthcare Medicare was initially conceived as a steppingstone to universal national healthcare. The Vietnam War put an end to that idea by syphoning off federal funds such an initiative would have required.
• A catalyst for desegregation Medicare law required hospitals who wanted to accept Medicare patients to desegregate. More than one thousand integrated during the first four months.
• A plus for longevity. According to the New York Times, in the 30 years between 1970 and 2010, life expectancy at age 65 went up by five years, even though coverage was even more restricted than it is now. Analysts attribute the increase in part to Medicare enabling people to get early treatment.
• A boon for all. Ever been treated in the ER even though you lacked insurance? A 1985 ruling required emergency rooms at any hospital participating in Medicare to provide basic treatment to everyone, insured or not.

And now….

• Growing, growing What started as barebones insurance has grown into a robust program of coverage for seniors, with benefits added over the years: long-term disability insurance (1972), home health coverage (1980), hospice coverage (1982), prescription drug coverage (2006 – but initially only for those with private Medicare plans), expanded free wellness checkups and tests (2010, with the Affordable Care Act) and an end to the denial of coverage of skilled care for chronic diseases like Alzheimer’s based on a patient not improving (2012) and most recently, permanent repeal of Medicare’s annual physical therapy caps (2018).

“I think there’s a significant potential that we will see a substantial expansion of home health care services,”

“I think there’s a significant potential that we will see a substantial expansion of home health care services,” says Social Security and Medicare expert Philip Moeller, author of Get What’s Yours for Medicare. “The Administration wants to provide something like $400 billion to expand the provision of home health care services.”

• More than 52.6 million seniors are now covered by Medicare. Another 9 million disabled are also covered by Medicare. Enrollment is expected to reach 79 billion by 2030, according to AARP.
• Having previously introduced nursing home ratings, the Centers for Medicare and Medicaid is paying attention to the growing numbers of seniors who want to age in place and introduced a five-star ratings system for home health care on Medicare.gov. The ratings are based on patient surveys and let you search by zip or name.

 Medicare in its 56th year – what’s on the horizon?

• The biggest change in Medicare has been the growth of Medicare Advantage Plans, says Moeller. Medicare Advantage Plans have grown to control 40 percent of the Medicare Market. That’s up from nearly 0 percent just 15 years ago. They are clearly the most popular choice of new enrollees to Medicare says Moeller. Enrollment is expected to reach 26 million in 2021.

• People with end-stage renal disease are now eligible to join Medicare Advantage plans, the result of the 21^st Century Cures Act of 2021. Previously Medicare Advantage Plans were unavailable to them unless there was a ESRN Special Needs Plan available in their area.

• High income brackets were introduced in 2007 for Part B and 2011 for Part D. For 2021, these thresholds have increased to $88,000 for a single person and $176,000 for a married couple. For 2021, the Part B premium for high-income beneficiaries ranges from $207.90/month to $540.90/month, depending on income.
• Only 8 percent of Medicare beneficiaries switch plans in any given year. That number has not changed much in recent years. Medicare Open Enrollment runs from Oct. 15 through Dec. 7, which coverage beginning Jan. 1. During the period you can change plans

• The standard Part B premium increased to $148.50 in 2021. The Part B deductible is $203 in 2021, up from $198 in 2020.

• President Joe Biden had proposed cutting the age of Medicare eligibility to 60 and expanding Medicare to cover dental, hearing and vision during his campaign. But neither has been included in his legislative agenda so far. Medicare does not cover dental cleanings, root canals, eyeglasses, or hearing aids. Some progressive Democrats are pushing for expanding coverage for Medicare, but these would be expensive, and face a united Republican front in opposition.
• Previously some politicians were pushing to raise the age of Medicare eligibility to 67. Medicare Part A is funded by the Medicare hospital trust fund funds. Since 2018 spending has exceeded revenue. The Kaiser Family Foundation (KFF.org) estimates that by the end of 2026 the fund will have a deficit of $31 billion.

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