July 30, 2014
Medicare and Medicaid at 49: Keeping the Generations-Old Promise Alive
By: Dr. Yanira Cruz

While the concept of national health insurance was developed in the early 20th century, President Harry S. Truman elevated the issue during his Administration:

“Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection.”

Twenty years later, his vision was brought to life under President Lyndon B. Johnson with the Social Security Amendments of 1965, which provided millions of older Americans and low-income families with access to healthcare through the Medicare and Medicaid programs. At the time, health insurance wasn’t attainable for older Americans, especially those living in poverty, because of their age and chronic conditions. Private insurance was also out-of-range for low-income families. By providing our most vulnerable populations with health insurance access, over the decades, Medicare has become a game-changer, especially for diverse seniors. The bottom line is that: without it, many diverse elders would have to assume their healthcare expenses, accrue substantial debt, and most likely not receive the care they need. Today, 49 years later, the Medicare and Medicaid programs have continued to fulfill their promise to all of our generations, allowing seniors and families to have access to the quality healthcare they deserve and otherwise, wouldn’t be able to afford.


Thanks to the Affordable Care Act, the life and solvency of Medicare has been extended with expanded benefits and savings for its beneficiaries. Since the ACA was enacted, over 8.2 million beneficiaries have saved $11.5 billion on prescription drugs, an average of $1,407 per person. The ACA is also successfully closing the “donut hole,” a gap in coverage in which beneficiaries pay the full cost of their prescriptions out-of-pocket, before catastrophic coverage for prescriptions takes effect. Beneficiaries affected by the “donut hole” will receive savings and discounts on brand-name and generic drugs that gradually increase each year until the gap is closed in 2020.

The use of preventive services among Medicare beneficiaries has also increased thanks to the ACA. The elimination of coinsurance payments and the Part B deductible for recommended preventive services, such as cancer screenings, has allowed more beneficiaries to take control of their health by preventing and monitoring health conditions as well as detect health problems in early stages.


Medicaid also provides health insurance for more than 4.6 million low-income older Americans, the majority of whom are concurrently enrolled in Medicare. Medicaid also covers nearly 4 million people with disabilities who are also enrolled in Medicare. This population of “dual eligibles”— those who are enrolled in Medicare and Medicaid— represents 17% all Medicaid enrollees. When the ACA was passed, states were required to expand Medicaid coverage to bring more low-income folks under the insured tent. However, the Supreme Court later ruled it voluntary, which has resulted in states “opting out” of expansion. Due to this, there are seniors whose incomes are too high to qualify for Medicaid under the current rules, yet too low to qualify for help purchasing coverage through the Marketplace.

A Birthday Wish for Medicare and Medicaid

As advocates for diverse elders across the country, our birthday wish for Medicare and Medicaid is two-fold: for these social insurance programs to be protected for future generations, and for the states which “opted out” of Medicaid expansion to reverse their decisions. However, for this birthday wish to come true, it will require less gridlock and resistance and more consensus and bipartisanship. It will require less rhetoric and more action. It will require our communities to speak up and speak out on behalf of those who benefit from these programs, and those who could.

Today, July 30, join the millions of seniors and families Medicare and Medicaid serve each year in wishing these programs a happy birthday. And, here’s to many more!

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Dr. Yanira Cruz is the President and CEO of the National Hispanic Council on Aging. The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.