Fifty years ago, the federal government enacted three important programs to protect the health and well-being of seniors: Medicare, Medicaid, and the Older Americans Act. Eighty years ago, Congress enacted Social Security as part of President Roosevelt’s “New Deal.”
In this anniversary year of those historic laws, it is worth reflecting upon their history. At the same time, it is important to consider how the nation will meet new challenges as its population continues to age. While Americans who are 65 or older constituted 13% of the country’s population in 2010, that age group is expected to account for 20% of America’s citizens in 2030.
The original Medicare program, consisting of hospital insurance (part A) and medical insurance (part B), took effect in 1965. While earlier proposals for comprehensive health insurance coverage for the elderly faltered, public demand grew in the early 1960s, when it became clear that more than half of the nation’s elderly were uninsured.
President Johnson signed Medicare into law on July 30, 1965. During the signing ceremony, the nation’s first Medicare card was issued to former President Truman.
The original Medicare program expanded in subsequent years. In the 1980s, Congress added certain home health and hospice services to Medicare coverage. Options for private health plan coverage (part C) and prescription drug coverage (part D) were added in subsequent decades.
The most recent changes in Medicare law were implemented in 2010 as part of the Affordable Care Act (also known as Obamacare). Medicare reforms reduced costs, improved delivery of services, boosted enrollment in Medicare Advantage programs while reducing premiums, and lowered the cost that Medicare part D enrollees pay for prescription drugs.
Medicaid, also enacted in 1965, is a means-tested program that provides health insurance to low-income and other needy individuals. Administered by state governments in partnership with the federal government, Medicaid currently provides assistance to 4.6 million seniors.
While coverage details and eligibility differ from state-to-state, Medicaid benefits available to seniors who are covered by Medicare typically include expanded nursing facility care and payment for eyeglasses, hearing aids, and prescription drugs. Recent changes to Medicaid have focused on making community-based care available to seniors so that they can “age at home.”
The other significant legislation enacted 50 years ago is the Older Americans Act. That law uses federal grants to assist states in establishing community-based programs that provide services to the elderly. Those services include elder abuse protection programs, job training for seniors, caregiver support, “meals on wheels” programs, transportation, preventive health services and “healthy aging” programs.
New protections for seniors are on the horizon, although some will require the approval of Congress. They include:
- A Department of Labor rule that would protect seniors from backdoor payments and hidden fees by requiring their retirement investment advisors to avoid conflicts of interest and to put the best interests of seniors ahead of their own profits.
- Proposed federal legislation that would require many employers to enroll workers automatically in an IRA to encourage retirement savings. Since Congress has repeatedly failed to enact that legislation, the Department of Labor is working on a proposed rule that would encourage states to do so.
- New rules to improve the care and safety of seniors residing in nursing homes and long-term care facilities by requiring proper training of staff, improved care planning, better dietary standards and expanded food choices, updated protections against infectious diseases, and measures to strengthen the rights of residents to seek remedies in court.
- Making the information in monthly social security benefit statements available in an electronic data file that can be plugged into software programs provided by private sector retirement plans so that seniors can have easy access to a comprehensive analysis of their financial condition.
- Implementing a National Aging and Disability Transportation Center to promote transportation options that will better serve the needs of seniors and caregivers.
- Expanding efforts to prevent and treat Alzheimer’s disease and to enhance the quality of care for seniors who suffer from dementia while expanding support for their caregivers. One such effort is the Brain Health Awareness Campaign to help seniors and their families understand and cope with the effects of dementia.
Through grants and direct action, new programs are being launched and funded to raise awareness of and prevent elder abuse, to reduce falls and other accidents among older Americans, to promote exercise and physical activity programs for seniors, and to encourage employers to give workers needed flexibility so that they can meet the elder care needs of family members. More information about these and other federal programs is available from the 2015 White House Conference on Aging.