Letters from an American - 60 Years of Medicare and Medicaid

Episode Date: July 31, 2026

July 30, 2026Sixty years ago, Medicare and Medicaid went into effect, Congress had amended the Social Security Act of 1935 to establish the two national health insurance programs, for seniors and for people who qualified on the basis of income, In 1945 Harry Truman had proposed an Economic Bill of Rights tht guaranteed certain rights including the right to adequate medical care, Truman said that “the health of this nation is a national concern,” John F Kennedy made the expansion of health insurance a priority, but faced strong opposition, With LBJ’s victory in 1964, he had the votes to pass Medicare and Medicaid, But in 2026 the Republicans are rejecting LBJ’s vision of a government that works to support its people, The One Big Beautiful Bill Act partially offset its tax custs with cuts to Medicaid, and the administration now plans to cut a program capping the cost of drugs for Medicare recipients.Watch today's recording here: https://www.youtube.com/live/g9TUa1Rwd6U?si=T8_KKcHQZElhpnZ-Get full, free access to Letters from an American here: https://heathercoxrichardson.substack.com/subscribeYou can also find me:Bluesky: https://bsky.app/profile/hcrichardson.bsky.socialInstagram: https://www.instagram.com/heathercoxrichardson/?hl=enFacebook: https://www.facebook.com/heathercoxrichardson/YouTube: https://www.youtube.com/@heathercoxrichardson Get full access to Letters from an American at heathercoxrichardson.substack.com/subscribe

July 30, 26, 60 years ago today, on July 30, 36, Medicare and Medicaid went into effect. A year earlier, President Lyndon B. Johnson had signed the Medicare and Medicaid amendments Congress had made to the Social Security Act of 1935, establishing two national health insurance programs. Medicare used federal funds to cover seniors, while Medicaid covered people who qualified on the basis of income using federal and state funding.

The programs expanded health insurance to millions of uninsured Americans. Americans and their leaders had called for government support for health care since the early 1900s, but the final push to expand health care coverage in the United States came out of the New Deal. In 1945, President Harry Truman continued to expand the social safety net, anchored by the 1935 Social Security Act, signed into law by his predecessor Franklin Delano Roosevelt. On November 19, 1945, Truman reminded Congress that in September he had proposed an economic bill of rights that guaranteed certain rights which ought to be assured to every American citizen. One of them, he reminded them, was the right to adequate medical care and the opportunity to achieve,

and enjoy good health. Another was the right to adequate protection from the economic fears of sickness. Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health, he said. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection. Truman reminded Congress how shocked Americans were when the World War II military draft revealed the widespread physical and mental incapacity among the young people of our nation. About 30 percent of those examined for military service were classified as unfit. Of those who made the cut to join the military, about a million and a half had to be discharged for physical or

mental disability, and an equal number had to be treated for pre-existing diseases or infirmities. More than a third of the women applying to the Women's Army Corps were also rejected. Access to the benefits of modern medical science had never been equal, Truman said, and never would be, unless government is bold enough to do something about it. People with low or moderate incomes do not get the same medical attention as those with high incomes. The poor have more sickness, but they get less medical care. People who live in rural areas do not get the same amount or quality of medical attention as those who live in our cities.

Our new Economic Bill of Rights should mean health security for all, regardless of residents, station, or race, everywhere in the United States. We should resolve now that the health of this nation is a national concern, that financial barriers in the way of attaining health shall be removed, that the health of all its citizens deserves the help of all the nation. Truman proposed a new health care program funded through fees and taxes, but Republicans who took control of the House in 1946 opposed new taxes, and although Truman had been careful to insist,

that the state would not take over hospitals, warned that the program looked too much like communism. Instead, under Republican President Dwight Eisenhower, Congress passed a bill covering health care costs for indigent elderly Americans. When he took office, President John F. Kennedy made the expansion of health insurance a priority. But while the American people liked the plan, it faced strong opposition from the American Medical Association, the chair of the House Ways and Means Committee, and the chair of the Senate Finance Committee. In 1964, after Kennedy's assassination, both chambers passed their own measures, but they couldn't resolve their differences to pass a law. When LBJ won a landslide victory over right-wing Republican Senator Barry Goldwater of Arizona

in 1964, he had the votes to pass Medicare and Medicare. Medicaid. LBJ made a point of signing the new measure into law at the Harry S. Truman Library in Independence, Missouri. He gave Truman and his wife Best Truman the first two Medicare cards. In his remarks at the signing, Johnson told the crowd, the people of the United States love and voted for Harry Truman, not because he gave them hell, but because he gave them hope. He told Truman that others like him, men of vision who are willing to stake their reputations and position to help others, illuminate the life and the history of a nation. He and his advisors had come to independence not in tribute to Truman himself, Johnson said, but in tribute to the America that he represented.

For a country can be known by the quality of the men it honors, he said. By praising you and by carrying forward your dreams, we really reaffirm the greatness of America. Johnson explained what the measure did. No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes and their own. hopes eaten away simply because they are carrying out their deep moral obligations to their parents

and to their uncles and their aunts. And he said, no longer will this nation refuse the hand of justice to those who have given a lifetime of service and wisdom and labor to the progress of this progressive country. But now in 26, the Republicans in charge of our government reject the vision of a government that works to support its people. They see government regulation, taxation, and a social safety net as an attack on individual liberty. In their one big beautiful bill act, which they passed in July 2025 with no Democratic votes,

the Republicans delivered Trump's signature economic policy. The law partially offset trillions of dollars in tax cuts by cutting $911 billion from Medicaid over 10 years. Most of those cuts will begin to take effect in late 26 and early 2027, after the mid-term election. And the cuts continue. On Tuesday, Anna Wild Matthews of the Wall Street Journal reported that the Trump administration is planning to end a Biden-era program

that capped out-of-pocket spending for drugs for Medicare research, recipients at $2,000 a year. The program provided subsidies for Medicare Part D, a Medicare prescription plan for seniors, by paying insurers. It also allowed Medicare to negotiate prices with drug companies for certain medicines. The Trump administration has taken aim at the subsidies in this program. It says the subsidies encouraged insurers to raise rates and that they weren't needed because other policies that hold down the cost of drugs will stay in place. Mehmet Oz, the administrator for the Centers for Medicare and Medicaid services, posted, We are stabilizing the market, so this bailout is no longer needed.

Matthews notes that higher prices for drugs could drive more Medicare participants into the private insurer version of Medicare, called Medicare Advantage. Pushing people toward Medicare Advantage was outlined, as a desired outcome in Project 2025, the right-wing program to unwind the modern American state. History shapes men, but it is a necessary faith of leadership that men can help shape history, Johnson said, as he signed the measure creating Medicare and Medicaid. He credited FDR with beginning the process of creating a basic social safety net when he signed the 1935 Social Security. Act. He noted that FDR at the time called the Social Security Act a cornerstone in a structure

which is being built, but it is by no means complete. Letters from an American was written and read by Heather Cox Richardson. It was produced at Soundscape Productions, Dead in Massachusetts, recorded with music composed by Michael Moss.