Medicare and Medicaid Act

On July 30, 1965, President Lyndon Johnson traveled to Independence, Missouri, to sign the Social Security Amendments of 1965 into law beside Harry Truman — who had proposed national health insurance 20 years earlier and been defeated by opposition from the American Medical Association and Cold War accusations that any such program was socialized medicine. The bill Johnson signed created Medicare, providing health coverage for all Americans 65 and older, and Medicaid, providing coverage for low-income individuals and families. It was the most significant expansion of the American social safety net since Social Security itself.

The passage of Medicare and Medicaid followed nearly two decades of failed attempts at national health coverage, and its success owed as much to political circumstance as to policy argument. Lyndon Johnson's landslide 1964 victory gave Democrats commanding Congressional majorities. The Civil Rights Act had passed, the Great Society was underway, and the legislative momentum of that window made ambitious social policy briefly possible in ways it had not been before. The American Medical Association — which had spent years and millions of dollars opposing "socialized medicine" — lost the fight it had been winning since the Truman years.

In its first half-century, Medicare grew into one of the largest health insurance programs in the world. By 2020 it covered over 60 million Americans; Medicaid covered nearly 80 million. Together they accounted for roughly 35 percent of total U.S. healthcare spending. The programs transformed the experience of aging in America — before Medicare, an estimated half of Americans over 65 had no health insurance at all — and launched a decades-long political argument about the proper role of government in healthcare that has not concluded.