On 50th Anniversary of Medicare and Medicaid, NCOA Offers Four Ways to Make Them Even Better


Vanessa Sink

Public Affairs Manager



Arlington, VA (July 29, 2015)—Fifty years ago, the National Council on Aging (NCOA) was there when President Lyndon B. Johnson signed the bills that created Medicare and Medicaid. Today, NCOA is celebrating the programs’ successes—and promoting ways to make them even more effective for future generations.

“Medicare and Medicaid are woven into the very fabric of American life and provide lifelines to seniors and individuals with disabilities in need—yet they are under constant threat from policymakers,” said Howard Bedlin, NCOA Vice President for Public Policy and Advocacy. “We need to move beyond the rhetoric and focus on the facts, so we can make informed, rational decisions about how to protect and strengthen these critical health programs for the future.”

Today, Medicare covers 55 million Americans, about 17% of the U.S. population. With emerging new payment and delivery models, it continues to shape innovations throughout America’s health care system. Medicaid provides a lifeline for the most vulnerable Americans, covering more than 9.6 million low-income seniors and individuals with disabilities by paying for long-term services and supports and assisting with Medicare premiums and cost-sharing.

But as the demographics of America change, so too must Medicare and Medicaid to keep up. NCOA sees four opportunities for improvement:

1. Find a bipartisan solution to long-term services and supports financing.

Most people mistakenly believe that Medicare covers long-term services and supports (LTSS). In fact, Medicaid offers this coverage—but only after individuals and their families are forced to spend-down into poverty to qualify. Private long-term care insurance is an option for some, but unavailable to those with pre-existing conditions and too expensive for most.

“The number of Americans needing long-term supports and services will more than double in the coming decades—affecting 27 million Americans by 2050,” said Joe Caldwell, NCOA Director of Long-Term Services and Supports Policy. “We can’t wait. Finding a solution to LTSS financing will take public and private collaboration to offer options that are varied and affordable. We also must do more within Medicaid to allow people to get the care they need at home instead of in costly nursing homes.”

2. Help low-income people with Medicare access benefits that make health care affordable.

Today’s Medicare beneficiaries have a median income of just $23,500. While Medicare has made substantial strides in the past 50 years to reduce out-of-pocket health care costs for older adults, the job is not finished. Congress recently made Medicare’s Qualifying Individual (QI) assistance program permanent, offering much-needed help for low-income individuals struggling to pay their premiums and cost-sharing. Yet, less than half of those eligible for this and other low-income protection programs actually receive it.

“State Health Insurance Assistance Programs (SHIPs) help eligible individuals understand and apply for low-income support, but Senate appropriators have proposed cutting these services by over 42%. With the senior population growing, we need to support and expand programs that assist and enroll eligible individuals,” said Leslie Fried, Senior Director of NCOA’s Center for Benefits Access.

In addition, stringent asset tests make it difficult for low-income people with Medicare to qualify for assistance, while low-income people under age 65 do not face this barrier. Some of these programs are paid for by Medicaid. “We should align low-income protections for people under age 65 and those over age 65,” said Fried.

3. Improve chronic care, prevention, and self-management.

Thanks to a series of reforms over the past decade, people with Medicare have easier access to many preventive programs and services. But more needs to be done, such as reducing expensive elder falls and promoting access to chronic disease self-management education (CDSME) for the millions of Americans with multiple chronic conditions.

“Evidence-based chronic disease self-management and falls prevention programs have been proven to reduce hospital and emergency room costs and improve health,” said James Firman, NCOA President and CEO. “We’re living longer than ever before, but we’re not supporting access to programs and services that can help us age well.”

4. Focus on the facts.

Too often, conversations about the future of Medicare include words like “bankruptcy” and “insolvency.” The truth is that the program is in good financial shape. Last week’s 2015 Medicare Trustees Report found that the Medicare Part A Hospital Insurance Trust Fund is fully funded through 2030—and can pay 86% of its obligations thereafter. The Trust Fund applies to Part A, which comprises only about a third of Medicare spending.

“The reality is that growth in Medicare per-person costs are at a historic low, and the outlook for future spending as a percentage of the total economy has improved significantly,” said Bedlin. “While the number of older adults aging into Medicare is increasing, many baby boomers are health aware and are seeking reliable information on how to choose the right Medicare coverage that can save them and the program money.”

As Medicare and Medicaid mark their 50th anniversary, NCOA’s goal is to find bipartisan solutions to improve both programs, so they continue to meet the evolving needs of America’s senior and vulnerable populations.

About NCOA

The National Council on Aging (NCOA) is a respected national leader and trusted partner to help people aged 60+ meet the challenges of aging. Our mission is to improve the lives of millions of older adults, especially those who are struggling. Through innovative community programs and services, online help, and advocacy, NCOA is partnering with nonprofit organizations, government, and business to improve the health and economic security of 10 million older adults by 2020. Learn more at ncoa.org and @NCOAging.