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Medicare and Medicaid at 60: Historic Milestones, Looming Changes

Published in RINewstoday on August 4, 2025

As 68 million Medicare beneficiaries recognize the 60th anniversary of Medicare, changes are coming to these landmark programs. Presented as efforts to slash costs and combat fraud, the thought of change to Medicare in almost any way leaves many older Americans feeling threatened that their health and financial security will be impacted in a negative way.

A Legacy Under Threat – or Repair?

On July 30, 1965, President Lyndon B. Johnson signed H.R. 6675 into law during a ceremony at the Truman Library in Independence, Missouri. Lasting between 45 and 60 minutes, the event marked the official creation of Medicare and extended guaranteed health coverage to 16 million Americans aged 65 and older—coverage that had not previously existed.

Former President Harry Truman, who had fought for national health insurance two decades earlier, was present for the ceremony. He was enrolled as Medicare’s first beneficiary and received the first Medicare card at the event.

Speaking at the bill signing, President Johnson declared, “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… 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.” Johnson concluded, “When the final chapter of this generation is written, it will be said that we met the needs of the old, and that we did not abandon them to the despair and loneliness and hardship that comes when illness strikes the aged.”

Today, Medicare provides universal health coverage to Americans age 65 and older—though, as the National Committee to Preserve Social Security and Medicare (NCPSSM) humorously noted in its blog, “Ironically, the program is not yet old enough to qualify for itself.”

 The law created Part A to provide hospital insurance funded through payroll taxes and Part B to cover doctor visits and outpatient services on a voluntary basis. Part C, known as Medicare Advantage, offers a privatized, for-profit alternative to traditional Medicare. Part D (coverage through private, for-profit insurers rather than through the traditional Medicare program), added in 2003, provides coverage for prescription drugs. Over the years, Medicare has evolved to offer a wider range of services, yet it still falls short in some areas. Efforts to expand coverage to include essential benefits like dental, hearing, and vision have repeatedly failed to pass Congress.

Medicaid is a federal-state program that offers health coverage to low-income individuals, including children, pregnant people, and those with disabilities — in addition to covering long-term care for eligible seniors. It is a key funding source for U.S. safety net healthcare providers.

NCPSSM’s President and CEO, Max Richtman said that, “We should take a moment to marvel at the fact that — like Social Security — Medicare was created by national leaders who had a vision of a more just society, where, instead of leaving older people to get sick and die in poor houses or becoming a burden to their children, America would commit itself to providing basic health (and financial) security to our most vulnerable citizens.  Through the foresight of Franklin D. Roosevelt and Lyndon Johnson, these benefits (Medicare Part A and Social Security) would be earned through workers’ payroll contributions, giving Americans a true stake in insuring themselves against the hardships of aging.”

What’s at Stake

Despite Medicare’s broad support, it has frequently come under political attack, often rationalized by concerns over its long-term financial viability. The most recent Medicare Trustees report projects that the program’s Part A trust fund could be depleted by 2033 if Congress does not act. At this point the fund’s reserves would only be able to pay 90% of the total scheduled benefits in what there is to spend on Part A.

In 2025, following weeks of political discourse, the “Big Beautiful Bill” was signed into law on July 4, 2025. Known formally as H.R. 1, the sweeping 900-page legislation passed the House on May 22 by the razor-thin margin of 215–214–1. Every House Democrat opposed the measure. Two Republicans joined them. Freedom Caucus Chair Andy Harris of Maryland voted “present.” Two Republican members abstained.

Richtman, sharply criticized the law, saying it “rips health coverage away from as many as 16 million Americans and food assistance from millions more.” Its Richtman’s opinion to warn that 7.2 million seniors who are dually enrolled in Medicare and Medicaid, and another 6.5 million who rely on SNAP (Supplemental Nutrition Assistance Program), stand to lose vital support for health care and nutrition.

The Center for Medicare Advocacy (CMA) also raised serious concerns. CMA is a national, non-profit law organization, working to advance access to Medicare and quality health care through advocacy on behalf of older and disabled people. They warn that Medicare is being steadily privatized. More than half of all beneficiaries now receive their care through Medicare Advantage plans, which costs taxpayers approximately 20 percent more than traditional Medicare. These plans often restrict access to care through networks and pre-authorization requirements. CMA estimates that the $84 billion in overpayments to Medicare Advantage plans this year alone could instead have funded comprehensive dental, vision, and hearing coverage for every Medicare recipient.

CMA further maintains that H.R. 1 strips Medicare coverage from certain lawfully present immigrants who had earned eligibility through their work histories. Undocumented immigrants are not eligible for Medicare. It also blocks implementation of enhancements to the Medicare Savings Program that would have helped low-income beneficiaries afford care, stops new federal nursing home staffing standards estimated to have the potential to save 13,000 lives per year, and limits Medicare’s ability to negotiate lower drug prices for some of the most expensive medications.

Medicaid, enacted alongside Medicare in 1965 to serve low-income individuals and families, faces even steeper reductions under H.R. 1. The law’s new eligibility restrictions are projected to cause from 10-16 million people to lose coverage.

Medicaid Fraud, Waste, and Abuse

Medicaid fraud, like other forms of healthcare fraud, involves intentionally submitting false information to receive payment for services not rendered, unnecessary services, or inflated claims. This fraudulent activity has serious consequences, harming patients, honest providers, and taxpayers. In 2024, the national Medicaid improper payment rate was estimated at 5.09%, translating to $31.1 billion in federal Medicaid improper payments. Medicaid Fraud Control Units (MFCUs) recovered $1.4 billion in FY 2024, representing a return of $3.46 for every $1 spent. Criminal recoveries in FY 2024 were the highest in 10 years, reaching $961 million, more than double the five-year average.

In 2024, 8% of Medicaid claims were deemed improper payments due to fraudulent practices. Fraudulent billing for services not rendered or exaggerated in complexity (upcoding or ghost billing) was a common theme in 2024 fraud cases. Misuse of telehealth and the involvement of third-party billing firms were also notable trends in Medicaid fraud cases in 2024. Prescription drug scams, especially involving opioids and controlled substances, remain among the most significant Medicaid fraud cases. Medicaid fraud in managed care settings increased by 30% in the past five years.

Examples of recipient fraud include lending or sharing a Medicaid Identification card; forging or altering a prescription or fiscal order, using multiple Medicaid ID cards, re-selling items provided by the Medicaid program, and selling or trading the card or number for money, gifts or non-Medicaid services.

Examples of provider Fraud, Waste, and Abuse include billing for Medicaid services that were not provided or for unnecessary services, selling prescriptions, intentionally billing for a more expensive treatment than was provided, giving money or gifts to patients in return for agreeing to get medical care, and accepting kickbacks for patient referrals.

Rhode Island Senators React 

In response to the changes in H.R. 1, Rhode Island’s U.S. Senators Jack Reed and Sheldon Whitehouse joined the entire Senate Democratic caucus to introduce S. 2556 on July 30, the 60th anniversary of Medicare and Medicaid. This three-page bill seeks to repeal the health care cuts included in H.R. 1 and permanently extend the Affordable Care Act’s enhanced tax credits, which are set to expire at the end of 2025. Full Democratic caucus sponsorship of legislation—led in this case by Senate Minority Leader Chuck Schumer—is exceptionally rare and underscores their urgent need to call out the Big Beautiful Bill for its healthcare changes.

S 2556 has been referred to the Senate Finance Committee and at press time no House companion measure has been introduced.

Senator Reed emphasized the wide-reaching impact of H.R. 1, saying that millions of people are expected to lose health coverage under the combined effects of the bill’s Medicaid and ACA cuts. The repercussions, he said, will be felt by health clinics, hospitals, seniors, nursing homes, and patients across the country.

According to an analysis by KFF (formerly the Kaiser Family Foundation) 43,000 Rhode Islanders could lose health coverage due to the bill. Of those, 38,000 would lose insurance as a result of Medicaid cuts, and another 5,500 due to changes in the Affordable Care Act. The same analysis projected that Rhode Island would lose $3 to 5 billion in federal Medicaid funding over the next decade due to the law’s provisions.

Reed also noted that the bill includes cuts to the SNAP (food stamps) program—reducing federal funding by 20 percent through 2034. States would have the option to pick up the difference using their own funds.  In Rhode Island, where 1/3 of the population is on social welfare assistance of some kind, including Medicaid and SNAP, an estimated 144,000 Rhode Islanders are expected to lose SNAP benefits entirely. To maintain SNAP provisions in Rhode Island, the estimated cost could be as high as $51 million.

Reed explained that without ACA premium tax credits, younger workers will also face rising health insurance premiums beginning in 2026, putting additional financial strain on working families. When people lose access to health insurance, they are more likely to delay or skip care, leading to poorer health outcomes and higher overall costs. Federal law would still require hospitals to provide emergency care, meaning hospitals will absorb the financial burden when patients cannot pay. There are also new limits on how medical costs can be held against individuals, especially in Rhode Island, with provisions against destroyed credit ratings, liens, and bankruptcy moves.

BBB Supporters Say It’s a Pill We May Need

According to supporters of H.R. 1, recent changes to Medicare, Medicaid, and SNAP may be seen as fearful, but positive, because they improve affordability, access, and long-term health outcomes.  They says that H.R. 1. Medicare’s new $2,000 cap on drug costs protects seniors from crushing out‑of‑pocket expenses. Medicaid’s pilot coverage for obesity treatments like GLP‑1 drugs supports preventative care and could reduce chronic illness. Meanwhile, efforts to modernize SNAP enrollment and target benefits more effectively aim to reduce administrative waste and better serve low‑income families. However, the introduction of new SNAP work requirements, while controversial, is intended to encourage workforce or volunteer participation among beneficiaries. These reforms reflect a broader commitment to updating essential safety net programs, making them more efficient, equitable, and responsive to today’s health and economic realities—without sacrificing core benefits, supporters add.

A New Reality

As aging advocates and policymakers mark the 60th anniversaries of Medicare and Medicaid, they are forced to address a new reality in both programs. Rather than continually expanding to meet growing needs of older adults, these programs now face reductions that could lead to challenges in access, lower quality care, increased paperwork, disruption in treatment, higher premiums, and fewer covered services. Provider reimbursements are also expected to be cut, which may further limit access to care.

Instead of being a milestone for celebration, the 60th anniversary of Medicare and Medicaid has become a turning point for aging advocate groups—marking not progress, but threat for millions of older Americans who depend on these essential programs to live with dignity, independence, and health.

Trustee Reports predict improved outlook for Social Security and Medicare

Published in RINewsToday on June 6, 2022

On June 2, 2022, following a meeting of the Social Security and Medicare Boards of Trustees, the Social Security Administration (SSA) – joined by the Departments of Health and Human Services and Labor, the Centers for Medicare & Medicaid Services, and the U.S. Department of Treasury — released a 275-page annual report giving us a snapshot of the financial health of the Social Security Trust Funds.

The Trustee reports findings

According to this year’s Trustee Reports, “Social Security and Medicare both face long-term financing shortfalls under currently scheduled benefits and financing. Costs of both programs will grow faster than gross domestic product (GDP) through the mid-2030s primarily due to the rapid aging of the U.S. population. Medicare costs will continue to grow faster than GDP through the late 2070s due to projected increases in the volume and intensity of services provided.”

The Social Security Trustees report that the combined asset reserves of the Old-Age and Survivors Insurance and Disability Insurance (OASI and DI) Trust Funds, paying benefits to 65 million retirees, disabled people as well as survivors of deceased workers, are projected to become depleted in 2035, one year later than projected last year, with 80 percent of benefits payable at that time. The DI Trust Fund asset reserves are not projected to become depleted during the 75-year projection period.

“It is important to strengthen Social Security for future generations. The Trustees recommend that lawmakers address the projected trust fund shortfalls in a timely way to phase in necessary changes gradually,” says Kilolo Kijakazi, Acting Commissioner of Social Security in a statement announcing the released report. “Social Security will continue to be a vital part of the lives of 66 million beneficiaries and 182 million workers and their families during 2022,” she adds.   

The Medicare Board of Trustees note in its 263 page report that the projected depletion date for Medicare’s trust fund for inpatient hospital care (Part A), covering around 64 million retirees and disabled persons, moved from last year’s forecast of 2026 to 2028. At this time Medicare will only be able to pay 90% of the scheduled benefits when the fund is depleted.

“We are committed to running a sustainable Medicare program that provides high quality, person-centered care to older Americans and people with disabilities,” said CMS Administrator Chiquita Brooks-LaSure. In a statement “Medicare trust fund solvency is an incredibly important, longstanding issue and we are committed to working with Congress to continue building a vibrant, equitable, and sustainable Medicare program,” she says.

Thoughts from senior advocacy groups

In a statement, AARP CEO Jo Ann Jenkins said that this year’s Social Security and Medicare Trustee report sends this clear message to Congress: “The Social Security and Medicare Trustees’ reports should send this “clear message” to Congress: “Despite the short-term improvement, you must act to protect the benefits people have earned and paid into both now and for the long-term. The stakes are too high for the millions of Americans who rely on Medicare and Social Security for their health and financial well-being.”

“These reports also underscore the urgent need for Congress to pass legislation allowing Medicare to negotiate for lower prescription drug prices, which would result in billions of dollars of savings for seniors, the Medicare program, and taxpayers,” says Jenkins.

Jenkins also calls on Congress to increase funding to fix serious long-time Social Security customer service problems, which currently impede or keep seniors and people with disabilities from getting their benefits in a timely manner.

Following the release of the Trustees Report, Executive Director Alex Lawson, of the Washington, DC-based Social Security Works, (SSW) a social welfare organization that lobbies for Social Security Reforms, also issued a statement: “Today’s report shows that our Social Security system remains strong. Protecting and expanding benefits is a question of values, not affordability. That this year’s projections are even stronger than last year’s proves once again that Social Security is built to withstand times of crisis, including pandemics.”

We don’t have a Social Security crisis, but we do have a retirement income crisis. With prices rising, seniors and people with disabilities are struggling to afford food and medicine. The solution is to expand Social Security,” says Lawson. 

According to SSW, the 2020 Social Security Trustee’s Report reported that Social Security has an accumulated surplus of about $2.85 trillion.  It projects that, even if Congress took no action whatsoever, Social Security not only can pay all benefits and associated administrative costs until 2035, it is 90 percent funded for the next quarter century, 84 percent for the next half century, and 81 percent for the next three quarters of a century.  

“At the end of the century, in 2095, Social Security is projected to cost just 5.86 percent of the gross domestic product (“GDP”), less than most other wealthy countries spend on their counterpart programs,” says SSW.

Max Richtman, President and CEO of the Washington, DC-based National Committee to Preserve Social Security and Medicare (NCPSSM), throws in his two cents about this year’s Trustee Report. “The takeaway from the latest Social Security Trustees report is this:  Congress must strengthen the program’s finances without delay. The Trustees project that the combined Social Security retirement and disability trust fund will become depleted by 2035, one year later than projected in their previous report. At that point, every Social Security beneficiary will suffer a 20% cut to their benefits.”

“Seniors struggling to meet rising living expenses need Social Security to be boosted and strengthened. The pandemic, runaway inflation and devastating stock market losses serve to remind us how vital a robust Social Security program is to workers, retirees, the disabled and their families. The clock is running down. The time for fair, just, and equitable action that safeguards Social Security’s financial stability is now,” adds Richtman.   

While acknowledging that the trust fund insolvency date may fluctuate from year to year, the urgent need to boost the program’s financing and benefits remains consistent, says Richtman. 

NCPSSM’s Richtman says, over the years, the GOP has opposed the expansion and strengthening of Social Security and has called for raising the retirement age, privatization, and more recently, ‘sunsetting’ Social Security and Medicare every five years.  He calls for passage of Rep. John Larson’s Social Security 2100: A Sacred Trust legislation that would extend trust fund solvency by requiring high wage earners to contribute their fair share through an adjustment in the payroll wage cap. 

A Washington Insider says that House Speaker’s Nancy Pelosi (D-CA) policy staff are concerned about the cost of Larson’s Social Security fix legislation and are seeking a CBO cost estimate. At press time this measure has more than 200 Democratic cosponsors in the House. The Congressional Asian Pacific American Caucus (CAPAC), Congressional Black Caucus (CBC), the Congressional Hispanic Caucus (CHC), the Task Force on Aging and Families, and the Congressional Progressive Caucus have all called on Pelosi to bring the bill to the House floor for a vote.

“Thanks to the American Rescue Plan, our economic recovery has strengthened both the Social Security and Medicare Hospital Insurance Trust Funds and improved financial projections for these vital programs. But to ensure that every American worker, senior, child, and person with disabilities receives the necessary and earned benefits provided by both Social Security and Medicare, we need to act. That’s why I am an original cosponsor of legislation like Social Security 2100: A Sacred Trust, to not only enhance benefits for seniors and some of our most vulnerable neighbors, but to also guarantee access to these programs for generations to come,” said Congressman David Cicilline, (D-RI).  

Congress can step in to financially strengthen the Social Security and Medicare programs. A message from the Social Security and Medicare Boards of Trustees suggest Congress pass legislation to reduce or eliminate the long-term financing shortfalls in both the Social Security and Medicare. “Taking action sooner rather than later will allow consideration of a broader range of solutions and provide more time to phase in changes so that the public has adequate time to prepare,” say the Trustees.

Congress should look for “medium-term solvency” fixes to ensure that Social Security program can pay full benefits for several decades rather than for the full 75-year projection period, suggests Paul N. Van De Water, Senior Fellow at the Washington, DC-based Center for Budget and Policy Priorities, a nonprofit nonpartisan research organization and policy institute that conducts research on government policies and programs. “But shoring up the program’s financing for a substantial period of time is important for assuring both current and future beneficiaries that Social Security will be there for them in the years to come,” he says.

At a crossroad

NCPSSM’s Richtman believes Social Security’s future is now at a crossroads. “We can either cut benefits or expand benefits and pay for it by requiring the wealthiest to pay their fair share,” he says, calling on Congress to hold an up or down votes on Larson’s Social Security legislation.

Polling shows that voters support fixing Social Security and Medicare. Seniors may well go to the polls, sending a message with their vote that strengthening and expanding Social Security is important to them.   

For a copy of the 2022 Social Security Trustee Report, go to https://www.ssa.gov/OACT/TR/2022/tr2022.pdf. For a copy of the 2022 Medicare Trustee Report, go to https://www.cms.gov/files/document/2022-medicare-trustees-report.pdf