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.