Theodore Roosevelt, who served from 1901–1909, advocated the
passage of social insurance programs his unsuccessful run for another
term in 1912. Since he believed that a strong country required healthy
people, he favored the passage of health insurance legislation,
although he assumed that such legislation would come from the
states, rather than the federal government, and cover only the
working classes.
Franklin D. Roosevelt, who was Theodore Roosevelt's distant cousin
and who was married to TR's niece, continued the fight for social
insurance. During the first of his four terms, Congress passed the
Social Security Act of 1935. This epochal piece of legislation contained
old-age insurance, unemployment compensation, and maternal and
child health, but not health insurance. Although important
administration officials, such as relief administrator Harry Hopkins,
favored the passage of health insurance, President Roosevelt decided
that it was too controversial to include in his proposed Social Security
Act and sent the issue off for further study.
Surgeon General Thomas Parran served as the Roosevelt's principal
spokesman on health care. As head of the Public Health Service, he
was sometimes wary of proposals that would expand the power of the
Social Security Board. He became an important proponent of federal
aid for hospital construction, which led in 1946 to the Hill-Burton
hospital construction program. In exchange for federal funds, hospitals
were required to serve the poor. He was the first to propose limiting
health insurance to Social Security beneficiaries.
Harry Truman, who became President upon FDR's death in 1945,
considered it his duty to perpetuate Roosevelt's legacy. In 1945, he
became the first president to propose national health insurance
legislation. After Congress rebuffed his request, he reiterated his
appeal after his surprising victory in the 1948 presidential elections.
Congress continued to oppose the measure. In 1950, he signed the
Social Security Amendments, which provided federal funds to states
for vendor payments for medical care of poor aged called Old-Age
Assistance; it became the foundation for the Medicaid program.
In 1954 Dwight Eisenhower proposed a plan to re-insure private
insurance companies against usually heavy losses on health insurance
as part of a comprehensive health and welfare program that Congress
ultimately rejected. Although his proposal failed, President Eisenhower
oversaw significant progress in services for the disabled. In 1954,
vocation rehabilitation legislation was passed for states to help the
disabled return to work. In 1956, in a significant expansion of Social
Security benefits, President Eisenhower signed the disability insurance
program into law. The Hill-Burton hospital construction program was
expanded to cover rehabilitation facilities.
Among the Congressional opponents of President Roosevelt and
Truman's approach to national health insurance was Senator Robert A.
Taft of Ohio. The son of President William Howard Taft, the younger
Taft, who served in the Senate from 1939 to 1953, became one of the
leading legislators of his generation. He favored providing federal aid
for health care for the poor that would be administered by the states.
Representative Aime Forand of Rhode Island introduced the legislation
in 1957 that is generally regarded as the direct precursor of Medicare.
Forand, who served on the House Committee on Ways and Means, was
not the first choice of the bill's authors. They turned to him only after
two more senior-ranking members of the Committee turned them
down.
Representative Wilbur Mills of Arkansas, who became head of the
Ways and Means Committee in 1958, exerted more influence over
Medicare and Medicaid than any other single legislator. The Social
Security Amendments of 1965, that initiated the two programs,
reflected many of the priorities and preferences of Representative
Mills.
Senator Robert Kerr of Oklahoma, who entered the Senate in 1949,
quickly became a major factor in its deliberations over Social Security.
His opposition to Medicare and his desire to find a constructive
alternative led to passage in 1960 of Medical Assistance to the Aged,
also known as Kerr-Mills. It expanded the Old-Age Assistance vendor
payment program to include coverage to the "medically needy" aged,
i.e., those not poor enough to qualify for Old-Age Assistance, but too
poor to pay their medical bills.
Senator Clinton P. Anderson of New Mexico had served as President
Truman's Secretary of Agriculture and entered the Senate in the same
year as Robert Kerr and Lyndon Johnson. In 1961 he became the
principal Senate sponsor of the Kennedy administration's Medicare bill.
Representative John Byrnes of Wisconsin served as the ranking
minority member of the Ways and Means Committee in 1965. His
alternative proposal to the administration's Medicare bill, a voluntary
program that would cover physician services, led to the inclusion of
Supplementary Medical Insurance (known as Medicare Part B) in the
final legislation.
John F. Kennedy made the passage of Medicare one of the priorities of
his administration. Despite intense bargaining with members of
Congress, Kennedy died before gaining his objective. The closest he
came to his goal was a vote in the Senate on July 17, 1962. Thanks in
part to the efforts of Senator Robert Kerr, the administration lost by 4
votes: a count of 52 to 48.
After the assassination of President Kennedy, the newly elected
President Johnson made passage of Medicare his top legislative
priority. Bureau of the Budget director Kermit Gordon echoed the
thoughts of many when he called Medicare the "jewel in the crown of
the federal government." Medicare and Medicaid were enacted as Title
XVIII and Title XIX of the Social Security Act. Medicare extended
health coverage to almost all Americans aged 65 or older (e.g., those
receiving retirement benefits from Social Security or the Railroad
Retirement Board). Medicaid provided health care services to those
receiving welfare benefits: low-income children deprived of parental
support and their caretaker relatives, the elderly, the blind, and
individuals with disabilities.
Lyndon Baines Johnson signed the Social Security Amendments of
1965 into law on July 30, 1965, at a dramatic ceremony held at the
Harry S Truman Presidential Library in Independence, Missouri. Some
of Johnson's advisors urged him to sign the legislation elsewhere, for
fear people would think that the administration wanted to pass
national health insurance for people of all ages, as President Truman
had. Johnson dismissed such objections, saying he wanted to
recognize President Truman as the "daddy of Medicare."
•
July 1, 1966—Medicare begins
Presidential Milestones
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