Social Security Act of 1965

The Social Security Act of 1965 resulted in the passing of two bills: Medicare and Medicaid. The act provided federal health insurance for the elderly (over 65) and for poor families. While Lyndon B. Johnson (LBJ) was responsible for signing the bill, there were many others involved in drafting the final bill that was introduced to the United States Congress in March 1965.

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The fight for national health insurance began in the early 1900s and greatly caught the public’s attention during Truman’s presidency. Between 1958 and 1964 controversy grew and the bill was drafted. The signing of the act, as part of LBJ’s Great Society, heralded in an era with a greater emphasis on public health issues.

Background

The idea of national health insurance came about around 1915 when the group American Association for Labor Legislation attempted to introduce a medical insurance bill to some state legislatures. These attempts were not successful and as a result the controversy about national insurance came about. National groups supporting the idea of government health aid included the AFL-CIO, American Nurses Association, National Association of Social Workers, and the Socialist Party USA. The most prominent opponent of national medical insurance was the American Medical Association (AMA); others included the American Hospital Association, the Chamber of Commerce and the Life Insurance Association of America.

In 1945, when President Franklin D. Roosevelt signed the Social Security Act, medical benefits were left out of the bill. While Roosevelt wished to include some sort of national health care clause in the bill, he believed the American population would not be ready and the idea would be unpopular. Still, the idea of government medical care insurance stayed in the minds of some politicians. Harry Truman took on the idea of national medical care and tried to integrate it into his Fair Deal program. Unfortunately, Truman’s attempts were also unsuccessful; however, during his presidency the fight for national medical care became specific to the aged population.

Before making it age specific, there were arguments against aiding the entire population: people believed it to be too great of a give away program, that it would help too many well-off Americans, that medical facilities did not have enough resources, and that nationalized medical insurance would result in too much federal control of physicians. As for the aged population (65+), they could not be expected to constantly save and earn money for themselves and falling back on their family would be inefficient and inconvenient. Thus, legislators agreed on an age group that deserved help.

Once the targeted age was decided during Truman’s presidency, an over-a-decade fight began over presenting a coherent medical care bill to Congress. The aforementioned groups spent a lot of time and money lobbying their respective causes. The controversy subsided during Dwight D. Eisenhower’s conservative presidency. During Eisenhower’s presidency, the House Ways and Means Committee was created. The members of this committee were mainly Republicans and Southern Democrats; as a result, any attempts to pass social health programs were difficult. Wilbur Mills, the man who chaired this committee, later played a large role in creating the health care program that was integrated into the Social Security Act.

Accompanied by John F. Kennedy’s presidency, the 1960s shuffled in more serious movements towards a national healthcare bill. In 1960, the Kerr-Mills Act gave states the power to decide what patients needed financial assistance; at the states decree, the federal government would provide individual assistance. While this seemed like a step forward, most states did not participate or abide by the Act. Another preliminary bill was formed in 1962 named the King-Anderson Bill. Under it, some hospital and nursing home costs for patients 65 and older would be covered. Although this bill was thwarted in Congress, the defeat was slim (12-11), showing the effect Kennedy’s years had. Also, it paved the way for the actual bill passed three years later.

Lyndon B. Johnson years

The election of Lyndon B. Johnson in 1964 gave hope to the healthcare bill. Both the President and Congress were Democrat. The United States House of Representatives had a 2:1 Democrat to Republican ratio and the Democrats had 32 more seats in the United States Senate. The Democrats in the House Ways and Means Committee shifted away from Southern Democrats, making the committee more sympathetic towards healthcare reform. Thus, the odds were in favor of passage of a national health care bill.

Those who had before worked on the King-Anderson Bill began drafting a new bill which included coverage of the aged, limited hospitalization and nursing home insurance benefits, and Social Security financing. Wilbur Cohen, the man in charge of the Health, Education and Welfare Committee, took up the Medicare bill. Cohen convinced Johnson to give the bill high priority; Johnson realized this bill had been in the works since before Truman’s time thus he declared its importance to his Great Society program. The healthcare bill was given the label H.R. I and S. I as it became the first bill introduced to the new Congress.

The groups who previously argued against national healthcare switched their focus from opposing the bill to creating new versions of it. As a result there were three prominent forms of the bill: John Byrne’s, the American Medical Association’s, and, of course, the Presidential administration's bill (known as Medicare). John Byrne was a Republican committee member who proposed that doctors' services and drugs would be financed; also, participation in government aid would be voluntary for the aged. If an elderly patient did need the help, his or her financing would be “scaled to the amounts of the participant’s Social Security cash benefits” and the financing would come from the government’s revenues. The AMA proposed Eldercare, which provided government financing for physician’s services, surgical charges, drugs, nursing home costs, x-ray and lab services. When brought back to the Ways and Means committee, these three bills were presented: John Byrnes, Eldercare, and Medicare. When deliberations began in 1965, both AMA members and their suggestions were rejected due to the AMA’s unruly conduct at meetings.

Deliberations became increasingly confusing. Wilbur Mills, the head of the Ways and Means committee, suggested combining Byrne’s ideas and Medicare. Mills took on the task of drafting the bill that ultimately became a law. In combining the two bills. John Byrne’s suggestion, which included lower taxes, had to be slightly altered as high-taxes were necessary for the program’s predicted high costs.

During March 1965, Wilbur Mills, with the help of many other people and groups, presented a draft of the bill to Congress. The bill went through more than five hundred changes between the Senate and the House. Finally, the bill passed with the majority vote in both the house (307-116) and the senate (70-24). It came about as two amendments to the Social Security Act. Title 18 became known as Medicare and Title 19 became known as Medicaid. Title 18 includes Part A, which provides hospital insurance to the aged, and Part B which provides supplemental medical insurance. Title 19 proclaims that at the states discretion, it can finance the healthcare for individuals who were at or close to the public assistance level.

On July 30, 1965, President Lyndon B. Johnson signed the bill making it Public Law 89-97. The signing took place in Independence, Missouri and was attended by Harry S. Truman. When LBJ signed the bill he “credited Truman for ‘planting the seeds of compassion and duty which have today flowered into care for the sick and serenity for the fearful’” Implementation of the amendments required extensive data processing and the re-configuration of hospital policies country wide.

The passage of the new healthcare program marked an important point in American history; it was the America’s first public health insurance program. Although the overall politics of Medicare and Medicaid were liberal, the help of both John Byrnes, a Republican, and the American Medical Association was essential in drafting what came to be known as the Social Security Amendments of 1965. Medicare and Medicaid were one of the few successful programs that lasted from Johnson’s vision of the Great Society.