Medicare and Medicaid: The Next 50 Years

On July 30, 1965, President Johnson signed landmark legislation creating Medicare and Medicaid, key elements of his administration’s vision of creating the “Great Society.”  Now reaching their 50^th anniversaries, these health programs have become integrally woven into the American social fabric and have undergone many reforms.  More changes are on the horizon as the nation faces new political, medical, demographic, and technical challenges and opportunities.  These two public programs – which have grown in complexity and cover many more people and services than originally conceived – will operate in conjunction with the rapidly evolving national coverage latticework created by the Affordable Care Act.

The National Academy of Social Insurance is the nation’s leading nonpartisan, nonprofit organization dedicating to advancing public understanding of Social Security, Medicare, Medicaid, and other vital programs.  Since its founding in 1986, NASI’s annual conferences have offered visionary perspectives, leadership, and rigorous inquiry addressing how our social insurance programs can best meet the changing needs of American families, employees and employers.

This conference began by looking back over Medicare and Medicaid’s first 50 years and considering what experience can tell us about meeting the challenges ahead.  Will Medicare and Medicaid soon play even larger roles in covering Americans?  How will program costs be managed and who will bear them?  As publicly subsidized health coverage expands for the working population, will these major public programs, which were not born identical twins, grow more similar and more integrated into privately financed health system?  Or will they become more distinct?  How will Americans make their way through an increasingly complex health coverage landscape as they move from childhood through the work force and into old age?

The conference co-chairs identified megatrends significant to health care policy innovations and invited conferees to explore several of those:

• The changing face of American society:  How are demographic, economic, and cultural shifts impacting the underlying health of Americans and what are the implications for health care?
• Advances in science and technology:  How will drugs, diagnostics,  telemedicine, robotics, devices and remote monitoring, health informatics and data analytics affect health care and what are the implications for both improved health outcomes and costs?
• Innovations in payment and delivery:  What will they mean for health coverage and services?
• Emerging trends in health coverage across the lifespan: How can we smooth the transitions between Medicare, Medicaid, the Affordable Care Act, and employee coverage?