COVERED: Johnson Promises a New Push for Health Care for the Elderly

Welcome to Covered: A Week-by-Week Look at the 1965 Politics that Created Medicare and Medicaid. Bob Rosenblatt, a Senior Fellow at the National Academy of Social Insurance, former Los Angeles Times Washington correspondent, and editor of the website HelpWithAging will blog on the maneuvers that led to the enactment of Medicare and Medicaid on July 30th, 1965 the first major expansion of U.S. social insurance to health care.

Johnson Promises a New Push for Health Care for the Elderly
Administration Sends Mixed Signals on JFK’s Proposed Medicare Program

January 9, 1965

These days in Washington, health insurance for people over 65 is a hot topic and a top priority for President Lyndon B. Johnson and his administration. Its fate in Congress, however, is uncertain. Johnson, fresh from an electoral victory in which the creation of Medicare was a highly visible component of the campaign, wants a bill. But he is facing off against Rep. Wilbur Mills (D-AR), the chairman of the powerful House Way and Means Committee, who last year was able to kill the Medicare proposal approved by the Senate.

The past week has also been marked by mixed messages from the President on his legislative priorities. He delivered a State of the Union speech on January 4th that was heavy in its personal appeal to lawmakers but failed to mention Medicare or health care for the elderly. Three days earlier, the White House sent a report to Congress from the Advisory Council on Social Security that strongly supported using an expansion of the Social Security system to provide hospital care and related services to the elderly and individuals who are permanently disabled. Such action is necessary to assure the continuing effectiveness of retirement protection provided by Social Security, according to the report of Council led by Commissioner Robert M. Ball. The program would be financed by individual contributions from workers and their employers, as is Social Security.

Johnson may have suggested where Medicare fits into his priorities by persuading Congressional leaders to give the bills the symbolic top spot on the list of new bills introduced in the 89th Congress. The Medicare proposal is H.R. 1 in the House, introduced by Rep. Cecil King (D-CA) and  S.1 in the Senate, introduced by Sen. Clinton P. Anderson (D-NM).  The Senate bill has broad support, with 46 co-sponsors, including three Republicans.

Johnson also hammered the importance of Medicare home in his first legislative message to the 89th Congress entitled, “Advancing the Nation’s Health,” which detailed a program that included both health insurance for the elderly under Social Security and health care for the needy. The latter would be accomplished through an expansion of the so-called Kerr-Mills program, created in 1960 to provide medical assistance to elderly individuals who could not qualify for public assistance but don’t have enough resources to pay their medical expenses. “I ask that our social security system—proved and tested by three decades of successful operation-be extended to finance the cost of basic health services,” Johnson said in the message.

To succeed, Johnson will have to overcome the tension within his own party, needing to persuade or defeat Mills – neither of them easy options. The Senate passed a bill last year by a vote of 49 to 44 to create the new health insurance program, but the proposal died in the House, where Mills blocked a vote in his committee.

The President is determined to woo Mills, but finds the task frustrating, according to the transcript of phone conversation with the President, provided by White House sources.  Larry O’Brien, a top legislative aide for the Administration, told the President on May 18^th last year  how committee Democrats were peeved with Mills because of leaked stories that he wanted to only focus on a Social Security increase.

According to sources, Johnson said, “Tell him (Mills) goddamnit, if they are getting to where that’s getting out I’d like to know what he has in mind. They’re asking me questions and I don’t know what the hell they’re doing. A Democratic President ought to know what a Democratic Chairman is doing. Just tell him that.”

The President, a veteran of the Senate himself, has been careful not to step on the authority and prerogatives of the powerful Congressional committee chairmen like Mills. Johnson in fact called Mills a few weeks later, in June, offering praise and help with any bill. You will be the leader – I don’t want to go into the details, Johnson told Mills, according to White House sources. “I’m not trying to write a new section every morning or a new title. I just let it go since the last time I talked to you. But I’ve looked at some of the stuff that’s being considered, from the press and other people, and it looks like to me that you’re approaching it right, and you’re getting it in shape,” Johnson reportedly said to Mills.

Passage of a Medicare bill would give them both a big place in history, the President told Mills. “There is not anything that has happened in my six months, or that will happen in my whole term, in my judgment, that will mean more to us as a party, or me or you as individuals than this piece of legislation. . . . You work it out, and anything you want me to do, let me know.”  But Mills killed the Medicare bill anyway.

The President’s efforts to do better this year may provide the most compelling legislative storyline of this first session of the 89^th Congress.

►See the next post in the COVERED series: “Johnson Seeks Broad Right to Health Care, Beyond Just Welfare,” January 17, 1965

►Directory of COVERED posts

► Learn more about the Academy’s celebration of the 50th anniversary of the enactment of Medicare and Medicaid