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President Kennedy, Senate Finance Committee, final bill medicare bill
June 29, 2022

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Reflections on enactment of Medicare and Medicaid

Health Care funding reviews Center - Medicare and Medicaid Services Wilbur Cohen additional articles information. Despite strong public support, the bill was defeated in 1962, due in part to opposition by powerful forces, including the American Medical Association.

Although Congress passed Medical Assistance for the Aged, known as the Kerr-Mills Act, only twenty-eight states had adopted it, and the guidelines for participation were so stringent that only one per cent of the elderly received benefits.

Evolution of Medicaid

It started in 1942 when Providence hoped to use some of the existing Social Security funds for direct payment to medical providers of medical services and other services. Nevertheless, Social Security officials determined there was no restriction in the amount of these payments by law. This led to a proposal from social security officials for a specific modification to the statute to allow for such “vendor payments”. A federally-state-run comprehensive public welfare plan would include the approval of medical aid and the Board approved this plan in 1949.

President Richard M. Nixon, concerned about Democrats gaining advantages from the issue and a possible Kennedy campaign for president, later offers his own version of a bill, the National Health Insurance Partnership Act.

Legislative process: 1964-65

Wilbur J. Mills was an influential advocate of social welfare contributions. He is an economic conservative and an intelligent, prudent politician. Until 1965, he didn't promote Medicare proposals. However, despite his vehement opposition to Medicare he always made sure to have room to evolve. He would commit himself to opposing specific legislation such as the “king-anderson bill”, but he took care not to reject purely the principle of health insurance for the aged, though he was unsure how implementing this in the social system.


The Medicare hospital part had been a subject in some form of staff debate for years from 1942 when the first national hospital insurance law passed the United States Congress in 1958. The numerous versions of the laws were used to pinpoint administrative and policy issues and to determine the best method to address it for effective administration. The adoption of disability insurance policies and regulations in the early 1960s helped the staff substantially in defining and developing medical certification policies.

On February 9, 1961, Massachusetts native son President John F. Kennedy asked Congress to approve a health insurance program for Americans 65 and older. On June 13 1963, President John F. Kennedy delivered the following speech before the National Council of Senior Citizens. It was published in the November 9, 1963 issue of the New Republic to coincide with hearings on the King-Anderson bill, which was intended to contribute to the costs of care for the elderly.


Wilbur J. Cohen has been a Professor of Public Administration at Lyndon B. Johnson University in Austin since 1980. In 1960, the senate remanded to the United States House for the United States House of Representatives. Between 1961 and 1960 he was Assistant Secretary Under Secretary of State. This position was the only one ever held by anyone in that role. He was one of a major architect of Medicare and Medicaid and was primarily responsible for introducing this legislation through Congress and for launching it.

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Cohen & Ball (1965 / 5) cites extensive legislative background to the 1965 Act. 2Several grammatical articles, and other arguments can be found in Campion (1984) and Harris (66). A comprehensive analysis of the legislative struggles are presented in 12 oral histories from Columbia University Libraries and summarized by Corning (1969). 3I helped write Wagner-Murray-Dingell's comprehensive national health policy of 1943 and Truman' health message of 1945.

Finally, on July 30, 1965, President Lyndon Johnson signed Medicare into law. But Mills had sent signals that he might allow Medicare to sneak in under the cloak of a welfare bill, which Mills wanted to pass. Medicare would be added to the bill in the Senate, and then Mills could water it down in the conference committee where the House and Senate versions of the welfare bill were reconciled. Anderson and President Harry Truman, who had also proposed such a program twenty years earlier, were present at the signing, which took place at the Truman Library in Independence, Missouri.

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As we go back to the 45-year health policy period (1940-85) and, particularly Medicare and Medicaid years (1950-1968) I see the Medicare and Medicaid Act 1965 as a long-term project – a continuing project. There have been several improvements since 1965. Our knowledge has increased over the past 20 years. I don't see the 1965 law as being a positive or negative thing either or a limitation of the federal government's function. President John F. Kennedy tragically did not live to see the Medicare legislation he championed become law.


I spent 15 years in the early 20th century assisting with designing the basic framework and piloting the program by the Congress. I remained in charge of the implementation in the United States during my 31-year career (1965 – 1967) primarily for the implementation. Understandably, I feel a personal or emotional distress with these programs that require such incredibly long-term investments from me.

Edward Kennedy never had to worry about getting quality healthcare, but he spent much of his career seeking to guarantee that all Americans had that same access to health services he had.

The beginnings

Several of these provisions were previously discussed and were examined during a recent study in a broader context that includes Medicare and Medicaid. I also participated in the decision. I selected those clauses in those laws whose interpretations remain unreliable. I cannot talk about aspects of the legislative framework as recorded in current publications (Hiris, 1966; Davis (1985).

Reimbursement policy under Medicare and Medicaid

It has never been formally discussed or rejected in any serious way during the period 1961 – 65. It was agreed by Congress to consider the provisions in subsections 3 and 4. It was not argued during the legislative process that costs were added. There was no evidence that inflation was the cause of cost increases.

Broadening and liberalizing requirements

The Medicaid Act of 1966 and 1903(b) provided for the Secretary not to make any payment under the provisions of this chapter to any State until the State has shown satisfactory efforts to extend the scope of its services.

Prohibition of Federal interference

The 1801 Medicare Act provides nothing in that title that shall allow a Federal officer a Federal employee to exercise a duty of supervision over medical practices.

In recognition of Anderson's efforts, President Johnson invited him to attend the Medicare signing ceremony in Independence, Missouri, with former president Harry Truman. While Obama crosses his fingers and waits for to flicker to life, he can at least comfort himself knowing that he has already done more to reform the health care system than JFK, a president with a vigorous reputation and vibrant legacy.

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