July 30, 1965
On July 30, 1965, President Lyndon Johnson traveled to the Truman Library in Independence, Missouri, to sign Medicare into law. His gesture drew attention to the 20 years it had taken Congress to enact government health insurance for senior citizens after Harry Truman had proposed it. In fact, Medicare’s history dated back even further.
Congress held its first hearings on government health insurance in 1916 during the Progressive Era. During the New Deal, health coverage became part of the deliberations over the Social Security program, but President Franklin Roosevelt decided it was better strategy to pass the old-age pension provisions first. In 1939 Senator Robert Wagner introduced national health legislation and held hearings, but the outbreak of World War II caused his bill to be shelved. It was not until after the war, in November 1945, that Harry Truman sent Congress the first comprehensive federal health insurance proposal. That bill went nowhere.
During Dwight Eisenhower’s presidency Congress enacted the Kerr-Mills bill for cases of “medical indigency,” to cover elderly individuals who needed help with their medical bills but who failed to qualify for welfare in their states. But reformers regarded Kerr-Mills as inadequate, given the rising number of elderly and rising cost of hospital care.
In 1961 President John F. Kennedy made Medicare a legislative priority and recruited Clinton Anderson of New Mexico to manage his bill. Anderson, a pragmatic and effective legislator, had suffered frequent bouts of illness throughout his life. “Perhaps a man who has spent much of his life fighting off the effects of illness,” he once wrote, “acquires . . . an understanding of the importance of professional health care to all people.”
Though public opinion polls suggested strong support for the bill, Anderson faced powerful opponents including the House Ways and Means chairman, the American Medical Association, and Senate Finance Committee chairman Harry Byrd. The bill’s opponents prevailed, narrowly defeating the bill in 1962. It was reintroduced in 1963, and following Kennedy’s assassination, Anderson worked painstakingly to build solid, bipartisan Senate support. Under intense pressure Anderson’s own health faltered, forcing him to manage portions of the bill from a hospital bed at Walter Reed. In 1964 the House and Senate passed alternative versions of the bill but failed to resolve those differences in conference.
Lyndon Johnson’s long coattails in the 1964 presidential contest increased support for Medicare in both chambers of Congress. Anderson seized the moment, working closely with House members to expand the scope of the original bill. On July 27 and 28, 1965, the House and the Senate agreed to the conference report on the final bill, which offered a “three layer cake” of coverage: hospital insurance for the aged, physicians’ insurance for the elderly, and expanded federal assistance to supplement state medical payments for the poor. In recognition of Anderson’s efforts, President Johnson invited him to attend the Medicare signing ceremony in Independence, Missouri, with former president Harry Truman.