Thirty years of Medicare: impact on the covered population.

The Medicare program completed its 30th year of operation on June 30, 1996. En­ acted on July 30, 1965, as Title XVIII of the Social Security Act, and implemented on July 1, 1966, Medicare was seen as filling a gap in the Nation's social insurance syg.. tern. That system had been providing in­ come protection for the population age 65 and over under the Social Security Act of 1935. But until the 1965 Medicare amend­ ments, many elderly persons were unpro­ tected against the risk of financial hardship arising from large hospital and medical bills. The passage of the Medicare legislation was preceded by many decades of debate in Congress over the need for a Federal health insurance program for the elderly. Although private hea:Ith insurance was gradually taking hold in the United States, it was acquired primarily through em­ ployer-based group coverage. In 1963, 2 years before Medicare was enacted, about 75 percent of adults under age 65 had hos­ pital insurance coverage, while the corre­ sponding figure for persons 65 years of age and over was only 56 percent (Andersen, Uon, and Anderson, 1976). Yet the idea of government sponsorship of health insur­ ance was vigorously challenged for many years by various opponents. The events leading up to the landmark Medicare legislation have been described as an excellent case history illustrating