I went to work at the Pulaski South offices of the Arkansas Department of Social Services in December 1974 as a Medicaid, Aid to Families with Dependent Children, and food-stamp eligibility caseworker. Housed in a former church located on Maryland Avenue in what is today the path of Interstate 630, I shared a large room with five other caseworkers.
Our job was to interview the very poor people--the poorest of the poor--who sat in front of our desks day after day. Medicaid was enacted by Congress in 1965, but was not implemented in Arkansas until 1970, and I'm pretty sure I'd never heard of it until I reported for duty in the old, run-down former church.
Signed into law by President Lyndon Johnson on July 30, 1965, Medicare and Medicaid were part of Johnson's War on Poverty. Medicare gave health-insurance coverage to the elderly. Medicaid, on the other hand, was very much a creation of Congress, led by House Ways and Means Chair Wilbur Mills of Arkansas. Congress was willing to pass the program in part because it was seen as a preferred alternative to universal health coverage, which surfaced as an idea as far back as Teddy Roosevelt in 1912 and again with Harry Truman in 1948.
In Medicare's first year, 19.1 million Americans were covered. Fifty years later, there are 55 million beneficiaries, including 591,353 Arkansans enrolled in traditional Medicare or Medicare Advantage plans.
For almost three generations, Medicare has protected the lives and financial security of a growing number of elderly and disabled Americans, and it remains a popular program. According to a recent Kaiser Family Foundation survey, 77 percent of Americans say Medicare is a very important government program, second only to Social Security.
Medicare is also a significant force for health-system reform, funding numerous initiatives to foster innovation and improve the quality of health care and lower cost. The Arkansas Foundation for Medical Care (AFMC), the nonprofit organization where I serve as president and CEO, has been the face of Medicare's improvement programs in the state for more than 40 years, first as the Medicare Peer Review Organization, then as a Medicare Quality Improvement Organization, and now as part of a regional Quality Innovation Network.
In contrast to Medicare, Medicaid has carried a stigma. Hobbled from its birth by its tie to welfare, Medicaid offered coverage to very poor mothers with dependent children, and the disabled. As fate would have it, I became the Arkansas Medicaid Director in 1986, when the entire Medicaid budget was only about $300 million for a program that still covered only the very poor and disabled at low incomes. Things would change dramatically for the program during the 16 years I held the job.
Through federal legislation and at the initiative of governors of both parties--with innovative legislative leadership--the Medicaid program I encountered in an abandoned church in 1974 morphed and changed to become the largest provider of health coverage in the state.
Under Gov. Bill Clinton, Arkansas was the first state to expand Medicaid coverage to pregnant women, and Gov. Mike Huckabee was at the helm when we created ARKids First, taking the state from the bottom ranks to near the top for insuring children. Arkansas Medicaid is also the primary funder of long-term care for the elderly and disabled and for mental health services.
Medicaid is far from a perfect program, and reform is both needed and inevitable. That said, I'm proud of what Arkansas has done with the program during the 40 years I've been involved with Medicaid, both from the government side and now for the past 13 years in the private sector.
I'm especially proud to lead AFMC as we serve both Medicaid patients and the wonderful health-care providers who give skilled care night and day by providing them education and technical assistance.
For 50 years, Medicare and Medicaid have provided health-insurance coverage to our most vulnerable populations--the elderly, the disabled, poor women, and children. Through the Affordable Care Act and programs like the private option, that protection has been expanded to another deserving group, the working poor.
It's a history we should be proud of while we continue to collaborate on making the program more efficient through our shared goals of delivering high-quality, cost-effective health care.
Ray Hanley is president and CEO of the Arkansas Foundation for Medical Care and was Arkansas Medicaid director from 1986-2002.
Editorial on 08/03/2015