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Happy 50th, Medicare

At 50, Medicare is comfortably settled into middle age, but with some of the aches and pains that go with getting older. As the granddaddy of the U.S. health care system, it helps pay for hospitalizations, doctors’ visits and prescription drugs for 55 million Americans who might otherwise go without.

Since its debut, it’s become bigger, older and a tad flabbier, much like the 65-and-older population it’s primarily designed to cover. (It also provides coverage for younger individuals with permanent disabilities.) Its sister program, Medicaid, the federal-and-state-funded program (called Medi-Cal in California) that covers mostly low-income Americans, has similarly ballooned in size, partly due to millions of children and adults enrolled under the Affordable Care Act. In California, about half of all children and a third of adults depend on Medi-Cal for health care.

Here are five things to know about Medicare at the half-century mark.

1. It was contentious.

Inked into law on July 30, 1965, by President Lyndon B. Johnson, Medicare was the country’s first major form of national health care. Much like Obamacare today, it took a contentious campaign for Medicare to become reality. President Harry S. Truman first broached the idea of a nationwide health care safety net – back in 1945. For his efforts, he was issued the country’s first Medicare card. His wife, Bess, got Medicare card No. 2.

2. Celebrations are happening nationwide.

This week’s 50th anniversary is sparking celebrations and calls to action. Medicare itself is urging Americans to “Share your Story” – at www.medicare.gov – by writing how Medicare or Medicaid has impacted or changed their lives. Advocacy groups, including the California Nurses Association, are hosting Medicare-at-50 events this month in U.S. cities including Chico, Woodland, Oroville and Oakland to rally support for a single-payer, government-run health system.

3. It’s on a growth spurt.

Back in 1965, more than half of U.S. seniors went without health care coverage; today, it’s estimated that fewer than 3 percent are uninsured. And aging baby boomers are fueling a growth spurt: An estimated 10,000 individuals – daily – are joining Medicare rolls, a trend that’s expected to last through 2030. By then, Medicare is projected to cover about 81 million people, roughly double its size in 2000. And Medicaid is booming under the federal Affordable Care Act. In California, since 2014, about 2.3 million adults and kids are enrolled in Medi-Cal, triple the 800,260 that were anticipated.

4. Lots of reform ideas out there.

Compared to 50 years ago, Americans are living longer, deal with more chronic conditions and have more access to sophisticated medical technologies, all of which boost health care costs. At the same time, the ratio of working Americans contributing to Medicare via their payroll taxes, compared with the number of older beneficiaries, is dropping.

That means Medicare and Medi-Cal are gobbling up sizable chunks of state and federal budgets, especially with an aging populace, rising health care costs and the Affordable Care Act covering more individuals. In a recent Kaiser Family Foundation look at Medicare’s long-term viability, the authors noted that “the sheer number of beneficiaries” will require increased revenues, “unless the country is willing to make fairly draconian decisions to cut benefits, cut payments to providers or plans, or limit eligibility.”

To shore up Medicare’s finances, Congress is considering a variety of proposals, including raising the eligibility age to 67; increasing premiums for the wealthy; negotiating prescription drug costs; streamlining care for “dual eligibles” (those qualifying for both Medicare/Medicaid coverage); cracking down on Medicare fraud; and increasing the role of private insurance.

5. Uncertainties lie ahead.

Political and health experts worry about Medicare and Medi-Cal’s long-term funding, as well as its coverage and costs. In recent years, it’s expanded to offer more – services such as hospice care and preventive care such as mammograms and drug/alcohol counseling. But many prescription drug prices are soaring and long-term care isn’t covered, so some seniors face serious out-of-pocket costs. California’s expanded Medi-Cal program also has coverage issues: Only half of enrolled children receive dental care and many Medi-Cal-covered adults can’t find specialists who will accept them because of low reimbursement rates for doctors and dentists.

“We’re celebrating the 50th anniversary, but what happens when Medicare turns 65?” asked Elaine Wong Eakin, executive director of California Health Advocates, a nonprofit Medicare advocacy and education group. “Will it still be there, will it be the same program as when it started? ... Some things are better; some are not.”

Where to get Medicare help

▪ Visit Medicare.gov or call 800-MEDICARE (633-4227). In California, the Health Insurance Counseling & Advocacy Program (HICAP) offers free counseling on Medicare options. For the nine-county office based in West Sacramento, call 800-434-0222 or go to: cahealthadvocates.org. Another free tool: the online AARP Medicare Q&A Tool at aarp.org

▪ Medi-Cal: In California, go to Medi-Cal at dhcs.ca.gov or call 800-541-5555; or visit CoveredCa.com.

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