Integrating Medicare and Medicaid: Successes to Date Lessons Learned and the Road Ahead

摘要

When medicare and medicaid were signed into law in the summer of 1965, the American health care landscape looked very different than today. The average life expectancy was 69, most of the top 10 causes of death were due to acute health events (eg, heart attack), and most people living with substantial functional impairment did so for only short periods of time before they died. Medicare was intended to pay for hospital and doctors’ costs while Medicaid served as a safety net for low‐income women of childbearing age and their children. The inclusion of nursing home care in Medicaid was basically an afterthought. Fast forward to 2019. Adults are living longer, causes of death are more likely associated with chronic health conditions (eg, diabetes), and the need for functional and community‐based supports is vastly greater than was originally envisioned by Medicare's and Medicaid's framers.