Medicare. Medicare ensures a universal right to health care for persons age 65 and older. Eligible populations and the range of benefits covered have gradually expanded. In 1972, individuals under age 65 with long-term disabilities or end-stage renal disease became eligible.
Medicaid. The Medicaid program first gave states the option to receive federal matching funding for providing health care services to low-income families, the blind, and individuals with disabilities. Coverage was gradually made mandatory for low-income pregnant women and infants, and later for children up to age 18.
Children’s Health Insurance Program. In 1997, the Children’s Health Insurance Program, or CHIP, was created as a public, state-administered program for children in low-income families that earn too much to qualify for Medicaid but that are unlikely to be able to afford private insurance. Today, the program covers 9.6 million children.5 In some states, it operates as an extension of Medicaid; in other states, it is a separate program.
Affordable Care Act. In 2010, the passage of the Patient Protection and Affordable Care Act, or ACA, represented the largest expansion to date of the government’s role in financing and regulating health care. Components of the law’s major coverage expansions, implemented in 2014, included:
requiring most Americans to obtain health insurance or pay a penalty (the penalty was later removed)
extending coverage for young people by allowing them to remain on their parents’ private plans until age 26
opening health insurance marketplaces, or exchanges, which offer premium subsidies to lower- and middle-income individuals
expanding Medicaid eligibility with the help of federal subsidies (in states that chose this option).
Role of government: The federal government’s responsibilities include:
setting legislation and national strategies
administering and paying for the Medicare program
cofunding and setting basic requirements and regulations for the Medicaid program
cofunding CHIP
funding health insurance for federal employees as well as active and past members of the military and their families
regulating pharmaceutical products and medical devices
running federal marketplaces for private health insurance
providing premium subsidies for private marketplace coverage.