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Great Society

The Great Society was a set of domestic programs in the United States launched by President Lyndon B. Johnson in 1964 and 1965. The term was first referenced during a 1964 speech by Johnson at Ohio University, then later formally presented at the University of Michigan, and came to represent his domestic agenda. The main goal was the total elimination of poverty and racial injustice.

New major federal programs that addressed civil rights, education, medical care, urban problems, rural poverty, and transportation were launched during this period. The program and its initiatives were subsequently promoted by LBJ and fellow Democrats in Congress in the 1960s. The Great Society in scope and sweep resembled the 1930s New Deal domestic agenda of Franklin D. Roosevelt.

Some Great Society initiatives were derived from earlier New Frontier proposals, which stalled during the Kennedy administration. Johnson's success depended on his skills of persuasion, coupled with the Democratic landslide victory in the 1964 elections that brought in many new liberals to Congress, making the House of Representatives in 1965 the most liberal House since 1938. In the 88th Congress it was estimated that there were 56 liberals and 44 conservatives in the Senate, and 224 liberals and 211 conservatives in the House. In the 89th Congress, by contrast, it was estimated that there were 59 liberals and 41 conservatives in the Senate, and 267 liberals and 168 conservatives in the House.

Anti-war Democrats complained that spending on the Vietnam War choked off the Great Society. While some of the programs have been eliminated or had their funding reduced, many of them, including Medicare, Medicaid, the Older Americans Act and federal education funding, continue to the present. The Great Society's programs expanded under the administrations of Republican Presidents Richard Nixon and Gerald Ford.

Economic and social conditions
Johnson's Great Society initiatives came during a period of rapid economic growth in the U.S., unlike the New Deal three decades earlier, which was a response to the Great Depression. Kennedy proposed an across-the-board tax cut lowering the top marginal income tax rate in the United States by 20%, from 91% to 71%, which was enacted in February 1964, three months after Kennedy's assassination, under Johnson. The tax cut also significantly reduced marginal rates in the lower brackets as well as for corporations. The gross national product rose 10% in the first year of the tax cut, and economic growth averaged a rate of 4.5% from 1961 to 1968.

GNP increased by 7% in 1964, 8% in 1965, and 9% in 1966. The unemployment rate fell below 5%, and by 1966 the number of families with incomes of $7,000 a year or more had reached 55%, compared with 22% in 1950. In 1968, when John Kenneth Galbraith published a new edition of The Affluent Society, the average income of the American family stood at $8,000, double what it had been a decade earlier.

Johnson's speeches in Ohio and Michigan
Johnson's first public reference to the "Great Society" took place during a speech to students on May 7, 1964, on Ohio University's historic College Green in Athens, Ohio: "And with your courage and with your compassion and your desire, we will build a Great Society. It is a society where no child will go unfed, and no youngster will go unschooled."

He later formally presented his specific goals for the Great Society in another speech at the University of Michigan in Ann Arbor, Michigan, on May 22, 1964.

"We are going to assemble the best thought and broadest knowledge from all over the world to find these answers. I intend to establish working groups to prepare a series of conferences and meetings—on the cities, on natural beauty, on the quality of education, and on other emerging challenges. From these studies, we will begin to set our course toward the Great Society."

Presidential task forces
Almost immediately after the Ann Arbor speech, 14 separate task forces began studying nearly all major aspects of United States society under the guidance of presidential assistants Bill Moyers and Richard N. Goodwin. In his use of task forces to provide expert advice on policy, Johnson was following Kennedy's example, but unlike Kennedy, Johnson directed his task forces to work in secret. His intent was to prevent his program from being derailed by public criticism of proposals that had not yet been reviewed. The average task force had five to seven members and generally was composed of governmental experts and academics.

After the task force reports were submitted to the White House, Moyers began a second round of review. The recommendations were circulated among the agencies concerned, and strategies were developed for getting the proposed legislation through Congress. On January 4, 1965, Johnson announced much of his proposed program in his State of the Union Address.

The election of 1964
With the exception of the Civil Rights Act of 1964, the Great Society agenda was not a widely discussed issue during the 1964 presidential election campaign. Johnson won the election with 61% of the vote, and he carried all but six states. Democrats gained enough seats to control more than two-thirds of each chamber in the Eighty-ninth Congress, with a 68–32 margin in the Senate and a 295–140 margin in the House of Representatives.

Johnson won a large majority of the Jewish vote, a liberal constituency that gave strong support to the Great Society.

The two sessions of the Eighty-Ninth Congress
The political realignment allowed House leaders to alter rules that had allowed Southern Democrats to kill New Frontier and civil rights legislation in committee, which aided efforts to pass Great Society legislation. In 1965, the first session of the Eighty-Ninth Congress created the core of the Great Society. It began by enacting long-stalled legislation such as Medicare and federal aid to education and then moved into other areas, including high-speed mass transit, rental supplements, truth in packaging, environmental safety legislation, new provisions for mental health facilities, the Teacher Corps, manpower training, the Head Start program, aid to urban mass transit, a demonstration cities program, a housing act that included rental subsidies, and an act for higher education. The Johnson Administration submitted 87 bills to Congress, and Johnson signed 84, or 96%, arguably the most successful legislative agenda in US congressional history.

Privacy
The Naked Society is a 1964 book on privacy by Vance Packard. The book argues that changes in technology are encroaching on privacy and could create a society in the future with radically different privacy standards. Packard criticized advertisers' unfettered use of private information to create marketing schemes. He compared a recent Great Society initiative by then-president Lyndon B. Johnson, the National Data Bank, to the use of information by advertisers and argued for increased data privacy measures to ensure that information did not find its way into the wrong hands. The essay led Congress to create the Special Subcommittee on the Invasion of Privacy and inspired privacy advocates such as Neil Gallagher and Sam Ervin to fight what they perceived as Johnson's flagrant disregard for consumer privacy. Ervin criticized Johnson's domestic agenda as invasive and claimed that the unfiltered database of consumers' information as a sign of presidential abuse of power. Ervin warned that "The computer never forgets". Jerry M. Rosenberg dedicated a chapter of his 1969 book The Death of Privacy to the National Data Bank.

Civil rights
Historian Alan Brinkley has suggested that the most important domestic achievement of the Great Society may have been its success in translating some of the demands of the civil rights movement into law. Four civil rights acts were passed, including three laws in the first two years of Johnson's presidency. The Civil Rights Act of 1964 forbade job discrimination and the segregation of public accommodations.

The Voting Rights Act of 1965 assured minority registration and voting. It suspended use of literacy or other voter-qualification tests that had sometimes served to keep African-Americans off voting lists and provided for federal court lawsuits to stop discriminatory poll taxes. It also reinforced the Civil Rights Act of 1964 by authorizing the appointment of federal voting examiners in areas that did not meet voter-participation requirements. The Immigration and Nationality Services Act of 1965 abolished the national-origin quotas in immigration law. The Civil Rights Act of 1968 banned housing discrimination and extended constitutional protections to Native Americans on reservations.

Johnson recognized the benefits and costs of passing civil rights legislation. His support for the 1964 Civil Rights Act was despite his personal opinions on racial matters, as Johnson regularly articulated thoughts and disparaging language against racial minorities, including against African-Americans and Asians. Scholar and biographer Robert Caro suggested that Johnson used racially charged language to appease legislators in an effort to pass civil rights laws, including adapting how he said the word 'negro' based upon where the legislator's district was located.

The "War On Poverty"
The most ambitious and controversial part of the Great Society was its initiative to end poverty. The Kennedy Administration had been contemplating a federal effort against poverty. Johnson, who, as a teacher, had observed extreme poverty in Texas among Mexican-Americans, launched an "unconditional war on poverty" in the first months of his presidency with the goal of eliminating hunger, illiteracy, and unemployment from American life. The centerpiece of the War on Poverty was the Economic Opportunity Act of 1964, which created an Office of Economic Opportunity (OEO) to oversee a variety of community-based antipoverty programs.

Federal funds were provided for special education schemes in slum areas, including help in paying for books and transport, while financial aid was also provided for slum clearances and rebuilding city areas. In addition, the Appalachian Regional Development Act of 1965 created jobs in one of the most impoverished regions of the country. The Economic Opportunity Act of 1964 provided various methods through which young people from poor homes could receive job training and higher education.

The OEO reflected a fragile consensus among policymakers that the best way to deal with poverty was not simply to raise the incomes of the poor but to help them better themselves through education, job training, and community development. Central to its mission was the idea of "community action", the participation of the poor in framing and administering the programs designed to help them.

Programs
The War on Poverty began with a $1 billion appropriation in 1964 and spent another $2 billion in the following two years. It gave rise to dozens of programs, among them the Job Corps, whose purpose was to help disadvantaged youth develop marketable skills; the Neighborhood Youth Corps, established to give poor urban youths work experience and to encourage them to stay in school; Volunteers in Service to America (VISTA), a domestic version of the Peace Corps, which placed concerned citizens with community-based agencies to work towards empowerment of the poor; the Model Cities Program for urban redevelopment; Upward Bound, which assisted poor high school students entering college; legal services for the poor; and the Food Stamp Act of 1964 (which expanded the federal food stamp program).

Programs included the Community Action Program, which initiated local Community Action Agencies charged with helping the poor become self-sufficient; and Project Head Start, which offered preschool education for poor children. In addition, funding was provided for the establishment of community health centers to expand access to health care, while major amendments were made to Social Security in 1965 and 1967 which significantly increased benefits, expanded coverage, and established new programs to combat poverty and raise living standards. In addition, average AFDC payments were 35% higher in 1968 than in 1960, but remained insufficient and uneven.

Education
The most important educational component of the Great Society was the Elementary and Secondary Education Act of 1965, designed by Commissioner of Education Francis Keppel. It was signed into law on April 11, 1965, less than three months after it was introduced. It ended a long-standing political taboo by providing significant federal aid to public education, initially allocating more than $1 billion to help schools purchase materials and start special education programs to schools with a high concentration of low-income children. During its first year of operation, the Act authorized a $1.1 billion program of grants to states, for allocations to school districts with large numbers of children of low-income families, funds to use community facilities for education within the entire community, funds to improve educational research and to strengthen state departments of education, and grants for the purchase of books and library materials. The Act also established Head Start, which had originally been started by the Office of Economic Opportunity as an eight-week summer program, as a permanent program.

The Higher Education Facilities Act of 1963, which was signed into law by Johnson a month after becoming president, authorized several times more college aid within a five-year period than had been appropriated under the Land Grant College in a century. It provided better college libraries, ten to twenty new graduate centers, several new technical institutes, classrooms for several hundred thousand students, and twenty-five to thirty new community colleges a year.

This major piece of legislation was followed by the Higher Education Act of 1965, which increased federal money given to universities, created scholarships and low-interest loans for students, and established a national Teacher Corps to provide teachers to poverty-stricken areas of the United States. The Act also began a transition from federally funded institutional assistance to individual student aid.

In 1964, basic improvements in the National Defense Education Act were achieved, and total funds available to educational institutions were increased. The yearly limit on loans to graduate and professional students was raised from $1,000 to $2,500, and the aggregate limit was raised from $5,000 to $10,000. The program was extended to include geography, history, reading, English, and civics, and guidance and counseling programs were extended to elementary and public junior high schools.

The Bilingual Education Act of 1968 offered federal aid to local school districts in assisting them to address the needs of children with limited English-speaking ability until it expired in 2002.

The Great Society programs also provided support for postgraduate clinical training for both nurses and physicians committed to work with disadvantaged patients in rural and urban health clinics.

Medicare
On August 31, 1964, an amendment to the proposed Social Security Amendments of 1964, which further increased the proposed level of Social Security benefits and added hospital insurance to the program, was passed in the Senate by a vote of 49 to 44. The following day the entire bill passed the Senate by 60 to 28 votes. Following this vote, as noted by one study, “Seeking to ensure that the health insurance proposal emerge from the conference committee as part of the report, the administration flirted with an effort to have the full House of Representatives vote to instruct the conference to yield to the Senate version. Though the health insurance provision appeared to have majority support in the House, the tactic did not, and the idea was dropped. Sure enough, the House conferees voted 3 to 2 against the Senate health provision; the Senate conferees voted 4 to 3 to accept a bill only if Medicare were included.” Medicare finally came about with the Social Security Act of 1965 which authorized Medicare and provided federal funding for many of the medical costs of older Americans. The legislation overcame the bitter resistance, particularly from the American Medical Association, to the idea of publicly funded health care or "socialized medicine" by making its benefits available to everyone over sixty-five, regardless of need, and by linking payments to the existing private insurance system.

Medicaid
In 1966 welfare recipients of all ages received medical care through the Medicaid program. Medicaid was created on July 30, 1965, under Title XIX of the Social Security Act of 1965. Each state administers its own Medicaid program while the federal Centers for Medicare and Medicaid Services (CMS) monitors the state-run programs and establishes requirements for service delivery, quality, funding, and eligibility standards.

Neighborhood health centers
Under the Economic Opportunity Act of 1964's Community Action Program, as noted by one study, "hospitals, medical schools, community groups, and health departments received grants to plan and administer neighborhood health centers in low-income areas." One hundred neighborhood health centers had been set up under the Economic Opportunity Act by 1971.

Welfare
A number of changes were made to the Social Security program in terms of both coverage and adequacy of benefits. The Tax Adjustment Act of 1966 included a provision for special payments under the social security program to certain uninsured individuals aged 72 and over. The Social Security Amendments of 1965 included a 7% increase in cash benefits, a liberalization of the definition of disability, a liberalization of the amount a person can earn and still get full benefits (the so-called retirement test), payment of benefits to eligible children aged 18–21 who are attending school, payment of benefits to widows at age 60 on an actuarially reduced basis, coverage of self-employed physicians, coverage of tips as wages, liberalization of insured-status requirements for persons already aged 72 or over, an increase to $6,600 the amount of earnings counted for contribution and benefit purposes (the contribution and benefit base), and an increase in the contribution rate schedule.

The Social Security Amendments of 1967 included a 13% increase in old-age, survivors, and disability insurance benefits, with a minimum monthly benefit of $55 for a person retiring at or after age-65 (or receiving disability benefits), an increase from $35 to $40 in the special age-72 payments, an increase from $1,500 to $1,680 in the amount a person may earn in a year and still get full benefits for that year, monthly cash benefits for disabled widows and disabled dependent widowers at age 50 at reduced rates, a liberalization of the eligibility requirements for benefits for dependents and Survivors of women workers, and an alternative insured-status test for workers disabled before age 31.

Additionally, new guidelines for determining eligibility for disability insurance benefits, additional non-contributory wage credits for servicemen, broadened coverage of clergy and members of religious orders who have not taken a vow of poverty, and an increase in the contribution and benefit base from $6,600 to $7,800, beginning in 1968. In addition, the Social Security Amendments of 1967 provided the first major amendments of Medicare. These social security amendments extended the coverage of the program to include certain services previously excluded, simplified reimbursement procedures under both the hospital and medical insurance plans, and facilitated the administrative procedures concerning general enrollment periods.

The Food Stamp Act of 1964 made the program permanent, while the Social Security Amendments of 1967 specified that at least 6% of monies for maternal and child health should be spent on family planning. By 1967, the federal government began requiring state health departments to make contraceptives available to all adults who were poor. Meal programs for low-income senior citizens began in 1965, with the federal government providing funding for "congregate meals" and "home-delivered meals." The Child Nutrition Act, passed in 1966, made improvements to nutritional assistance to children such as in the introduction of the School Breakfast Program.

The arts and cultural institutions
Johnson promoted the arts in terms of social betterment, not artistic creativity. He typically emphasized qualitative and quantitative goals, especially the power of the arts to improve the quality of life of ordinary Americans and to reduce the inequalities between the haves and the have-nots. Karen Patricia Heath observes that, "Johnson personally was not much interested in the acquisition of knowledge, cultural or otherwise, for its own sake, nor did he have time for art appreciation or meeting with artists."

National Endowments for the arts and the humanities
In September 1965, Johnson signed the National Foundation on the Arts and Humanities Act into law, creating both the National Endowment for the Arts and National Endowment for the Humanities as separate, independent agencies. Lobbying for federally funded arts and humanities support began during the Kennedy Administration. In 1963 three scholarly and educational organizations—the American Council of Learned Societies (ACLS), the Council of Graduate Schools in America, and the United Chapters of Phi Beta Kappa—joined to establish the National Commission on the Humanities. In June 1964, the commission released a report that suggested that the emphasis placed on science endangered the study of the humanities from elementary schools through postgraduate programs. In order to correct the balance, it recommended "the establishment by the President and the Congress of the United States of a National Humanities Foundation."

In August 1964, Representative William S. Moorhead of Pennsylvania proposed legislation to implement the commission's recommendations. Support from the White House followed in September, when Johnson lent his endorsement during a speech at Brown University. In March 1965, the White House proposed the establishment of a National Foundation on the Arts and Humanities and requested $20 million in start-up funds. The commission's report had generated other proposals, but the White House's approach eclipsed them. The administration's plan, which called for the creation of two separate agencies each advised by a governing body, was the version that the Congress approved. Richard Nixon dramatically expanded funding for NEH and NEA.

Public broadcasting
After the First National Conference on Long-Range Financing of Educational Television Stations in December 1964 called for a study of the role of noncommercial education television in society, the Carnegie Corporation agreed to finance the work of a 15-member national commission. Its landmark report, Public Television: A Program for Action, published on January 26, 1967, popularized the phrase "public television" and assisted the legislative campaign for federal aid. The Public Broadcasting Act of 1967, enacted less than 10 months later, chartered the Corporation for Public Broadcasting as a private, non-profit corporation.

The law initiated federal aid through the CPB for the operation, as opposed to the funding of capital facilities, of public broadcasting. The CPB initially collaborated with the pre-existing National Educational Television system, but in 1969 decided to start the Public Broadcasting Service (PBS). A public radio study commissioned by the CPB and the Ford Foundation and conducted from 1968 to 1969 led to the establishment of National Public Radio, a public radio system under the terms of the amended Public Broadcasting Act.

Cultural centers
Two long-planned national cultural and arts facilities received federal funding that would allow for their completion through Great Society legislation. A National Cultural Center, suggested during the Franklin Roosevelt Administration and created by a bipartisan law signed by Dwight Eisenhower, was transformed into the John F. Kennedy Center for the Performing Arts, a living memorial to the assassinated president. Fundraising for the original cultural center had been poor prior to legislation creating the Kennedy Center, which passed two months after the president's death and provided $23 million for construction. The Kennedy Center opened in 1971.

In the late 1930s the U.S. Congress mandated a Smithsonian Institution art museum for the National Mall, and a design by Eliel Saarinen was unveiled in 1939, but plans were shelved during World War II. A 1966 act of the U.S. Congress established the Hirshhorn Museum and Sculpture Garden as part of the Smithsonian Institution with a focus on modern art, in contrast to the existing National Art Gallery. The museum was primarily federally funded, although New York financier Joseph Hirshhorn later contributed $1 million toward building construction, which began in 1969. The Hirshhorn opened in 1974.

Transportation
Transportation initiatives started during President Johnson's term in office included the consolidation of transportation agencies into a cabinet-level position under the Department of Transportation. The department was authorized by Congress on October 15, 1966, and began operations on April 1, 1967. Congress passed a variety of legislation to support improvements in transportation including The Urban Mass Transportation Act of 1964 which provided $375 million for large-scale urban public or private rail projects in the form of matching funds to cities and states and created the Urban Mass Transit Administration (now the Federal Transit Administration), High Speed Ground Transportation Act of 1965 which resulted in the creation of high-speed rail between New York and Washington, and the National Traffic and Motor Vehicle Safety Act of 1966—a bill largely taken credit for by Ralph Nader, whose book Unsafe at Any Speed he claims helped inspire the legislation.

Consumer protection
In 1964, Johnson named Assistant Secretary of Labor Esther Peterson to be the first presidential assistant for consumer affairs.

The Cigarette Labeling and Advertising Act of 1965 required packages to carry warning labels. The Motor Vehicle Safety Act of 1966 set standards through creation of the National Highway Traffic Safety Administration. The Fair Packaging and Labeling Act requires products identify manufacturer, address, clearly mark quantity and servings. The statute also authorized the HEW and the FTC to establish and define voluntary standard sizes. The original would have mandated uniform standards of size and weight for comparison shopping, but the final law only outlawed exaggerated size claims.

The Child Safety Act of 1966 prohibited any chemical so dangerous that no warning can make it safe. The Flammable Fabrics Act of 1967 set standards for children's sleepwear, but not baby blankets.

The Wholesome Meat Act of 1967 required inspection of meat which must meet federal standards. The Truth-in-Lending Act of 1968 required lenders and credit providers to disclose the full cost of finance charges in both dollars and annual percentage rates, on installment loan and sales. The Wholesome Poultry Products Act of 1968 required inspection of poultry which must meet federal standards. The Land Sales Disclosure Act of 1968 provided safeguards against fraudulent practices in the sale of land. The Radiation Safety Act of 1968 provided standards and recalls for defective electronic products.

Environment
Joseph A. Califano Jr. has suggested that the Great Society's main contribution to the environment was an extension of protections beyond those aimed at the conservation of untouched resources. In a message he transmitted to Congress, President Johnson said:

"The air we breathe, our water, our soil and wildlife, are being blighted by poisons and chemicals which are the by-products of technology and industry. The society that receives the rewards of technology, must, as a cooperating whole, take responsibility for [their] control. To deal with these new problems will require a new conservation. We must not only protect the countryside and save it from destruction, we must restore what has been destroyed and salvage the beauty and charm of our cities. Our conservation must be not just the classic conservation of protection [against] development, but a creative conservation of restoration and innovation."

At the behest of Secretary of the Interior Stewart Udall, the Great Society included several new environmental laws to protect air and water. Environmental legislation enacted included:
 * Water Quality Act of 1965
 * Clean Air Act of 1963
 * Wilderness Act of 1964
 * Endangered Species Preservation Act of 1966
 * National Trails System Act of 1968
 * Wild and Scenic Rivers Act of 1968
 * Land and Water Conservation Fund Act of 1965
 * Solid Waste Disposal Act of 1965
 * Motor Vehicle Air Pollution Control Act of 1965
 * National Historic Preservation Act of 1966
 * National Environmental Policy Act of 1969

Housing
Under the Economic Opportunity Act of 1964 loans were authorized “to low income farm families for small farm improvements and nonfarm enterprises that would add to family income.” That same year the quality of the housing program was improved by requiring minimum standards of code enforcement, providing assistance to dislocated families and small businesses and authorizing below market interest loans for rehabilitating housing in urban renewal areas. Housing Act 1964 In 1965, the rural housing program was converted to one largely funded on an insured-loan basis, which opened the way “for a great increase in volume of the program and expanded the loan program for rural waste systems to a loan and grant program for water and waste disposal systems, raising the maximum population of rural towns served to 5,500 and maximum financing per project to $4 million. In addition, the annual ceiling on insured loans for community facilities and farm ownership was increased from $200 million to $450 million. New housing legislation in 1966 removed a 62-year age minimum “on tenants of low income rural rent housing financed through the agency, and on borrowers obtaining individual housing loans on the basis of cosigners. It also authorized FmHa to finance purchase of newly-constructed homes.”

The Housing and Urban Development Act of 1965 included important elements such as rent subsidies for low-income families, rehabilitation grants to enable low-income homeowners in urban renewal areas to improve their homes instead of relocating elsewhere, and improved and extended benefits for relocation payments. The Demonstration Cities Act of 1966 established a new program for comprehensive neighborhood renewal, with an emphasis on strategic investments in housing renovation, urban services, neighborhood facilities, and job creation activities.

Rural development
A number of measures were introduced to improve socio-economic conditions in rural areas. Under Title III of the 1964 Economic Opportunity Act, Special Programs to Combat Rural Poverty, the Office for Economic Opportunity was authorized to act as a lender of last resort for rural families who needed money to help them permanently increase their earning capacity. Loans could be made to purchase land, improve the operation of family farms, allow participation in cooperative ventures, and finance non-agricultural business enterprises, while local cooperatives which served low-income rural families could apply for another category of loans for similar purposes.

Title III also made loans and grants available to local groups to improve housing, education, and child care services for migrant farm workers, while Titles I and II also included potentially important programs for rural development. Title I established the Job Corps which enrolled school dropouts in community service projects: 40% of the corpsmen were to work in a Youth Conservation Corps to carry out resource conservation, beautification, and development projects in the National Forests and countryside. Arguably more important for rural areas were the Community Action Programs authorized by Title II. Federal money was allocated to States according to their needs for job training, housing, health, and welfare assistance, and the States were then to distribute their shares of the Community Action grants on the basis of proposals from local public or non-profit private groups.

The Public Works and Economic Development Act of 1965 reorganized the Areas Redevelopment Administration (ARA) into the Economic Development Administration (EDA), and authorized $3.3 billion over 5 years while specifying seven criteria for eligibility. The list included low median family income, but the 6% or higher unemployment applied to the greatest number of areas, while the Act also mentioned outmigration from rural areas as a criterion. In an attempt to go beyond what one writer described as "ARA's failed scattershot approach" of providing aid to individual counties and inspired by the European model of regional development, the EDA encouraged counties to form Economic Development Districts (EDDs) as it was recognized that individual distressed counties (called RAs or Redevelopment Areas) lacked sufficient resources for their own development.

EDDs encompassed from 5 to 15 counties and both planned and implemented development with EDA funding and technical assistance, and each EDD had a "growth center" (another concept borrowed from Europe) called a redevelopment center if it was located in an RA or development center if in another county. With the exception of the growth centers, EDD counties were ineligible for assistance unless they were RAs, but they were all expected to benefit from "coordinated districtwide development planning."

Labor
A number of measures concerning labor were also introduced during Johnson's presidency. Amendments made to the 1931 Davis-Bacon Act in 1964 extended the prevailing wage provisions to cover fringe benefits, while several increases were made to the federal minimum wage. The Service Contract Act of 1965 provided for minimum wages and fringe benefits as well as other conditions of work for contractors under certain types of service contracts. A comprehensive minimum rate hike was also signed into law that extended the coverage of the Fair Labor Standards Act to about 9.1 million additional workers.

Conservative opposition
In the 1966 midterm elections, the Republicans made major gains in part through a challenge to the "War on Poverty." Large-scale civic unrest in the inner-city was escalating (reaching a climax in 1968), strengthened demand for law and order. Urban white ethnics who had been an important part of the New Deal Coalition felt abandoned by the Democratic Party's concentration on racial minorities. Republican candidates ignored more popular programs, such as Medicare or the Elementary and Secondary Education Act, and focused their attacks on less popular programs. Furthermore, Republicans made an effort to avoid the stigma of negativism and elitism that had dogged them since the days of the New Deal, and instead proposed well-crafted alternatives—such as their "Opportunity Crusade." The result was a major gain of 47 House seats for the GOP in the 1966 United States House of Representatives elections that put the conservative coalition of Republicans and Southern Democrats back in business. Despite conservatives who attacked Johnson's Great Society making major gains in Congress in the 1966 midterm elections, and with anger and frustration mounting over the Vietnam War, Johnson was still able to secure the passage of additional programs during his last two years in office. Laws were passed to extend the Food Stamp Program, to expand consumer protection, to improve safety standards, to train health professionals, to assist handicapped Americans, and to further urban programs.

In 1968, a new Fair Housing Act was passed, which banned racial discrimination in housing and subsidized the construction or rehabilitation of low-income housing units. That same year, a new program for federally funded job retraining for the hardcore unemployed in fifty cities was introduced, together with the strongest federal gun control bill (relating to the transportation of guns across state lines) in American history up until that point.

By the end of the Johnson Administration, 226 out of 252 major legislative requests (over a four-year period) had been met, federal aid to the poor had risen from $9.9 billion in 1960 to $30 billion by 1968, one million Americans had been retrained under previously non-existent federal programs, and two million children had participated in the Head Start program.

Legacy
Interpretations of the War on Poverty remain controversial. The Office of Economic Opportunity was dismantled by the Nixon and Ford administrations, largely by transferring poverty programs to other government departments. Funding for many of these programs was further cut in President Ronald Reagan's Gramm-Latta Budget in 1981.

Alan Brinkley has suggested that "the gap between the expansive intentions of the War on Poverty and its relatively modest achievements fueled later conservative arguments that government is not an appropriate vehicle for solving social problems." One of Johnson's aides, Joseph A. Califano Jr., has countered that "from 1963 when Lyndon Johnson took office until 1970 as the impact of his Great Society programs were felt, the portion of Americans living below the poverty line dropped from 22.2 percent to 12.6 percent, the most dramatic decline over such a brief period in this century."

In the long run, statistical analysis shows that the Official Poverty Rate fell from 19.5 percent in 1963 to 12.3 percent in 2017. However, using a broader definition that includes cash income, taxes, and major in-kind transfers and inflation rates, the "Full-income Poverty Rate" based on President Johnson's standards fell from 19.5 percent to 2.3 percent over that period.

The percentage of African Americans below the poverty line dropped from 55 percent in 1960 to 27 percent in 1968. From 1964 to 1967, federal expenditures on education rose from $4 billion to $12 billion, while spending on health rose from $5 billion to $16 billion. By that time, the federal government was spending $4,000 per annum on each poor family of four, four times as much as in 1961.

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title: Great Society


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Medicare

Medicare may refer to several publicly funded health insurance programs:

 * Medicare (Australia), the publicly funded universal health care insurance scheme in Australia
 * Medicare card (Australia), a single plastic identity card used to identify individuals both inside and outside of the Medicare scheme
 * Medicare (Canada), an unofficial designation of health care system of Canada
 * Medicare (United States), a federal health insurance program in the United States for older people and people with certain disabilities and diseases

title: Medicare


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Medicaid

In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding.

Medicaid was established in 1965 and was significantly expanded by the Affordable Care Act (ACA), which was passed in 2010. In most states, any member of a household with income up to 138% of the federal poverty line qualifies for Medicaid coverage under the provisions of the ACA. A 2012 Supreme Court decision established that states may continue to use pre-ACA Medicaid eligibility standards and receive previously established levels of federal Medicaid funding; in states that make that choice, income limits may be significantly lower, and able-bodied adults may not be eligible for Medicaid at all.

Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 85 million low-income and disabled people as of 2022; in 2019, the program paid for half of all U.S. births. As of 2017, the total annual cost of Medicaid was just over $600 billion, of which the federal government contributed $375 billion and states an additional $230 billion. States are not required to participate in the program, although all have since 1982. In general, Medicaid recipients must be U.S. citizens or qualified non-citizens, and may include low-income adults, their children, and people with certain disabilities. 45% of those receiving Medicaid or CHIP were children.

Medicaid also covers long-term services and supports, including both nursing home care and home- and community-based services, for those with low incomes and minimal assets; the exact qualifications vary by state. Medicaid spent $215 billion on such care in 2020, over half of the total $402 billion spent on such services. Of the 7.7 million Americans who used long-term services and supports in 2020, about 5.6 million were covered by Medicaid, including 1.6 million of the 1.9 million in institutional settings.

Medicaid covers healthcare costs for people with low incomes, while Medicare is a universal program providing health coverage for the elderly. Medicaid offers elder care benefits not normally covered by Medicare, including nursing home care and personal care services. There are also dual health plans for people who have both Medicaid and Medicare. Along with Medicare, Tricare, and ChampVA, Medicaid is one of the four government-sponsored medical insurance programs in the United States. The U.S. Centers for Medicare & Medicaid Services in Baltimore, Maryland provides federal oversight.

Research shows that existence of the Medicaid program improves health outcomes, health insurance coverage, access to health care, and recipients' financial security and provides economic benefits to states and health providers.

Features
Beginning in the 1980s, many states received waivers from the federal government to create Medicaid managed care programs. Under managed care, Medicaid recipients are enrolled in a private health plan, which receives a fixed monthly premium from the state. The health plan is then responsible for providing for all or most of the recipient's healthcare needs. Today, all but a few states use managed care to provide coverage to a significant proportion of Medicaid enrollees. As of 2014, 26 states have contracts with managed care organizations (MCOs) to deliver long-term care for the elderly and individuals with disabilities. The states pay a monthly capitated rate per member to the MCOs, which in turn provide comprehensive care and accept the risk of managing total costs. Nationwide, roughly 80% of Medicaid enrollees are enrolled in managed care plans. Core eligibility groups of low-income families are most likely to be enrolled in managed care, while the "aged" and "disabled" eligibility groups more often remain in traditional "fee for service" Medicaid.

Because service level costs vary depending on the care and needs of the enrolled, a cost per person average is only a rough measure of actual cost of care. The annual cost of care will vary state to state depending on state approved Medicaid benefits, as well as the state specific care costs. A 2014 Kaiser Family Foundation report estimates the national average per capita annual cost of Medicaid services for children to be $2,577, adults to be $3,278, persons with disabilities to be $16,859, aged persons (65+) to be $13,063, and all Medicaid enrollees to be $5,736.

History
The Social Security Amendments of 1965 created Medicaid by adding Title XIX to the Social Security Act, 42 U.S.C. §§ 1396 et seq. Under the program, the federal government provided matching funds to states to enable them to provide Medical Assistance to residents who met certain eligibility requirements. The objective was to help states assist residents whose income and resources were insufficient to pay the costs of traditional commercial health insurance plans.

By 1982, all states were participating. The last state to do so was Arizona.

The Medicaid Drug Rebate Program and the Health Insurance Premium Payment Program (HIPP) were created by the Omnibus Budget Reconciliation Act of 1990 (OBRA-90). This act helped to add Section 1927 to the Social Security Act of 1935 and became effective on January 1, 1991. This program was formed due to the costs that Medicaid programs were paying for discount price outpatient drugs.

The Omnibus Budget Reconciliation Act of 1993 (OBRA-93) amended Section 1927 of the Act, bringing changes to the Medicaid Drug Rebate Program. It requires states to implement a Medicaid estate recovery program to recover from the estate of deceased beneficiaries the long-term-care-related costs paid by Medicaid, and gives states the option of recovering all non-long-term-care costs, including full medical costs.

Medicaid also offers a Fee for Service (Direct Service) Program to schools throughout the United States for the reimbursement of costs associated with the services delivered to students with special education needs. Federal law mandates that children with disabilities receive a "free appropriate public education" under Section 504 of The Rehabilitation Act of 1973. Decisions by the United States Supreme Court and subsequent changes in federal law require states to reimburse part or all of the cost of some services provided by schools for Medicaid-eligible disabled children.

Expansion under the Affordable Care Act

The Affordable Care Act (ACA), passed in 2010, substantially expanded the Medicaid program. Before the law was passed, some states did not allow able-bodied adults to participate in Medicaid, and many set income eligibility far below the Federal poverty level. Under the provisions of the law, any state that participated in Medicaid would need to expand coverage to include anyone earning up to 138% of the Federal poverty level beginning in 2014. The costs of the newly covered population would initially be covered in full by the Federal government, although states would need to pay for 10% of those costs by 2020.

However, in 2012, the Supreme Court held in National Federation of Independent Business v. Sebelius that withdrawing all Medicaid funding from states that refused to expand eligibility was unconstitutionally coercive. States could choose to maintain pre-existing levels of Medicaid funding and eligibility, and some did; over half the national uninsured population lives in those states. As of March 2023, 40 states have accepted the Affordable Care Act Medicaid extension, as has the District of Columbia, which has its own Medicaid program; 10 states have not. Among adults aged 18 to 64, states that expanded Medicaid had an uninsured rate of 7.3% in the first quarter of 2016, while non-expansion states had a 14.1% uninsured rate.

The Centers for Medicare and Medicaid Services (CMS) estimated that the cost of expansion was $6,366 per person for 2015, about 49 percent above previous estimates. An estimated 9 to 10 million people had gained Medicaid coverage, mostly low-income adults. The Kaiser Family Foundation estimated in October 2015 that 3.1 million additional people were not covered in states that rejected the Medicaid expansion.

In some states that chose not to expand Medicaid, income eligibility thresholds are significantly below 133% of the poverty line. Some of these states do not make Medicaid available to non-pregnant adults without disabilities or dependent children, no matter their income. Because subsidies on commercial insurance plans are not available to such individuals, most have few options for obtaining any medical insurance. For example, in Kansas, where only non-disabled adults with children and with an income below 32% of the poverty line were eligible for Medicaid, those with incomes from 32% to 100% of the poverty level ($6,250 to $19,530 for a family of three) were ineligible for both Medicaid and federal subsidies to buy insurance.

Studies of the impact of Medicaid expansion rejections calculated that up to 6.4 million people would have too much income for Medicaid but not qualify for exchange subsidies. Several states argued that they could not afford the 10% contribution in 2020. Some studies suggested that rejecting the expansion would cost more due to increased spending on uncompensated emergency care that otherwise would have been partially paid for by Medicaid coverage.

A 2016 study found that residents of Kentucky and Arkansas, which both expanded Medicaid, were more likely to receive health care services and less likely to incur emergency room costs or have trouble paying their medical bills. Residents of Texas, which did not accept the Medicaid expansion, did not see a similar improvement during the same period. Kentucky opted for increased managed care, while Arkansas subsidized private insurance. Later, Arkansas and Kentucky governors proposed reducing or modifying their programs. From 2013 to 2015, the uninsured rate dropped from 42% to 14% in Arkansas and from 40% to 9% in Kentucky, compared with 39% to 32% in Texas.

A 2016 DHHS study found that states that expanded Medicaid had lower premiums on exchange policies because they had fewer low-income enrollees, whose health, on average, is worse than that of people with higher income.

The Census Bureau reported in September 2019 that states that expanded Medicaid under ACA had considerably lower uninsured rates than states that did not. For example, for adults between 100% and 399% of poverty level, the uninsured rate in 2018 was 12.7% in expansion states and 21.2% in non-expansion states. Of the 14 states with uninsured rates of 10% or greater, 11 had not expanded Medicaid. A July 2019 study by the National Bureau of Economic Research (NBER) indicated that states enacting Medicaid expansion exhibited statistically significant reductions in mortality rates.

The ACA was structured with the assumption that Medicaid would cover anyone making less than 133% of the Federal poverty level throughout the United States; as a result, premium tax credits are only available to individuals buying private health insurance through exchanges if they make more than that amount. This has given rise to the so-called Medicaid coverage gap in states that have not expanded Medicaid: there are people whose income is too high to qualify for Medicaid in those states, but too low to receive assistance in paying for private health insurance, which is therefore unaffordable to them.

State implementations
States may bundle together the administration of Medicaid with other programs such as the Children's Health Insurance Program (CHIP), so the same organization that handles Medicaid in a state may also manage the additional programs. Separate programs may also exist in some localities that are funded by the states or their political subdivisions to provide health coverage for indigents and minors.

State participation in Medicaid is voluntary; however, all states have participated since 1982. In some states Medicaid is subcontracted to private health insurance companies, while other states pay providers (i.e., doctors, clinics and hospitals) directly. There are many services that can fall under Medicaid and some states support more services than other states. The most provided services are intermediate care for mentally disabled, prescription drugs and nursing facility care for under 21-year-olds. The least provided services include institutional religious (non-medical) health care, respiratory care for ventilator dependent and PACE (inclusive elderly care).

Most states administer Medicaid through their own programs. A few of those programs are listed below:
 * Arizona: AHCCCS
 * California: Medi-Cal
 * Connecticut: HUSKY D
 * Maine: MaineCare
 * Massachusetts: MassHealth
 * New Jersey: NJ FamilyCare
 * Oregon: Oregon Health Plan
 * Oklahoma: Soonercare
 * Tennessee: TennCare
 * Washington: Washington Apple Health
 * Wisconsin: BadgerCare

As of January 2012, Medicaid and/or CHIP funds could be obtained to help pay employer health care premiums in Alabama, Alaska, Arizona, Colorado, Florida, and Georgia.

Differences by state
States must comply with federal law, under which each participating state administers its own Medicaid program, establishes eligibility standards, determines the scope and types of services it will cover, and sets the rate of reimbursement physicians and care providers. Differences between states are often influenced by the political ideologies of the state and cultural beliefs of the general population. The federal Centers for Medicare and Medicaid Services (CMS) closely monitors each state's program and establishes requirements for service delivery, quality, funding, and eligibility standards.

Medicaid estate recovery regulations also vary by state. (Federal law gives options as to whether non-long-term-care-related expenses, such as normal health-insurance-type medical expenses are to be recovered, as well as on whether the recovery is limited to probate estates or extends beyond.)

Political influences
Several political factors influence the cost and eligibility of tax-funded health care. According to a study conducted by Gideon Lukens, factors significantly affecting eligibility included "party control, the ideology of state citizens, the prevalence of women in legislatures, the line-item veto, and physician interest group size". Lukens' study supported the generalized hypothesis that Democrats favor generous eligibility policies while Republicans do not. When the Supreme Court allowed states to decide whether to expand Medicaid or not in 2012, northern states, in which Democratic legislators predominated, disproportionately did so, often also extending existing eligibility.

Certain states in which there is a Republican-controlled legislature may be forced to expand Medicaid in ways extending beyond increasing existing eligibility in the form of waivers for certain Medicaid requirements so long as they follow certain objectives. In its implementation, this has meant using Medicaid funds to pay for low-income citizens' health insurance; this private-option was originally carried out in Arkansas but was adopted by other Republican-led states. However, private coverage is more expensive than Medicaid and the states would not have to contribute as much to the cost of private coverage.

Certain groups of people, such as migrants, face more barriers to health care than others due to factors besides policy, such as status, transportation and knowledge of the healthcare system (including eligibility).

Eligibility and coverage
Medicaid eligibility policies are very complicated. In general, a person's Medicaid eligibility is linked to their eligibility for Aid to Families with Dependent Children (AFDC), which provides aid to children whose families have low or no income, and to the Supplemental Security Income (SSI) program for the aged, blind and disabled. States are required under federal law to provide all AFDC and SSI recipients with Medicaid coverage. Because eligibility for AFDC and SSI essentially guarantees Medicaid coverage, examining eligibility/coverage differences per state in AFDC and SSI is an accurate way to assess Medicaid differences as well. SSI coverage is largely consistent by state, and requirements on how to qualify or what benefits are provided are standard. However AFDC has differing eligibility standards that depend on:

 * 1) The Low-Income Wage Rate: State welfare programs base the level of assistance they provide on some concept of what is minimally necessary.
 * 2) Perceived Incentive for Welfare Migration. Not only do social norms within the state affect its determination of AFDC payment levels, but regional norms will affect a state's perception of need as well.

Reimbursement for care providers
Beyond the variance in eligibility and coverage between states, there is a large variance in the reimbursements Medicaid offers to care providers; the clearest examples of this are common orthopedic procedures. For instance, in 2013, the average difference in reimbursement for 10 common orthopedic procedures in the states of New Jersey and Delaware was $3,047. The discrepancy in the reimbursements Medicaid offers may affect the type of care provided to patients.

In general, Medicaid plans pay providers significantly less than commercial insurers or Medicare would pay for the same care, paying around 67% as much as Medicare would for primary care and 78% as much for other services. This disparity has been linked to lower provider rates of participation in Medicaid programs vs Medicare or commercial insurance, and thus decreased access to care for Medicaid patients. One component of the Affordable Care Act was a federally-funded increase in 2013 and 2014 in Medicaid payments to bring them up to 100% of equivalent Medicare payments, in an effort to increase provider participation. Most states did not subsequently continue this provision.

Enrollment
In 2002, Medicaid enrollees numbered 39.9 million Americans, with the largest group being children (18.4 million or 46%). From 2000 to 2012, the proportion of hospital stays for children paid by Medicaid increased by 33% and the proportion paid by private insurance decreased by 21%. Some 43 million Americans were enrolled in 2004 (19.7 million of them children) at a total cost of $295 billion. In 2008, Medicaid provided health coverage and services to approximately 49 million low-income children, pregnant women, elderly people, and disabled people. In 2009, 62.9 million Americans were enrolled in Medicaid for at least one month, with an average enrollment of 50.1 million. In California, about 23% of the population was enrolled in Medi-Cal for at least 1 month in 2009–10. As of 2017, the total annual cost of Medicaid was just over $600 billion, of which the federal government contributed $375 billion and states an additional $230 billion. According to CMS, the Medicaid program provided health care services to more than 92 million people in 2022.

Loss of income and medical insurance coverage during the 2008–2009 recession resulted in a substantial increase in Medicaid enrollment in 2009. Nine U.S. states showed an increase in enrollment of 15% or more, putting a heavy strain on state budgets.

The Kaiser Family Foundation reported that for 2013, Medicaid recipients were 40% white, 21% black, 25% Hispanic, and 14% other races.

Comparisons with Medicare
Unlike Medicaid, Medicare is a social insurance program funded at the federal level and focuses primarily on the older population. Medicare is a health insurance program for people age 65 or older, people under age 65 with certain disabilities, and (through the End Stage Renal Disease Program) people of all ages with end-stage renal disease. The Medicare Program provides a Medicare part A covering hospital bills, Medicare Part B covering medical insurance coverage, and Medicare Part D covering purchase of prescription drugs.

Medicaid is a program that is not solely funded at the federal level. States provide up to half of the funding for Medicaid. In some states, counties also contribute funds. Unlike Medicare, Medicaid is a means-tested, needs-based social welfare or social protection program rather than a social insurance program. Eligibility is determined largely by income. The main criterion for Medicaid eligibility is limited income and financial resources, a criterion which plays no role in determining Medicare coverage. Medicaid covers a wider range of health care services than Medicare.

Some people are eligible for both Medicaid and Medicare and are known as Medicare dual eligible or medi-medi's. In 2001, about 6.5 million people were enrolled in both Medicare and Medicaid. In 2013, approximately 9 million people qualified for Medicare and Medicaid.

Benefits
There are two general types of Medicaid coverage. "Community Medicaid" helps people who have little or no medical insurance. Medicaid nursing home coverage helps pay for the cost of living in a nursing home for those who are eligible; the recipient also pays most of his/her income toward the nursing home costs, usually keeping only $66.00 a month for expenses other than the nursing home.

Some states operate a program known as the Health Insurance Premium Payment Program (HIPP). This program allows a Medicaid recipient to have private health insurance paid for by Medicaid. As of 2008 relatively few states had premium assistance programs and enrollment was relatively low. Interest in this approach remained high, however.

Included in the Social Security program under Medicaid are dental services. Registration for dental services is optional for people older than 21 years but required for people eligible for Medicaid and younger than 21. Minimum services include pain relief, restoration of teeth and maintenance for dental health. Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is a mandatory Medicaid program for children that focuses on prevention, early diagnosis and treatment of medical conditions. Oral screenings are not required for EPSDT recipients, and they do not suffice as a direct dental referral. If a condition requiring treatment is discovered during an oral screening, the state is responsible for paying for this service, regardless of whether or not it is covered on that particular Medicaid plan.

Dental
Children enrolled in Medicaid are individually entitled under the law to comprehensive preventive and restorative dental services, but dental care utilization for this population is low. The reasons for low use are many, but a lack of dental providers who participate in Medicaid is a key factor. Few dentists participate in Medicaid – less than half of all active private dentists in some areas. Cited reasons for not participating are low reimbursement rates, complex forms and burdensome administrative requirements. In Washington state, a program called Access to Baby and Child Dentistry (ABCD) has helped increase access to dental services by providing dentists higher reimbursements for oral health education and preventive and restorative services for children. After the passing of the Affordable Care Act, many dental practices began using dental service organizations to provide business management and support, allowing practices to minimize costs and pass the saving on to patients currently without adequate dental care.

Eligibility
While Congress and the Centers for Medicare and Medicaid Services (CMS) set out the general rules under which Medicaid operates, each state runs its own program. Under certain circumstances, an applicant may be denied coverage. As a result, the eligibility rules differ significantly from state to state, although all states must follow the same basic framework.

As of 2013, Medicaid is a program intended for those with low income, but a low income is not the only requirement to enroll in the program. Eligibility is categorical—that is, to enroll one must be a member of a category defined by statute; some of these categories are: low-income children below a certain wage, pregnant women, parents of Medicaid-eligible children who meet certain income requirements, low-income disabled people who receive Supplemental Security Income (SSI) and/or Social Security Disability (SSD), and low-income seniors 65 and older. The details of how each category is defined vary from state to state.

PPACA income test standardization
As of 2019, when Medicaid has been expanded under the PPACA, eligibility is determined by an income test using Modified Adjusted Gross Income, with no state-specific variations and a prohibition on asset or resource tests.

Non-PPACA eligibility
While Medicaid expansion available to adults under the PPACA mandates a standard income-based test without asset or resource tests, other eligibility criteria such as assets may apply when eligible outside of the PPACA expansion, including coverage for eligible seniors or disabled. These other requirements include, but are not limited to, assets, age, pregnancy, disability, blindness, income, and resources, and one's status as a U.S. citizen or a lawfully admitted immigrant.

As of 2015, asset tests varied; for example, eight states did not have an asset test for a buy-in available to working people with disabilities, and one state had no asset test for the aged/blind/disabled pathway up to 100% of the Federal Poverty Level.

More recently, many states have authorized financial requirements that will make it more difficult for working-poor adults to access coverage. In Wisconsin, nearly a quarter of Medicaid patients were dropped after the state government imposed premiums of 3% of household income. A survey in Minnesota found that more than half of those covered by Medicaid were unable to obtain prescription medications because of co-payments.

The Deficit Reduction Act of 2005 (DRA) requires anyone seeking Medicaid to produce documents to prove that he is a United States citizen or resident alien. An exception is made for Emergency Medicaid where payments are allowed for the pregnant and disabled regardless of immigration status. Special rules exist for those living in a nursing home and disabled children living at home.

Supplemental Security Income beneficiaries
Once someone is approved as a beneficiary in the Supplemental Security Income program, they may automatically be eligible for Medicaid coverage (depending on the laws of the state they reside in).

Five year "look-back"
The DRA has created a five-year "look-back period". This means that any transfers without fair market value (gifts of any kind) made by the Medicaid applicant during the preceding five years are penalizable.

The penalty is determined by dividing the average monthly cost of nursing home care in the area or State into the amount of assets gifted. Therefore, if a person gifted $60,000 and the average monthly cost of a nursing home was $6,000, one would divide $6000 into $60,000 and come up with 10. 10 represents the number of months the applicant would not be eligible for Medicaid.

All transfers made during the five-year look-back period are totaled, and the applicant is penalized based on that amount after having already dropped below the Medicaid asset limit. This means that after dropping below the asset level ($2,000 limit in most states), the Medicaid applicant will be ineligible for a period of time. The penalty period does not begin until the person is eligible for Medicaid.

Elders who gift or transfer assets can be caught in the situation of having no money but still not being eligible for Medicaid.

Immigration status
Legal permanent residents (LPRs) with a substantial work history (defined as 40 quarters of Social Security covered earnings) or military connection are eligible for the full range of major federal means-tested benefit programs, including Medicaid (Medi-Cal). LPRs entering after August 22, 1996, are barred from Medicaid for five years, after which their coverage becomes a state option, and states have the option to cover LPRs who are children or who are pregnant during the first five years. Noncitizen SSI recipients are eligible for (and required to be covered under) Medicaid. Refugees and asylees are eligible for Medicaid for seven years after arrival; after this term, they may be eligible at state option.

Nonimmigrants and unauthorized aliens are not eligible for most federal benefits, regardless of whether they are means tested, with notable exceptions for emergency services (e.g., Medicaid for emergency medical care), but states have the option to cover nonimmigrant and unauthorized aliens who are pregnant or who are children, and can meet the definition of "lawfully residing" in the United States. Special rules apply to several limited noncitizen categories: certain "cross-border" American Indians, Hmong/Highland Laotians, parolees and conditional entrants, and cases of abuse.

Aliens outside the United States who seek to obtain visas at U.S. consulates overseas or admission at U.S. ports of entry are generally denied entry if they are deemed "likely at any time to become a public charge". Aliens within the United States who seek to adjust their status to that of lawful permanent resident (LPR), or who entered the United States without inspection, are also generally subject to exclusion and deportation on public charge grounds. Similarly, LPRs and other aliens who have been admitted to the United States are removable if they become a public charge within five years after the date of their entry due to causes that preexisted their entry.

A 1999 policy letter from immigration officials defined "public charge" and identified which benefits are considered in public charge determinations, and the policy letter underlies current regulations and other guidance on the public charge grounds of inadmissibility and deportability. Collectively, the various sources addressing the meaning of public charge have historically suggested that an alien's receipt of public benefits, per se, is unlikely to result in the alien being deemed to be removable on public charge grounds.

Children and SCHIP
A child may be eligible for Medicaid regardless of the eligibility status of his parents. Thus, a child may be covered by Medicaid based on his individual status even if his parents are not eligible. Similarly, if a child lives with someone other than a parent, he may still be eligible based on its individual status.

One-third of children and over half (59%) of low-income children are insured through Medicaid or SCHIP. The insurance provides them with access to preventive and primary services which are used at a much higher rate than for the uninsured, but still below the utilization of privately insured patients. As of 2014, rate of uninsured children was reduced to 6% (5 million children remain uninsured).

HIV
Medicaid provided the largest portion of federal money spent on health care for people living with HIV/AIDS until the implementation of Medicare Part D, when the cost of prescription drugs for those eligible for both Medicare and Medicaid was shifted to Medicare. Unless low income people who are HIV positive meet some other eligibility category, they are not eligible for Medicaid assistance unless they can qualify under the "disabled" category to receive Medicaid assistance — for example, if they progress to AIDS (T-cell count drops below 200). The Medicaid eligibility policy differs from Journal of the American Medical Association (JAMA) guidelines, which recommend therapy for all patients with T-cell counts of 350 or less and even certain patients with a higher T-cell count. Due to the high costs associated with HIV medications, many patients are not able to begin antiretroviral treatment without Medicaid help. It is estimated that more than half of people living with AIDS in the United States receive Medicaid payments. Two other programs that provide financial assistance to people living with HIV/AIDS are the Social Security Disability Insurance (SSDI) and the Supplemental Security Income programs.

Utilization
During 2003–2012, the share of hospital stays billed to Medicaid increased by 2.5%, or 0.8 million stays. As of 2019, Medicaid paid for half of all births in the United States.

Medicaid super utilizers (defined as Medicaid patients with four or more admissions in one year) account for more hospital stays (5.9 vs.1.3 stays), longer lengths of stay (6.1 vs. 4.5 days), and higher hospital costs per stay ($11,766 vs. $9,032). Medicaid super-utilizers were more likely than other Medicaid patients to be male and to be aged 45–64 years. Common conditions among super-utilizers include mood disorders and psychiatric disorders, as well as diabetes, cancer treatment, sickle cell anemia, sepsis, congestive heart failure, chronic obstructive pulmonary disease, and complications of devices, implants, and grafts.

Budget and financing
Unlike Medicare, which is solely a federal program, Medicaid is a joint federal-state program. Each state administers its own Medicaid system that must conform to federal guidelines for the state to receive Federal matching funds. Financing of Medicaid in the American Samoa, Puerto Rico, Guam, and the U.S. Virgin Islands is instead implemented through a block grant. The Federal government matches state funding according to the Federal Medical Assistance Percentages. The wealthiest states only receive a federal match of 50% while poorer states receive a larger match.

Medicaid funding has become a major budgetary issue for many states over the last few years, with states, on average, spending 16.8% of state general funds on the program. If the federal match expenditure is also counted, the program, on average, takes up 22% of each state's budget. Some 43 million Americans were enrolled in 2004 (19.7 million of them children) at a total cost of $295 billion. In 2008, Medicaid provided health coverage and services to approximately 49 million low-income children, pregnant women, elderly people, and disabled people. Federal Medicaid outlays were estimated to be $204 billion in 2008. In 2011, there were 7.6 million hospital stays billed to Medicaid, representing 15.6% (approximately $60.2 billion) of total aggregate inpatient hospital costs in the United States. At $8,000, the mean cost per stay billed to Medicaid was $2,000 less than the average cost for all stays.

Medicaid does not pay benefits to individuals directly; Medicaid sends benefit payments to health care providers. In some states Medicaid beneficiaries are required to pay a small fee (co-payment) for medical services. Medicaid is limited by federal law to the coverage of "medically necessary services".

Since the Medicaid program was established in 1965, "states have been permitted to recover from the estates of deceased Medicaid recipients who were over age 65 when they received benefits and who had no surviving spouse, minor child, or adult disabled child". In 1993, Congress enacted the Omnibus Budget Reconciliation Act of 1993, which required states to attempt to recoup "the expense of long-term care and related costs for deceased Medicaid recipients 55 or older." The Act allowed states to recover other Medicaid expenses for deceased Medicaid recipients 55 or older, at each state's choice. However, states were prohibited from estate recovery when "there is a surviving spouse, a child under the age of 21 or a child of any age who is blind or disabled". The Act also carved out other exceptions for adult children who have served as caretakers in the homes of the deceased, property owned jointly by siblings, and income-producing property, such as farms". Each state now maintains a Medicaid Estate Recovery Program, although the sum of money collected significantly varies from state to state, "depending on how the state structures its program and how vigorously it pursues collections."

On November 25, 2008, a new federal rule was passed that allows states to charge premiums and higher co-payments to Medicaid participants. This rule enabled states to take in greater revenues, limiting financial losses associated with the program. Estimates figure that states will save $1.1 billion while the federal government will save nearly $1.4 billion. However, this meant that the burden of financial responsibility would be placed on 13 million Medicaid recipients who faced a $1.3 billion increase in co-payments over 5 years. The major concern is that this rule will create a disincentive for low-income people to seek healthcare. It is possible that this will force only the sickest participants to pay the increased premiums and it is unclear what long-term effect this will have on the program.

A 2019 study found that Medicaid expansion in Michigan had net positive fiscal effects for the state.

Coverage gains
A 2019 review by Kaiser Family Foundation of 324 studies on Medicaid expansion concluded that "expansion is linked to gains in coverage; improvements in access, financial security, and some measures of health status/outcomes; and economic benefits for states and providers."

Mortality and disability reduction
A 2021 study found that Medicaid expansion as part of the Affordable Care Act led to a substantial reduction in mortality, primarily driven by reductions in disease-related deaths. A 2018 study in the Journal of Political Economy found that upon its introduction, Medicaid reduced infant and child mortality in the 1960s and 1970s. The decline in the mortality rate for nonwhite children was particularly steep. A 2018 study in the American Journal of Public Health found that the infant mortality rate declined in states that had Medicaid expansions (as part of the Affordable Care Act) whereas the rate rose in states that declined Medicaid expansion. A 2020 JAMA study found that Medicaid expansion under the ACA was associated with reduced incidence of advanced-stage breast cancer, indicating that Medicaid accessibility led to early detection of breast cancer and higher survival rates. A 2020 study found no evidence that Medicaid expansion adversely affected the quality of health care given to Medicare recipients. A 2018 study found that Medicaid expansions in New York, Arizona, and Maine in the early 2000s caused a 6% decline in the mortality rate: "HIV-related mortality (affected by the recent introduction of antiretrovirals) accounted for 20% of the effect. Mortality changes were closely linked to county-level coverage gains, with one life saved annually for every 239 to 316 adults gaining insurance. The results imply a cost per life saved ranging from $327,000 to $867,000 which compares favorably with most estimates of the value of a statistical life."

A 2016 paper found that Medicaid has substantial positive long-term effects on the health of recipients: "Early childhood Medicaid eligibility reduces mortality and disability and, for whites, increases extensive margin labor supply, and reduces receipt of disability transfer programs and public health insurance up to 50 years later. Total income does not change because earnings replace disability benefits." The government recoups its investment in Medicaid through savings on benefit payments later in life and greater payment of taxes because recipients of Medicaid are healthier: "The government earns a discounted annual return of between 2% and 7% on the original cost of childhood coverage for these cohorts, most of which comes from lower cash transfer payments". A 2019 National Bureau of Economic Research paper found that when Hawaii stopped allowing Compact of Free Association (COFA) migrants to be covered by the state's Medicaid program that Medicaid-funded hospitalizations declined by 69% and emergency room visits declined by 42% for this population, but that uninsured ER visits increased and that Medicaid-funded ER visits by infants substantially increased. Another NBER paper found that Medicaid expansion reduced mortality.

A 2021 American Economic Review study found that early childhood access to Medicaid "reduces mortality and disability, increases employment, and reduces receipt of disability transfer programs up to 50 years later. Medicaid has saved the government more than its original cost and saved more than 10 million quality adjusted life years."

Rural hospitals boosted revenue
A 2020 study found that Medicaid expansion boosted the revenue and operating margins of rural hospitals, had no impact on small urban hospitals, and led to declines in revenue for large urban hospitals. A 2021 study found that expansions of adult Medicaid dental coverage increasingly led dentists to locate to poor, previously underserved areas. A 2019 paper by Stanford University and Wharton School economists found that Medicaid expansion "produced a substantial increase in hospital revenue and profitability, with larger gains for government hospitals. On the benefits side, we do not detect significant improvements in patient health, although the expansion led to substantially greater hospital and emergency room use, and a reallocation of care from public to private and better-quality hospitals."

Financial and health security increase
A 2017 survey of the academic research on Medicaid found it improved recipients' health and financial security. Studies have linked Medicaid expansion with increases in employment levels and student status among enrollees. A 2017 paper found that Medicaid expansion under the Affordable Care Act "reduced unpaid medical bills sent to collection by $3.4 billion in its first two years, prevented new delinquencies, and improved credit scores. Using data on credit offers and pricing, we document that improvements in households' financial health led to better terms for available credit valued at $520 million per year. We calculate that the financial benefits of Medicaid double when considering these indirect benefits in addition to the direct reduction in out-of-pocket expenditures." Studies have found that Medicaid expansion reduced rates of poverty and severe food insecurity in certain states. Studies on the implementation of work requirements for Medicaid in Arkansas found that it led to an increase in uninsured individuals, medical debt, and delays in seeking care and taking medications, without any significant impact on employment. A 2021 study in the American Journal of Public Health found that Medicaid expansion in Louisiana led to reductions in medical debt.

Political participation increase
A 2017 study found that Medicaid enrollment increases political participation (measured in terms of voter registration and turnout).

Crime reduction
Studies have found that Medicaid expansion reduced crime. The proposed mechanisms for the reduction were that Medicaid increased the economic security of individuals and provided greater access to treatment for substance abuse or behavioral disorders. A 2022 study found that Medicaid eligibility during childhood reduced the likelihood of criminality during early adulthood.

Oregon Medicaid health experiment and controversy
In 2008, Oregon decided to hold a randomized lottery for the provision of Medicaid insurance in which 10,000 lower-income people eligible for Medicaid were chosen by a randomized system. The lottery enabled studies to accurately measure the impact of health insurance on an individual's health and eliminate potential selection bias in the population enrolling in Medicaid.

A sequence of two high-profile studies by a team from the Massachusetts Institute of Technology and the Harvard School of Public Health found that "Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years", but did "increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain."

The study found that in the first year:

 * 1) Hospital use increased by 30% for those with insurance, with the length of hospital stays increasing by 30% and the number of procedures increasing by 45% for the population with insurance;
 * 2) Medicaid recipients proved more likely to seek preventive care. Women were 60% more likely to have mammograms and recipients overall were 20% more likely to have their cholesterol checked;
 * 3) In terms of self-reported health outcomes, having insurance was associated with an increased probability of reporting one's health as "good", "very good", or "excellent"—overall, about 25% higher than the average;
 * 4) Those with insurance were about 10% less likely to report a diagnosis of depression.
 * 5) Patients with catastrophic health spending (with costs that were greater than 30% of income) dropped.
 * 6) Medicaid patients had cut in half the probability of requiring loans or forgoing other bills to pay for medical costs.

The studies spurred a debate between proponents of expanding Medicaid coverage and fiscal conservatives challenging the value of this expansive government program.

title: Medicaid


text:
Full Employment Act

Full Employment Act may refer to:
 * Employment Act of 1946, a United States federal law
 * Humphrey–Hawkins Full Employment Act of 1978

title: Full Employment Act


text:
Trade Expansion Act

The Trade Expansion Act of 1962 (, codified at ) is an American trade law.

Section 232 of the Act permits the President to impose tariffs based on a recommendation by the U.S. Secretary of Commerce if "an article is being imported into the United States in such quantities or under such circumstances as to threaten or impair the national security." This section was used only in 1979 and 1982, and had not been invoked since the creation of the World Trade Organization in 1995, until President Trump cited it on March 8, 2018 to impose tariffs on steel and aluminum.

History
In 1962, Congress granted the President of the United States unprecedented authority to negotiate tariff reductions of up to 80%. It paved the way for the Kennedy Round of General Agreement on Tariffs and Trade (GATT) negotiations, concluding on June 30, 1967, the last day before expiration of the Act.

On April 27, 2017, President Donald Trump ordered a review of the aluminum imports and threats to national security under the Trade Expansion Act of 1962. On March 8, 2018, President Trump signed an order to impose the tariffs on steel and aluminum under Section 232 of the Act and citing "national security" grounds.

On May 23, 2018, President Trump "instructed Secretary Ross to consider initiating a Section 232 investigation into imports of automobiles, including trucks, and automotive parts to determine their effects on America's national security. Core industries such as automobiles and automotive parts are critical to our strength as a Nation."

In mid-February 2019, Commerce Department Secretary Wilbur Ross delivered a confidential report to President Trump which concluded the Department's investigation under Section 232, that there was a legal rationale for the imposition of steep tariffs on the import of foreign automobiles, as these imports—like steel and aluminum—posed a threat to U.S. national security. According to a March 20, 2019 article in Politico, the proposed tariffs could be as high as 25%. Politico also reported that as of March 20, the requests by the Chair of the Senate Finance Committee—Chuck Grassley (R-Iowa) to access a copy of the confidential report, had been denied. The deadline for Trump's decision on the imposition of the tariffs is in mid-May, ninety days after the report's release.

title: Trade Expansion Act