This year marks major anniversaries for three cornerstone programs that have shaped the nation’s health and economic well-being. Social Security, signed into law by President Franklin D. Roosevelt on August 15, 1935, turns 90 in 2025. Medicare and Medicaid, established thirty years later through the Social Security Amendments of 1965 and signed by President Lyndon B. Johnson, will celebrate their 60th anniversaries on July 30.
The Programs Are Wildly Popular and Effective
In a new AARP poll, 96% of respondents said Social Security is important, and 2023 KFF polling showed that 80% of respondents held a positive or very positive view of the program. Recent research shows that Social Security alone slashes poverty for older adults by 75%, and many rely on it—or plan to do so—for a substantial part of their retirement income.
Before Medicare and Medicaid, half of older adults were uninsured.
Medicare and Medicaid are also extremely popular. KFF polling in early 2025 found that 82% of respondents had a favorable view of Medicare with 77% saying the same for Medicaid. By June, as Congress targeted Medicaid in the reconciliation, polling revealed its favorability had climbed to 83%. Before Medicare and Medicaid, half of older adults were uninsured. Today, less than 1% are without coverage. Together, Medicare and Medicaid continue to be the bedrock of our nation’s health care system and critical pillars for enrollee well-being. Despite their clear popularity and proven successes, the programs face headwinds.
Medicare Sustainability Hampered by Medicare Advantage Overpayment and Gaps in Coverage
Although the conversation about Medicare’s future often revolves solely around “solvency” and the trust funds, there are functional challenges—like problematic payment structures and outdated coverage rules—that if reformed could promote sustainability and reduce friction.
The program’s overspending on Medicare Advantage alone drains billions of dollars from the program every year.
The program’s overspending on Medicare Advantage alone, driven by built-in overpayments, an overabundance of plans, and misaligned incentives for insurance companies, drains billions of dollars from the program every year.
Other issues, too, increase pressure on Medicare financing, including lack of coverage for dental, hearing, and vision care that could reduce long-term costs, and payments that incentivize providers to treat patients in more expensive settings.
Medicare remains strong, and policy changes could make it even more so. Looking ahead, policymakers could address the systemic inefficiencies, misaligned incentives, gaps in coverage, and growing complexities that drive up program, beneficiary, and taxpayer costs.
Legislative Cuts Endanger Medicaid and Medicare
Massive Medicaid cuts in the just-passed budget reconciliation bill put access to care at risk for millions of people, including older adults and people with disabilities who the need the program to access care, stay healthy, and live safely in their homes and communities. The bill makes it harder for people with Medicare to access Medicaid-funded assistance like Medicare Savings Programs (MSPs) that help them afford their Medicare and meet other basic needs like food and housing.
Because the bill increases the national debt, it triggers substantial cuts to Medicare through a budgetary rule known as “PAYGO.”
Medicare, too, was directly cut in the same reconciliation bill, through policies that roll back eligibility, modernizations, and beneficiary protections. Even bigger reductions loom. Because the bill increases the national debt, it triggers substantial cuts to Medicare through a budgetary rule known as “PAYGO.” This means an automatic cut of nearly $500 billion will start next year unless Congress takes immediate action.
Administrative Cuts and Staffing Shortages Put Access to Services at Risk for Older Adults and People with Disabilities
Procedural rules prevented Congress from harming Social Security in the reconciliation bill, but recent administrative changes have undermined it nonetheless. Since January, the Trump administration has taken aim at Social Security’s ability to support people applying for or receiving benefits by slashing staffing, closing offices, and changing rules, creating widespread confusion and service barriers.
Similarly, Medicare, Medicaid, and other programs within the Department of Health and Human Services have been harmed by the administration’s arbitrary cuts to staffing and funding. For those impacted, the effects are often cumulative and exponential. The planned elimination of the Administration for Community Living and termination of vital staff at the Medicare-Medicaid Coordination Office are especially devastating for older adults and people with disabilities.
Protecting the Promise of All Three Programs
At Medicare Rights, we know how important Medicare, Medicaid, and Social Security are to the health, well-being, and financial stability of older adults and people with disabilities. We celebrate the enormous successes of these programs while continuing to work to protect and strengthen them for current and future generations.
Further Reading
Read more from Medicare Rights about opportunities to improve Medicare in our ongoing three-part series on Medicare Sustainability.
Learn more about issues with Medicare Advantage here.
