When President Lyndon B. Johnson signed Medicaid into law in 1965, few could have predicted just how many lives it would touch—or how complex it would become. What began as a modest safety net for low-income families has grown into one of the largest sources of health coverage in the United States. Medicaid serves more than 71 million Americans.
Understanding the roots of Medicaid helps us see not just how we got here, but why it remains such a critical piece of the healthcare hoopla. In the first part of this four-part series, we’ll take a deep dive into Medicaid’s history. Follow the Check My Insurance blog for related statistics, how Medicaid measures up to healthcare regulations in other parts of the world, and updates on how the “One Big Beautiful Bill Act” will impact the healthcare landscape of the United States as we know it.
Medicaid’s Origins: A Fruition of the Great Society
The 1960s were a time of sweeping social reform in the United States. Under Johnson’s “Great Society” vision, the federal government expanded its role in combating poverty and promoting equality. As part of the Social Security Amendments of 1965, two major healthcare programs were introduced: Medicare, which covered older adults, and Medicaid, which catered to certain low-income groups.
Unlike Medicare, which is fully federally run, Medicaid was structured as a joint federal-state program. The federal government would provide funding and broad guidelines, while states had the freedom to administer their own versions of the program within those parameters. This meant Medicaid would look slightly different depending on where you lived. This is still the case today.
Early Years: Limited and Targeted
At first, Medicaid only covered a narrow slice of the population: low-income children, their parents, pregnant women, and people with disabilities who qualified for public assistance. It was never originally intended to be universal or far-reaching. Still, it quickly became a lifeline for millions.
As healthcare costs rose through the 1970s and 1980s, states increasingly relied on Medicaid to support not just families, but also seniors in long-term care facilities. The program became the primary funder of nursing home care in the U.S., a role it continues to hold.
The 1990s: Expansion and Managed Care
In the 1990s, Medicaid shifted away from traditional fee-for-service models toward managed care. States partnered with private insurers to deliver services more efficiently and control costs. This change marked the beginning of a larger transformation in how Medicaid operated and who it served.
The Children’s Health Insurance Program (CHIP), enacted in 1997, was another milestone. Although technically separate, CHIP works closely with Medicaid to cover children in families who earn too much to qualify for Medicaid but still find affording private insurance unrealistic. Today, the American Academy of Pediatrics reports that CHIP and Medicaid together insure nearly 40 million children.
The Affordable Care Act: A New Era
One of the most significant turning points in Medicaid’s history came with the Affordable Care Act (ACA) of 2010. The Affordable Care Act is often called “Obamacare,” a nickname that began as a political jab but was later embraced by President Obama himself to some extent. Today, it’s the more commonly recognized term.
The ACA offered states federal funding to expand Medicaid, covering nearly all adults earning up to 138% of the federal poverty level. For the first time, eligibility was based primarily on income rather than specific categories like pregnancy or disability.
Although the Supreme Court later ruled that states could choose whether to adopt the expansion, the impact was undeniable. Millions of low-income adults—many of whom work jobs without health benefits—gained coverage in the states that opted in. As of 2025, 41 states (including Washington, D.C.) have adopted the expansion.
The Choice to Not Expand Medicaid and Its Impact: A Brief Overview
For many so-called “red” states that have chosen not to expand Medicaid, the uninsured rate is nearly double that of states that have expanded their Medicaid programs. In Texas alone, for example, Health Affairs estimates that more than two million people remain uninsured and that extending coverage could lead to 184,192 fewer cases of depression, a common and treatable condition.
On average, families in states that have expanded Medicaid spend $754 less each year on out-of-pocket healthcare costs and $379 less on premiums than those in non-expansion states. These unnerving statistics don’t even begin to scratch the surface. Black, Indigenous, Hispanic, Asian, and other people of color make up about 60% of those in the substantial gaps of Medicaid coverage. This share is significantly higher than that of adults in non-expansion states (49%) and nationwide (44%). It’s no surprise that this striking imbalance contributes to ongoing racial and ethnic disparities in health coverage.
Here’s a list of the ten states that have yet to expand their Medicaid program as of July 2025:
- Alabama
- Florida
- Georgia
- Kansas
- Mississippi
- South Carolina
- Tennessee
- Texas
- Wisconsin
- Wyoming
Medicaid Today: A Program in Motion
Medicaid now covers more than one in four Americans. It provides care for children, people with disabilities, older adults, and increasingly, working-age adults without children. It funds behavioral health treatment, home and community-based services, and maternal health support, among many other essential health services.
It’s also evolved to support innovative care models, such as integrating physical and mental health care, addressing social determinants of health, and expanding telehealth access. But it hasn’t been without challenges. Political debates, budget pressures, and administrative hurdles continue to shape how the program works—and who it reaches.
Why Medicaid Still Matters
Medicaid has always stayed true to its core purpose: ensuring that those who can’t afford care aren’t left behind. It’s not just a program—it’s a reflection of our values as a country. From its modest beginnings to its expansive role today, Medicaid has proven to be one of the most impactful public health efforts in American history.
Whether you’re a parent getting your child’s vaccinations, a senior receiving long-term care, or someone managing a mental health or chronic condition, Medicaid plays a role in keeping communities healthier and more secure. Its history is still being written—but its impact is undeniable.
Stay tuned as we continue exploring Medicaid’s significance, specifically current statistics. What does the “One Big Beautiful Bill Act” mean for you, your dependents, your grandparents, and your neighbors? How will where you live and your employment status influence your access to life-saving care? Gain answers to these pertinent questions and more in the second part of Check My Insurance’s series on the Medicaid mayhem presently shaping American history and healthcare.
