Among the many initiatives launched during Lyndon Johnson’s presidency, none had a greater impact on physical therapists than enactment in 1965 of the Medicare and Medicaid programs. Medicare (which was appended to the 1935 Social Security Act as Title XVIII) provided federal funding for many of the medical costs of older Americans and the disabled. It overcame deeply entrenched resistance to what had been perceived as “socialized medicine” by making benefits available to everyone over 65 regardless of financial need; by linking payments to the existing private insurance system; and by allowing patients to choose their medical providers in the open market. Medicaid extended the insurance concept to recipients of all ages and was administered by the states with a combination of federal and state funding.
The effects of the two programs were far-reaching. Many millions of people previously receiving little or no health care suddenly gained access, with the result that the market, and the need for skilled personnel in virtually every sector of health care expanded dramatically. As Catherine Worthingham noted at a symposium at the 1964 Annual Conference in Denver, “The dilemma with which physical therapy is faced is that there are not enough physical therapists to perform the [current] essential physical therapy services.” With national insurance legislation on the verge of going into effect, she warned, the problem might well become so severe that others could decide to solve it for them if physical therapists persisted in “playing ostrich with their collective heads in the sand.”
Of note, Medicare as initially enacted contained no provisions for covering the services of physical therapists in independent practice. Beginning in 1966, two members of Section on Self-Employed, Clem G. Eischen and John Pellow, led the charge to have the services of private practice PTs included. Congress passed new legislation before the end of 1967, and as a result of the profession’s efforts the Medicare and Medicaid included the services of private practitioners. What’s more, as the decade closed the reimbursement limit of $100 was raised to $500, an astonishing change of heart on the part of congressional watchdogs.