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How LBJ's Medicare & Medicaid Changed Disability Forever (and Why It's Still Under Attack!) · Living Loud and Proud: Disability Conversations

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  We refer to the One Big Beautiful Bill Act in
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  this episode. However, the act officially has
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  no name. We use this title for ease of discussion
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  surrounding the omnibus spending bill signed
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  into law on July 4th, 2025. Welcome to the Living
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  Loud and Proud Podcast, brought to you by Disability
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  Pride Pennsylvania. If you need a link to the
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  transcript for this episode, please visit our
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  accessible website at www .disabilitypridepa
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  .org slash podcast. And now, here is your host.
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  Hey everyone, and welcome back to Living Loud
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  and Proud, the podcast that examines disability
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  -related issues and stories. I'm your host, Phil
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  Rosen. And I'm your co -host, Ray Decker Horton.
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  Today, we're actually jumping into the time machine,
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  heading straight back to the 1960s. All right.
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  And we're talking about a massive and ambitious
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  vision for America. President Lyndon B. Johnson's
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  Great Society. That's what we're going to be
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  talking about. And, you know, it's wild to think
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  about in the wake of President Kennedy's assassination.
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  LBJ stepped into office and pretty quickly laid
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  out this incredibly bold domestic agenda. His
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  dream? To build on what he called a great society
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  where poverty and racial injustice would be wiped
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  out and every American would get a fair shot
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  at thriving. It was a huge promise, abundance
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  and liberty for all, and a real demand to end
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  systemic inequalities. And today we're really
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  drilling down into three major pillars of that
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  vision. There's Medicare, Medicaid, and the Food
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  Stamp Act. We're going to spotlight how these
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  programs, born out of a genuine desire to meet
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  fundamental human needs, have transformed millions
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  of lives, especially for Americans with disabilities.
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  They've been absolute lifelines, you know, helping
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  people live with more independence. But let's
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  be real. Their journey has been anything but
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  smooth. I mean, we have tons of debates, political
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  fights, and honestly, those same battles are
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  still echoing in today's headlines. Yeah, to
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  really get a handle on the impact of Medicare,
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  Medicaid, and food stamps, we've got to understand
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  what the 1960s were like. It was a time of immense
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  social change. The civil rights movement was
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  gaining serious traction, laying bare just how
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  deep racial injustice ran. And poverty, even
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  if it was often out of sight, was widespread,
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  especially amongst older folks and in rural areas.
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  For people with disabilities, life was incredibly
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  challenging. Opportunities were super limited,
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  and institutionalization was often a grim reality,
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  leading to profound isolation. Oh yeah, it's
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  almost hard to wrap your head around now. But
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  before the Great Society, health care for seniors
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  was a looming catastrophe. And for folks with
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  disabilities, comprehensive support barely existed
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  outside of those state run institutions. Think
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  about it. In 1964, a staggering 44 percent of
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  seniors had zero health insurance and people
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  with disabilities faced. just impossible hurdles
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  to get medical care, let alone any kind of community
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  -based services. Plus, getting enough healthy
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  food was a major struggle for low -income families,
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  and that absolutely included families with disabled
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  members. Hunger and malnutrition were just commonplace
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  across the country. LBJ, a guy who had seen extreme
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  poverty firsthand as a teacher back in Texas.
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  He didn't see these problems as individual failures,
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  but as big societal challenges that demanded
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  a strong governmental response. He truly believed
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  that the federal government had the power to
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  create opportunity and protect the well -being
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  of its citizens. Here's a quote from his 1965
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  State of the Union address about the Great Society.
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  The Great Society asks, not how much, but how
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  good. Not only to create wealth, but how to use
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  it. Not only how fast we are going, but where
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  we are headed. It proposes as the first test
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  for a nation, the quality of its people. Let's
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  kick things off with Medicare, okay? Alright,
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  so LBJ signed it into law on July 30th, 1965
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  at the Truman Library. A really symbolic gesture
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  giving a nod to Harry Truman's earlier... though
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  unsuccessful attempts at national health insurance.
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  Medicare was primarily designed to give health
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  insurance to Americans age 65 and older. And
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  here's what President Johnson himself said at
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  the signing of Medicare, which I think perfectly
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  captures the spirit. No longer will older Americans
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  be denied the healing miracle of modern medicine.
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  No longer will illness crush and destroy the
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  savings that they have so carefully put away
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  over a lifetime so that they may enjoy dignity
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  in their later years. And no longer will this
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  nation refuse the hand of justice to those who
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  have given a lifetime of service and wisdom and
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  labor to the progress of this progressive country.
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  Powerful stuff. Okay, absolutely. Now, while
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  we start... started with seniors, Medicare's
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  reach pretty quickly grew to include certain
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  people with disabilities under age 65. And this
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  honestly was a monumental step. you know, for
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  the disability community. I mean, if you give
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  a qualifying disability, you generally become
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  eligible for Medicare after getting Social Security
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  Disability Insurance or SSDI benefits for 24
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  months. There are a couple of exceptions, like,
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  you know, for folks with end -stage renal disease
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  or ESRD and amyotrophic lateral sclerosis. You
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  know, I've never said it out loud before, but
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  I hope I pronounced it right. But we all call
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  that ALS. You know, those people who qualify
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  without that waiting period. Think about it.
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  This meant that individuals who had worked and
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  paid into Social Security but then acquired a
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  disability could actually get comprehensive health
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  insurance down the line. It was revolutionary.
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  Before Medicare, a severe disability often meant
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  not only losing your income, but also losing
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  any real shot at affordable health care. That
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  often led to institutionalization or just financial
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  ruin for entire families. Yeah. Today, Medicare
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  covers like over 60 million Americans, and that
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  includes millions with disabilities. It covers
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  a huge range of services, you know, which include
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  hospital stays, doctor visits, prescription drugs
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  through Part D, and also some other health services.
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  While there are still changes, you know, like
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  out -of -pocket costs, challenges, I meant to
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  say, like out -of -pocket costs in certain long
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  -term services, Medicare's fundamental role is
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  providing health care security for individuals
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  with disabilities is just, you know, undeniably
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  crucial. All right. So hand in hand with Medicare,
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  President Johnson also signed Medicaid into law
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  in 1965. Now, unlike Medicare, which is mainly
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  a federal program, Medicaid is more of a partnership.
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  It's a cooperative effort jointly funded by the
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  federal government and individual states. It
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  was designed to help states provide medical assistance
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  to eligible low income individuals and families.
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  Yeah, and it's also worth remembering LBJ's broader
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  perspective on all these social programs, okay?
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  In his famous War on Poverty Declaration, he
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  said, our aim is not only to relieve the symptoms
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  of poverty, but to cure it, and above all, to
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  prevent it. Medicaid definitely fits into that
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  grand vision. Absolutely. So unlike Medicare's
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  focus on age and SSDI status, Medicaid's eligibility
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  is mostly about income and specific categories
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  of need. And guess what? That absolutely includes
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  individuals with disabilities. This means that
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  even if someone with a disability hasn't worked
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  or doesn't qualify for SSDI, they can still get
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  access to vital health care services through
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  Medicaid. If they meet the income and asset rules.
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  Yeah. And here's the really critical part, especially
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  for our listeners in the disability community.
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  Medicaid is the primary payer for long term services
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  and supports or LTSS. This is a massive range
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  of services that are absolutely vital for people
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  with significant disabilities to live in their
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  own homes and communities instead of being stuck
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  in institutions. We're talking about things like.
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  personal care attendants, home health aides,
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  adult day services, case management, and crucial
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  assistive technology. This whole emphasis on
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  community -based services has been a constant
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  fight pushed for and expanded by amazing disability
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  rights advocates like our very own ADAPT, who
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  have literally put their bodies on the line protesting
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  for our homes, not nursing homes. And also, Medicaid's
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  significance for the disability community goes
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  way beyond just direct medical care. It covers
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  vital therapies, necessary durable medical equipment,
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  and even transportation to medical appointments.
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  While states do have some flexibility in their
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  specific offerings and waiver programs, the federal
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  framework ensures essential, okay, ensures essential
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  services for eligible individuals with disabilities,
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  making it an indispensable safety net and a true
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  cornerstone of independent living. Okay. So beyond
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  health care, the Great Society also took a direct
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  shot at a super basic human need, food. On August
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  31st, 1964, President Johnson signed this Food
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  Stamp Act, making what had been a pilot program
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  a permanent fixture. And exactly as he said at
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  the signing, it is one of, this is what he says,
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  it is one of many sensible and needed steps we
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  have. taken to apply the power of America's new
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  abundance to the task of building a better life
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  for every American. As a permanent program, the
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  food stamp plan will be one of our most valuable
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  weapons for the war on poverty. I mean, you can
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  really hear his conviction there, you know? Oh,
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  totally. The food stamp program, which we now
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  know as the Supplemental Nutrition Assistance
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  Program, or SNAP, plays a huge role in fighting
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  hunger for low -income households, and that includes
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  a really significant portion of the disability
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  community. A lot of individuals with disabilities,
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  especially those living on fixed incomes from
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  Social Security or SSI, often face really tight
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  financial situations that make it super tough
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  to afford nutritious food. Yeah, and that's where
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  SNAP steps in. It provides eligible households
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  with electronic benefits, those EBT cards we
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  all recognize now, that they can use to buy food
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  at grocery stores. Now, while eligibility is
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  mainly based on income, there are some really
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  important provisions that acknowledge the unique
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  financial circumstances of individuals with disabilities.
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  Okay, first, higher asset limits. For households
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  with an elderly or disabled member, they often
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  get higher countable resource limits. This recognizes
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  that they might need to hold on to a bit more
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  in savings for unexpected medical bills or living
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  expenses. Yeah, and next are medical expense
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  deductions. This is a massive one. For elderly
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  or disabled household members, any out -of -pocket
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  medical expenses over a certain amount, say $35
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  a month, can actually be deducted from their
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  gross income when SNAP eligibility is calculated.
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  This effectively allows more of their income
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  to be disregarded, making it easier to qualify
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  or get higher benefits. And finally, there are
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  waivers for work requirements. While SNAP generally
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  has work requirements for able -bodied adults,
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  these are typically waived for folks who are
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  getting federal disability or blindness payments,
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  like SSI or SSDI, or who are otherwise determined
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  to be unable to work because of a permanent disability.
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  SNAP's role as a nutritional safety net for the
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  disability community is absolutely profound.
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  It doesn't just address immediate hunger. but
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  also contributes to better health outcomes, which
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  is particularly vital for individuals with chronic
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  conditions or complex medical needs. So we've
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  just laid out how absolutely crucial Medicare
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  and Medicaid are, especially for people with
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  disabilities. But now we have to talk about something
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  really immediate, something that's hitting these
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  programs hard right now. And we're talking about
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  the One Big Beautiful Bill Act. which was just
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  signed into law on July 4th, 2025. Okay, this
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  bill, which is nearly a thousand pages long,
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  is unfortunately making massive changes to federal
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  spending, essentially stripping healthcare and
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  nutrition away from tens of millions. of our
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  most vulnerable neighbors. It slashes vital programs
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  like Medicaid and Medicare and SNAP, the very
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  programs we've seen, we've been discussing, you
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  know, to pay for tax cuts that frankly disproportionately
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  benefit the wealthiest Americans. It's a really
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  chilling reversal of the Great Society's original
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  intent. For Medicaid, this new law introduces
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  some really serious hurdles. It's putting in
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  place significant new paperwork requirements.
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  The concern here is that many eligible people
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  will actually lose their coverage simply because
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  they mess a piece of mail, submit something late,
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  or their state gets totally swamped by the new
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  administrative burden. And it gets tougher. The
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  bill imposes new work requirements for many Medicaid
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  recipients. age 19 to 64 who are considered able
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  -bodied. They'll now have to prove they're working,
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  doing community service, or participating in
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  work training for at least 80 hours a month,
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  or attending school part -time. This includes
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  parents of children over 13. While there are
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  some mandatory exemptions for certain groups
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  like pregnant women or those with serious medical
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  conditions, the reality is that many individuals
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  individuals with disabilities who don't have
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  SSI or SSDI but still struggle to work due to
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  their conditions are at huge risk. Research has
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  shown these kinds of, you know, requirements
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  often don't increase employment but instead lead
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  to significant coverage loss. And beyond that,
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  the bill introduces cost -sharing requirements
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  for Medicaid expansion recipients. meaning people
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  could face up to a $35 copay per health care
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  service. For folks with chronic illnesses or
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  disabilities who often have multiple appointments
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  and needs, these small amounts can quickly add
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  up to unmanageable costs, effectively creating
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  a barrier to essential care. And Medicare isn't
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  safe either. The bill is projected to trigger
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  significant cuts to Medicare from 2027 to 2034,
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  largely due to the statutory pay -as -you -go
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  act. Plus, it prohibits the implementation of
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  rules that would have made it easier for low
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  -income Medicare enrollees to access Medicare
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  saving programs, which help to cover premiums
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  and co -pays. disproportionately hits disabled
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  people who are more likely to have lower incomes.
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  And now there's SNAP. This new law threatens
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  to cut and reduce benefits for an estimated 22
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  million families. It expands work requirements
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  for SNAP recipients, ending exemptions for veterans,
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  young adults aging out of foster care, and even
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  parents with children older than 15. The age
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  for work exemptions for adults is also being
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  raised from 54 to 64. These changes mean more
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  people struggling to find consistent work will
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  lose crucial food assistance. You know, it's
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  a lot to take in. And it's clear these changes
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  pose a direct threat to the very lifelines we've
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  just explored from the Great Society era. So
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  what can be done? Well, it's easy to feel overwhelmed,
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  but the disability community in particular has
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  a long, powerful history of advocacy. As we discussed
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  earlier, groups like ADAPT have literally put
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  their bodies on the line. Now more than ever,
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  we need to channel that loud and proud spirit
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  into action. Yeah, exactly. And the first step
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  is to stay informed, accurately informed. Understand
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  exactly how these changes... from the one big
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  beautiful bill act will impact you or your loved
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  ones. I mean, knowledge is power. Follow reliable
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  news sources and advocacy organizations like
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  the ARC, the National Disability Rights Network,
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  NDRN as it's called, the Center for Medicare
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  Advocacy, and the Center on Budget and Policy
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  Priorities. They are tracking this bill and its
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  implications very closely. And next, contact
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  your elected officials. This is absolutely critical.
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  I know it sounds like, you know, it feels like
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  screaming at the wall sometimes, but trust me,
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  it does make a difference. Your senators and
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  representatives need to hear from you. Phone
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  calls are often considered more impactful than
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  emails, but emails still matter. Tell them your
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  story if you feel comfortable. Explain how Medicare,
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  Medicaid, or SNAP impacts your life directly.
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  Personal stories are incredibly powerful and
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  can sway opinions. Emphasize that these aren't
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  just budget lines. They are human lives. Yeah,
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  and don't just stop at your federal... I mean,
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  reach out to your state legislators, too. Remember,
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  Medicaid is a federal state partnership. So state
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  policy decisions about funding and program implementation
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  will become even more critical under these new
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  federal rules. Advocate for your state, you know,
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  to resist harmful cuts and, you know, protect
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  services. And of course, you can join advocacy
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  groups. There's strength in numbers, folks. Organizations
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  like ADAPT, The Arc, and other local disability
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  rights centers are already doing incredible work.
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  They have coordinated campaigns, provide resources,
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  and can help amplify your voice. Look for your
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  state's Protection and Advocacy, or P &A, system.
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  They offer legally -based advocacy services.
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  Yeah, and share your story publicly if you're
• 21:15
  comfortable. Social media, local news outlets,
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  community meetings, sharing your experiences
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  can raise awareness and galvanize others. The
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  more people understand the real world consequences
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  of these cuts, the more pressure there will be
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  to change. And finally, support organizations
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  that are fighting on the front lines. Financial
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  contributions. volunteering your time, or simply
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  spreading their message can make a significant
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  difference. This is a long game fight, and every
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  bit of effort helps maintain these vital programs.
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  When we look at the great society programs, Medicare,
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  Medicaid, and the Food Stamp Act, they represent
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  a pivotal, truly defining moment in American
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  history for the disability community. They dramatically
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  expanded access to healthcare, long -term services,
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  and nutritious food. Fundamentally shifting how
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  we approach disability from old ideas of institutionalization
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  and charity to real support for independent living
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  and dignity. Yeah, and as LBJ himself noted about
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  progress and the challenges still ahead, I quote,
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  we have done much, but we have much more to do.
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  Okay, now that's as true today as it was then.
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  Yeah, the gains made for people with disabilities
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  because of these programs are undeniable. They've
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  fostered greater integration into society, significantly
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  improved health and well -being, and really laid
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  a crucial foundation for the modern disability
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  rights movement. Yeah, but here's the kicker,
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  okay? The debates that started way back in the
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  1960s are still going on today, and they often
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  have direct implications for people with disabilities.
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  I mean, we constantly hear discussions about
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  the affordability of Medicare, the sustainability
• 23:11
  of Medicaid, especially, you know, its long -term
• 23:15
  care component, and proposals for cuts or stricter
• 23:19
  eligibility for SNAP. I mean, just look at the
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  impact of the recent One Big Beautiful Bill Act
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  with this proposed Medicaid cuts and potential
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  work requirements. It really highlights how...
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  highlights how vulnerable these essential lifelines
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  can be. And as we look at the current political
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  landscape with these renewed calls for budget
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  cuts and reforms, it's so important to remember
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  the original intent of these programs, to ensure
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  that every American has access to basic necessities,
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  health care and food, and the opportunity to
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  live a dignified life. The war on poverty, as
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  it's called, might not have ended poverty entirely.
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  But it certainly equipped millions with disabilities
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  with the tools to fight it and live loud and
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  proud in their communities. Yeah, the legacy
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  of the Great Society isn't just about the laws
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  it passed. It's about the enduring spirit of
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  possibility it ignited for disability inclusion.
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  I mean, it really does remind us that the government
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  can be a powerful force for good, tackling big
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  societal challenges, and genuinely... improving
• 24:30
  the quality of life for all of its citizens.
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  Medicare, Medicaid, and SNAP are more than just
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  programs. They're lifelines. They empower millions
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  of disabled Americans to live independently,
• 24:43
  manage their health, and access nutritious food.
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  They are true testaments to the idea that a society
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  that truly cares for its most vulnerable is a
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  stronger, more just society. So as we continue
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  to navigate the complexities of our present,
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  let's draw inspiration from the vision of the
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  Great Society. And keep living loud and proud,
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  always advocating for the programs that uplift
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  us all. All right. So thank you for joining us
• 25:08
  all on Living Loud and Proud. We'll be back next
• 25:12
  time with another deep dive into the policies
• 25:15
  that shape our world. Please visit our accessible
• 25:19
  website at www .disabilitypridepa .org. You can
• 25:26
  find us on social media at Disability Pride PA
• 25:30
  on Facebook, Instagram, and TikTok.