OPINION:
On July 30, 1965, the Social Security Amendments, a bill establishing health care coverage for the elderly and poor, was signed into law by President Lyndon B. Johnson. Today, what we now call Medicare and Medicaid have grown to represent 39% of total national health expenditures, consume almost a third of our federal budget, and provide coverage to over 138 million Americans.
This 60th anniversary of their creation serves as a timely reminder that Congress must act decisively to preserve their viability for another 60 years. Although Medicare and Medicaid were created together, and fall under mandatory spending, they have primarily distinct patient populations, different funding mechanisms, and face unique challenges.
Despite their differences, both have become fiscal behemoths with unsustainable growth trajectories. The ratio of the number of individuals paying into Medicare relative to beneficiaries continues to shrink, and according to the latest Medicare Trustees Report, the program will reach insolvency in 2033. Prior to the passage of H.R. 1, the One Big Beautiful Bill Act (OBBB), Medicaid expenditures were projected to grow approximately 5% annually through 2032. The reconciliation bill curbed this growth with modest and reasonable eligibility requirements designed to encourage work for able-bodied adults and protect benefits for vulnerable Americans rather than illegal immigrants and those who are not actually eligible for the program.
Against the backdrop of this financial predicament are soaring health care expenditures driven by a sick and aging population. Roughly 129 million Americans suffer from at least one chronic disease, a number that has risen consistently over the last two decades. In fact, 90% of the $4.1 trillion spent on health care each year is attributable to chronic disease. Meanwhile, the proportion of individuals 65 years and older continues to increase, while those under the age of 18 is declining. We face a funding math problem.
As a physician of over 30 years, who continues to serve a rural 29-county referral area made up predominantly of Medicare, Medicaid, and uninsured patients, I intimately understand the challenges Washington must grapple with. These are the patients I see in my doctor’s office.
Reflecting upon the legacy of Medicare and Medicaid in America, we must be clear about the intent of the programs, whom they are designed to serve, and how we ensure they retain value for generations to come. The status quo is not sustainable, but a slash-and-burn approach is not the answer either.
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During the bill-making process for OBBB, I had the opportunity to tell the story of Eastern North Carolina and share how our work reforming Medicaid could impact people’s lives. Throughout the process, I worked alongside my GOP Doctors Caucus colleagues to call balls and strikes objectively on the provisions under consideration. In the end, we delivered meaningful improvements that protect benefits for Americans in need. The government simply cannot be everything for everybody.
While Medicare’s patient population is clear older Americans the program’s complexity is more opaque. With over a decade since the last major reform, efforts to root out waste, fraud, and abuse at a program-wide level are overdue. Much of this waste, fraud and abuse stems from business decisions that put the bottom line of insurers ahead of patients and their doctors last.
Since coming to Congress, I have championed numerous Medicare reforms to improve the affordability and access of high-quality care, including eliminating improper payments, taking on health care monopolies, and cutting out greedy pharmacy benefit managers responsible for inflating drug prices. However, there is no issue I have been more vocal about than achieving a permanent update to the Medicare Physician Fee Schedule (PFS).
Doctors who see Medicare patients do so out of the goodness of their hearts, not because it makes financial sense. Unfortunately, due to persistent cuts to the PFS, amounting to an inflation-adjusted 33% decline since 2001, private practice physicians are at risk of extinction. The consequences of forcing these doctors out of business would be devastating for rural and underserved communities. As evidenced by MedPAC, the independent advisory commission to Congress on Medicare payment issues, supporting inflationary updates to the physician fee schedule should not be a partisan issue.
As we approach the 60th anniversary of Medicare and Medicaid, I am fighting in Congress to protect these vital programs with sincerity and objectivity. Neither inaction, nor political brinksmanship, are the answer to the very complex and personal policy landscape ahead of us. We must be thoughtful in our approaches to deliver durable solutions that can withstand the test of time.
• Rep. Greg Murphy, M.D., represents North Carolina’s 3rd Congressional District. He serves on the Health subcommittees of both the Ways and Means and Veterans’ Affairs Committees, and co-chairs the House GOP Doctors’ Caucus.
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