The Kerr–Mills Act and the Puzzles of Health‐Care Reform

Objective This article explores the passage and implementation of the Kerr–Mills Act of 1960. The Kerr–Mills Act created the Medical Assistance for the Aged program that preceded the 1965 creation of Medicare and Medicaid. Method Using primary and secondary sources, I seek to explore how the legislation was passed and how it was implemented. Results Kerr–Mills was passed because of an alliance between policy entrepreneur Wilbur Cohen and conservative southern Democratic members of Congress, Wilbur Mills and Roger Kerr. Cohen helped to craft a modest bill that gained easy approval. Three years after the passage of the law less than 1 percent of older Americans were covered, not every state implemented the legislation, and there were large discrepancies in terms of services and access. However, individual states reported success in creating programs. The Medicaid program took the structure of Kerr–Mills but included dependent children as recipients and incentives for states to participate. Conclusion While criticized as an unsuccessful program, Kerr–Mills provided the template for what is today the largest health insurance program: Medicaid.