which particular factors that earlier may have been somewhat weak in bringing about national health insurance later led to the passage of Medicare and Medicaid? which particular factors that earlier may have been somewhat weak in bringing about national health insurance later led to the passage of Medicare and Medicaid? Solution Often, when charity care was provided, private payers were charged more to make up the difference, a practice referred to as cost-shifting or cross-subsidization. In 1965, Congress passed the amendments to the Social Security Act and created the Medicare and Medicaid programs. Thus, for the first time in US history, the govern-ment assumed direct responsibility to pay for some of the health care on behalf of two vulnerable population groups—the elderly and the poor. Medicaid and Medicare were designed to cover only the most vulnerable populations. The proposals did not reengineer how the majority of the Americans would receive health care. The growing elderly population was becoming a politically active force among middle-class Americans..