Forty eight years ago this summer, President Lyndon Johnson signed Medicare into law, providing healthcare for millions of older Americans. As our state begins full implementation of the Affordable Care Act, it is appropriate to reflect on the progress we have made on giving healthcare access to Americans, and commit to delivering Medicare for All.

At the signing of the Medicare law, President Johnson said, "No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years."

The Medicare program has largely succeeded in fulfilling that promise. Seniors get the healthcare they need, when they need it. It still doesn't cover all medical needs, but over the years, it has been expanded several times to increase the number of people covered, and the number of services provided. In 1972, people under age 65 who had long-term disabilities were included in Medicare. In 2003, prescription drug coverage was added.

More recently, the Affordable Care Act (often called ObamaCare) added preventive care services to Medicare, as well as mammograms and other health screenings, and it reduced the co-payments seniors pay for prescription drugs.

For older Minnesotans, Medicare has been a lifesaver.

Minnesotans under 65, however, have been covered - or not covered - under a fragmented and broken system of employer-based health insurance, private plans, public programs, or no insurance at all.

Fortunately, during the next five months, many previously uninsured Minnesotans will receive healthcare coverage through the MNSure insurance exchange of the Affordable Care Act (ACA). Those who were denied coverage because of preexisting conditions should no longer face that problem. Young adults whose parents have good coverage are now eligible for coverage through them.

Minnesota, under Gov. Dayton and the DFL legislature this year, is leading the nation in its thoughtful and comprehensive implementation of the ACA. By upgrading MinnesotaCare and expanding Medicaid, Minnesota will make healthcare accessible to hundreds of thousands of additional people.

However, the ACA is not Medicare. It does little to eliminate the bureaucratic waste in our current system or reduce the overall costs of our health care system - and it will not cover everyone.

Nationally, about two thirds of the low income people eligible for coverage under the ACA will not be covered because their states have chosen not to expand Medicaid. Minnesota is doing much better than those states, but there will still be a couple hundred thousand Minnesotans without coverage, and many more who have coverage will not have affordable access to some needed services. Although the ACA will close some gaps in our dysfunctional healthcare system, gaps will remain, and many people needing care will fall into those cracks.

As soon as the ACA is fully implemented, it is time to turn our attention to completing the promise of Medicare for all. Legislation to enact a proposed Minnesota Health Plan (MHP), a Medicare-style plan for everyone, is the only solution to rapidly rising medical costs.

The MHP would beef up the coverage that Medicare recipients get - including nursing home care and many other needed services - and extend those same benefits to everyone, regardless of age. The Minnesota Health Plan would cover all Minnesotans for all of their medical needs.

Yet the MHP would save money, eliminating the costly bureaucratic insurance system and delivering healthcare directly. And, in providing healthcare to all instead of health insurance for some, we would leave medical decision-making with patients and their doctors, not subject to government or insurance company interference. A growing number of Minnesota physicians and nurses are supporting the MHP, because they are tired of patients who get inferior treatment based on insurance company restrictions.

Two years from now, when the nation celebrates the 50th anniversary of Medicare, we want to be on the verge of passing the Minnesota Health Plan. Five decades after Medicare covered people over 65, it is time for Minnesota to cover people under age 65 as well, finally delivering Medicare for All.

John Marty is a Minnesota state senator affiliated with the Apple Pie Alliance, which works to strengthen the democratic process and promote ethics and integrity in public service. The alliance seeks to increase thoughtful discussion and to promote policies that will build a better society and healthy communities for the 21st century.