Administration & Society 1–26 © The Author(s) 2015 DOI: 10.1177/0095399715581030 aas.sagepub.com Article Understanding the Implementation of Medicaid and Medicare: Social Construction and Historical Context Jaclyn S. Piatak 1 Abstract This article examines the history and formation of Medicare and Medicaid to determine how America’s two major public health insurance programs came to have such vastly different implementation structures. Drawing upon theories of social construction and path dependence, findings show how the programs were set on divergent paths. This article also explores how the intergovernmental nature of Medicaid has promoted inequities, both between programs and among recipients across states. The findings show how social construction can influence the policy tool chosen and how the implementation structure impacts the individuals whom these programs are intended to serve for years to come. Keywords social construction, federalism, intergovernmental relations, implementation Medicaid and Medicare are two of the largest public health insurers in the world, but despite similar mandates and roots in the same legislation, their implementation has been starkly different. The Social Security Amendments 1 University of North Carolina at Charlotte, NC, USA Corresponding Author: Jaclyn S. Piatak, Department of Political Science & Public Administration, University of North Carolina at Charlotte, Charlotte, NC 28223, USA. Email: jpiatak@uncc.edu 581030AAS XX X 10.1177/0095399715581030Administration & SocietyPiatak research-article 2015 doi:10.1177/0095399715581030 Administration & Society OnlineFirst, published on April 22, 2015 as