Getting Ready for the 21st Century: The Aging of America and the Older Americans Act

Thirty-four years after the establishment of three of the four major federal programs for older Americans, national policymakers in the Executive and Legislative branches are engaged in crafting and advancing proposals to modernize, redirect, and secure Social Security (enacted in 1935), the Medicare program (enacted in 1965), and the Older Americans Act (OAA, P.L. 89-73, enacted in 1965). These proposals are being introduced for public discussion and congressional action in 1999, an auspicious year for older Americans - the United Nations International Year of Older Persons. Motivating factors underlying the flurry of activity around these programs for older Americans can be readily identified. They include a growing measure of apprehension about some of the more obvious economic, social, and other consequences that would result from :inattention to an unprecedented longer-living population. Specifically, the potential policy and program effect of the aging of 76 million baby boomers is beginning to develop a critical mass of interest as more sectors realize that the boomers will make up the largest generation of older people the world and our nation have ever seen. The interest of both the public and the private sectors in managing and containing the costs of health and long-term care, providing quality care for consumers, and ensuring the availability and viability of a mix of provider organizations and programs also are motivating factors. Finally, aging issues, in particular a desire for longterm care reform, already are being promoted as a core concern for the 2000 election. Possibly the most complex discussions in the nation's capital have to do with the Medicare program. Although the Medical Trust Fund has declared the solvency of the trust fund until 2015 instead of 2008, there is abiding interest in adjusting the benefits package and other features to be more responsive to emerging health care needs and issues. Unfortunately, the Bipartisan Medicare Commission, charged with the daunting task of reviewing the Medicare program and developing policy and program recommendations, was unable to arrive at a consensus before it adjourned. The plan articulated by the commission cochairs, Senators John Breaux (D-LA) and Craig Thomas (R-WY), called for raising the eligibility age for beneficiaries from 65 to 67 and included a very modest prescription drug benefit administered as a means-tested Medicaid benefit. The Breaux-Thomas plan also proposed "premium support" or higher premiums, that is, the shifting of costs to program beneficiaries through higher premiums for Medicare, and envisioned a new administering bureaucracy but did not address the long-term solvency of the fund. Dissenting members did not embrace premium support and called for more generous prescription drug coverage. As an alternative, a set of guiding principles and a proposal have been offered by the Clinton administration. The administration has called for a more "competitive" Medicare program, has emphasized the need to "smooth-out provisions in the Balanced Budget Act that may be affecting Medicare beneficiaries' access to quality services" ("President Clinton's plan," 1999), and has called for the use of 15 percent of the budget surplus over the next 15 years to underwrite modernization of the program. Proposed new benefits include a $1,000 prescription drug benefit for both older and disabled Americans and free preventive health services, such as mammograms, prostate cancer screenings, and diabetes self-management. Close scrutiny of all options may be expected to precede legislative action in the remaining days of the first session of the 106th Congress. Policy decisions that result in the modernization of social security, Medicare, and OAA will determine very much the quality of life of the nation's longer-lived, increasingly diverse, predominantly female older Americans and their families in the 21st century. …