Obama Challenges: Medicare, Social Security, Health Care Law

Same president. Same Republican control of the U.S. House. Same Democratic control of the U.S. Senate.

But that doesn't mean that issues especially important to voters 50 and older will stay the same.

With the nation's looming fiscal problems, Social Security, Medicare and Medicaid could face changes. And President Obama's signature accomplishment - the Affordable Care Act - now faces the implementation phase (instead of a prospective battle over repealing it had Republican Mitt Romney had been elected).

Medicare and Social Security wouldn't be affected by the approaching fiscal cliff, the fallout from last year's failed budget negotiations. And advocates for older Americans, including AARP, continue to argue that it should stay that way. The programs' long-term funding imbalances - more boomers are using both programs and health care costs rise faster than inflation - deserve to be sorted out separately, not mixed in with deficit issues, they say.

But as lawmakers and Obama scramble to come up with a budget deal before the end of the year, both programs could indeed be swept into the larger battle over federal spending as the nation struggles with its deficit. Discussions are likely to include such major changes as raising the eligibility age for Medicare to 67 and changing the way Social Security cost-of-living adjustments are calculated.

Like Medicare, the health care law faced the possibility of much further-reaching change if Romney had won. But it, too, faces new challenges in the coming months.

Some Republican stalwarts in Congress will continue to try to chisel off pieces of health care reform, but odds are higher that the reform will largely stay intact. That means people on Medicare will get help with prescription drug expenses that once fell into a " doughnut hole" without coverage, preexisting conditions will be covered and, starting in 2014, individuals will be required to have insurance or pay a penalty.

Some states have watched from the sidelines, waiting to see who won the presidential race. With the health care law here to stay, those states are faced with two big decisions:

• whether to expand access to Medicaid, using new funds from the law.
• whether to set up insurance exchanges to help those who want to buy coverage, or cede that power to the federal government.

In a victory speech in the wee hours of Thursday morning, Obama said: "we are not as divided as our politics suggest."

Some of the issues most important to older voters are the ones that will test that premise. -Tamara Lytle

Photo: Saul Loeb/AFP/Getty Images