Fresh from their history-making election victory, Republicans are poised to make the 2003 congressional session the most active in years.

At stake will be a number of long-standing issues critical to 50-plus Americans, with prospects strong that a prescription drug benefit of modest proportions will be among the new measures written into law.

The outlook is murkier for Medicare and Social Security overhaul, health care for the uninsured, long-term care and pension reform, but these issues, along with tax cuts and economic stimulus, are on the agenda.

"It all adds up to a lot of legislative activity," says AARP policy director John Rother. "And for the first time a Republican Congress is taking the lead to address health care issues."

NOT SINCE IKE HAS GOP WIELDED SO MUCH CLOUT

The new game in Washington grows out of the GOP sweep of the Nov. 5 election in which Republicans surprised the nation by winning the Senate and strengthening their hold on the House.

The victory ended an era. Not since 1954, when Eisenhower was president and a postage stamp cost 3 cents, have Republicans controlled both houses of Congress and the White House as they do today.

Republicans succeeded by drawing on President Bush's popularity and sounding themes of homeland security and defense—issues that resonated particularly with older Americans. [See How Did Older Americans Vote?]

"Americans believe conservatives will be stronger in doing what needs to be done [on terrorism]," says Robert Blendon, a policy analyst at Harvard University.

Given that the election was largely driven by the terrorism issue, most political experts interviewed by the AARP Bulletin doubt that the election marks a fundamental sea change in American political attitudes.

But they do agree that the election gives the Republicans a historic opportunity to launch a new era of control—although one not without risk.

"If things go well," says Columbia University historian Alan Brinkley, "and in 2004 the Republicans can make a plausible case that they've done a good job governing the country ... this could be the beginning of a long period of Republican dominance."

But he quickly adds, "It's equally plausible that by 2004 things won't be going well, and there will be nobody to blame but the Republicans, and they'll do poorly [in the elections]."

Recognizing all that is at stake, Bush is expected to move rapidly and aggressively, starting with his State of the Union address later this month, to keep Republican momentum going. The day after the election, he said the vote signified that "people want something to get done"—and analysts see GOP lawmakers trying hard to deliver that something this year.

Experts say the midterm election will strengthen Bush's ability to advance a conservative philosophy emphasizing marketplace solutions to social problems and the shifting of longtime federal functions to the private sector.

"[The November vote] gives the president and the Republicans an advantage," says Charles O. Jones, professor emeritus of political science at the University of Wisconsin.

DEMOCRATS STILL STRONG—ESPECIALLY IN SENATE

While the GOP's new power is great, Democrats will make their voices heard—especially in the Senate, where Republicans hold a scant 51-49 edge. Under Senate rules, 60 votes are required to break a filibuster, which means, Jones says, that Republicans "are still going to [need] some Democratic votes" to get things done.

On the other hand, he adds, "The Democrats in the Senate don't want to go into 2004 being the bad guys," portrayed as obstructionists.

Ultimately, experts say, Bush's success may hinge not only on what happens in Congress, but also on his ability to manage a looming conflict with Iraq and, at the same time, ignite a drifting American economy.

The president's ousting of his top two economic advisers last month left no doubt about his concern over the direction of the economy. He is expected to push strongly to accelerate or make permanent some of the tax cuts in his 2001 tax package and to argue for some new cuts—all in the name of stimulating the economy.

In fact, Larry Sabato, head of the University of Virginia Center for Politics, believes "economic stimulus will be the White House's priorities No. 1, 2 and 3."

HERE'S WHAT TO EXPECT AS THE GAME BEGINS

As America enters the new year, here is how major issues affecting 50-plus Americans shape up:

Prescription Drugs
Lawmakers are expected to move quickly to try to pass a Medicare drug benefit this year.

Sen. Chuck Grassley, R-Iowa, who will chair the powerful Senate Finance Committee in the new Congress, says a benefit will rank "second after tax legislation" in his committee's priorities.

But it will be no easy ride. Last year's obstacles—how much a benefit should cost and how it would be managed—remain. And there may be less money available this year.

GOP leaders themselves are split on whether a benefit should be for all Medicare beneficiaries or only for those with low incomes. Nor can they count on 100 percent Republican support for any expensive new program. "It's going to take some bipartisanship," says Grassley, who supports a comprehensive plan.

Congress has the desire to pass a drug benefit, says Paul Ginsburg, president of Washington's nonpartisan Center for Studying Health Policy Change. But given the difficulties, he adds, "I have to say I'm skeptical it will get done."

Most analysts believe that political pressures will lead to some kind of measure to make prescriptions more affordable. But, they say, tax cuts and budget constraints may dictate that it falls short of the comprehensive coverage promised by both parties.

Medicare Reform
Many Republicans do not want to pass a drug benefit without some kind of "reform" of Medicare.

This generally means having the program run more by private insurers than directly by the government. It is an approach most Democrats oppose.

Such reform "is a very important ingredient to get conservative Republican support" for a drug benefit, Grassley tells the Bulletin.

But, says Ginsburg, "reform has been set back by the implosion of the Medicare+Choice program," in which HMOs have annually raised premiums, lowered benefits or left the program entirely as costs rose. "Until there's more positive experience with private plans in Medicare," he adds, "I think the chances for significant reform are limited."

Social Security
No one doubts Bush's commitment to creating individual investment accounts in Social Security.

But few believe that, given all his other challenges in 2003, he will do anything more than give the plan a ringing endorsement in his State of the Union address and other speeches.

As most observers see it, if the president is re-elected in 2004 and the stock market rebounds, he will then be well-positioned to expend the immense political capital needed to push this still-prickly issue.

"We're not quite ready yet for a major reform [on Social Security]," says Rudolph Penner, senior fellow at the Urban Institute, a Washington think tank, who favors personal investment accounts. "I think the issue still needs more public education."

Covering the Uninsured
A number of GOP leaders have put health care for the uninsured at or near the top of their priority lists.

Observers believe this effort is likely to take the form of tax credits to help the uninsured purchase coverage.

Twice during the last Congress, the House voted to give $17 billion in tax credits to unemployed workers to buy continuing coverage through their former employers' health care plans. That measure stalled, however, in the Senate, where Democrats pushed to extend health care benefits to the unemployed through Medicaid.

The shift in the balance of power "means help for the uninsured should be able now to make it through the Senate," says Robert E. Moffit, director of domestic and economic policy at the Heritage Foundation, a Washington think tank.

David Himmelstein, M.D., associate professor at Harvard Medical School and a founder of Physicians for a National Health Program, says Congress may take action this year, but in a minor way. "They may make a publicity gesture," he says, "offering some tax credits that in fact would help few of the uninsured but would be trumpeted as a great victory." Or, he says, Congress could give states wider latitude with their Medicaid programs, but that's also unlikely to help the uninsured.

Long-Term Care
Two proposals are likely to get more consideration in the new Congress than the last.

They are: tax credits to help people buy long-term care insurance and tax breaks for family caregivers, as embodied in legislation sponsored by Sen. Grassley and Sen. Bob Graham, D-Fla.

Last year the House passed a tax relief bill that critics said would not help enough people—for example, there was no provision for family caregivers.

"Long-term care is a high priority of AARP, and we expect federal action on tax policy, quality measures and fiscal relief for Medicaid programs in the states this year," says AARP's Rother.

Retirement Savings
High on the list of unfinished business from last year is pension reform—how to protect workers' 401(k)s when companies collapse.

The issue was hot when Enron and WorldCom went bankrupt, leaving thousands of workers who were heavily invested in company stock losing not only their jobs but retirement savings as well.

The House passed 401(k) reforms last April. But after attempts to strengthen the House version stalled, the Senate failed to produce a bill.

Still, pension reform has broad bipartisan support, and "it would be hard to imagine a bill not getting through this year," says Dallas Salisbury, president of the Employee Benefit Research Institute in Washington.

Salisbury also expects Congress to consider accelerating the timetable for raising maximum contributions to 401(k)s and IRAs and increasing the age (now 70 1/2) at which investors must begin drawing money out of such plans.

Bulletin senior editors Patricia Barry and Trish Nicholson contributed to this article.