w 'hen Ronald Reagan assumed the presidency, both conservative and liberal analysts predicted revolutionary changes in the health and welfare system of the country. When Reagan left office eight years later, major programs affecting the elderly that had been targeted for radical modification or elimination still existed. Medicare continues as a federal program that pays half of the medical bills of the elderly. Medicaid remains a joint federalstate program that pays the medical bills of a large number of elderly poor. Social Security offers federally administered income support, while other programs provide federal funds for social services, food, and other needs. While the Reagan years did not revolutionize health policy for the elderly, significant structural trends were initiated and /or reinforced. These trends could have long-lasting consequences for the elderly. As the number of elderly grows dramatically over the next fifty years, the federal health policy for the aged will reflect the heritage of New Federalism, fiscal crisis and austerity, and deregulation.