Older Americans have benefited substantially from the two key government entitlement programs, Social Security and Medicare, and from Supplemental Security Income and Medicaid, which are specifically targeted on the very poor. But the gains from these programs and from other sources of retirement security have slowed over time and low and modest income seniors in the future likely will not experience substantial improvements in financial security unless these public programs are expanded in ways that do not now seem likely. Indeed, people reaching the age of 65 who have had only low incomes over their lifetimes will continue to suffer from a lack of financial resources, and others with modest incomes may face declining economic status, particularly when the costs of health care are taken into account. It is essential to look at both health and income security issues since they go hand in hand.