Upon its enactment in July 1988, the Medicare Catastrophic Coverage Act (MCCA) was hailed as the first major expansion of government health care since the creation of Medicare in 1965. Supported by President Reagan, majorities in both houses of Congress, and the nation's largest senior-citizen interest group, the American Association of Retired Persons (AARP), the legislation effectively plugged many of the holes in the existing Medicare system by providing protection against some but not all catastrophic health care expenses. Additionally, the consensus behind the MCCA appeared to establish a precedent for expanding social insurance in an era of high federal deficits. However, less than eighteen months later, the House and the Senate, responding to a tidal wave of criticism, would vote to repeal virtually all of the legislation.

Utilizing varied source materials, including interviews with policy makers and surveys of senior-citizen opinion gathered by the AARP, Richard Himelfarb undertakes a comprehensive analysis of how and why this unprecedented series of events transpired. In the process, he also examines the politics of federal entitlement programs in an era of high deficits and senior citizens' political influence, topics that are of particular interest in light of recent federal attempts to tackle health care reform.