[141][142]

Social services and Social Security
Following Republican efforts to pass the Medicare Act of 2003, Bush signed the bill, which included major changes to the Medicare program by providing beneficiaries with some assistance in paying for prescription drugs, while relying on private insurance for the delivery of benefits.[143] The retired persons lobby group AARP worked with the Bush Administration on the program and gave their endorsement. Bush said the law, estimated to cost $400 billion over the first ten years, would give the elderly "better choices and more control over their health care".[144]
Bush began his second term by outlining a major initiative to "reform" Social Security,[145] which was facing record deficit projections beginning in 2005. Bush made it the centerpiece of his domestic agenda despite opposition from some in the U.S. Congress.[145] In his 2005 State of the Union Address, Bush discussed the potential impending bankruptcy of the program and outlined his new program, which included partial privatization of the system, personal Social Security accounts, and options to permit Americans to divert a portion of their Social Security tax (FICA) into secured investments.[145] Democrats opposed the proposal to partially privatize the system.