Among the key stakeholders in the legislation, there were definite winners and losers. In the wake of this political breakthrough, public opinion on the final product was remarkably negative:Īfter years of fierce campaigning, lobbying, and legislating over the issue, a landmark agreement finally emerged in Congress this week to provide Medicare prescription drug benefits. Other beneficiaries will face significant gaps in coverage and, as a result, will still be liable for up to $3,600 or more in annual expenses. Medicare will subsidize the cost of coverage for about 14 million low-income beneficiaries. ![]() At that time, more than 40 million beneficiaries will have the following options: (1) they may keep any private prescription drug coverage they currently have (2) they may enroll in a new, freestanding prescription drug plan or (3) they may obtain drug coverage by enrolling in a Medicare managed care plan. In 2006 the full-fledged program is scheduled to begin. By mid-2004, the federal government will authorize cards that can be used to obtain price discounts on prescription drug purchases and will offer a $600 credit to about 4.7 million low-income beneficiaries. In fact, for many Medicare beneficiaries, the benefits of the new law are not so immediate or valuable. Today they are just moments away from the drug coverage they desperately need and deserve” ( Pear and Hulse 2003). Seniors have waited 38 years for this prescription drug benefit to be added to the Medicare program. Senate Majority Leader Bill Frist (R-Tenn.), one of the initiative's chief negotiators and political investors, hailed its passage: “Today is a historic day and a momentous day. The drug assistance and other provisions of the law are projected to cost taxpayers at least $395 billion, and possibly as much as $534 billion, over the next decade ( CBO 2004a, b Pear 2004a). The new drug assistance represents a major new federal entitlement for Medicare beneficiaries, who now spend an average of $2,322 per year on prescription drugs ( Kaiser Family Foundation 2003c). 108–173), which authorizes Medicare coverage of outpatient prescription drugs as well as a host of other changes to the program. Bush (R) signed the Medicare Prescription Drug, Improvement, and Modernization Act (P.L. Based on several new circumstances in 2003, the article demonstrates why there was a historic opportunity to add a Medicare prescription drug benefit and identify challenges to implementing an effective policy. They ignored lessons from past episodes, however, about the need to match expanded benefits with adequate mechanisms for cost containment. ![]() Policymakers concluded from past episodes that participation in the new program should be voluntary, with Medicare beneficiaries and taxpayers sharing the costs. Third, the provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 reflect earlier missed opportunities. Second, action has been hampered by divided government, federal budget deficits, and ideological conflict between those seeking to expand the traditional Medicare program and those preferring a greater role for private health care companies. First, prescription drug coverage has usually been tied to the fate of broader proposals for Medicare reform. It identifies several important patterns in policymaking over four decades. This article examines the history of efforts to add prescription drug coverage to the Medicare program.
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