The Medicare Prescription Drug, Modernization, and Improvement Act of 2003: Why it Passed and What it Says About the State of American Politics

In recent years, senior citizens have called upon government to add a benefit to Medicare to cover prescription drugs, upon which they are increasingly reliant. Late in 2003, Congress and President Bush approved the Medicare Prescription Drug, Modernization and Improvement Act of 2003 (MPDMIA), adding a prescription drug benefit to Medicare, the primary health care provider for Americans over 65. Considering that there was broad public support for such reform, MPDMIA appears to be a breakthrough. However, closer examination suggests that the bill falls short of seniors' need. After the drug benefit is implemented in 2006, seniors' out-of pocket drug costs will remain high and many will lose their retiree benefits because of the legislation. Also of concern, the stability of Medicare as a whole may be threatened due to privatization mandates in the bill. This paper explains the puzzles behind MPDMIA's passage, first uncovering motivations of the Republican Party and pharmaceutical industry. Next, the paper discloses information behind Democratic support of the legislation and that of AARP, formerly known as American Association of Retired Persons. Evidence suggests that some lawmakers' decisions were inappropriately manipulated by the bill's proponents, and that AARP's support of the bill, which was an influential factor for legislators, did not in fact reflect the interests of seniors. Finally, the analysis of the creation and passage of MPDMIA exposes a breakdown in the central tenet of representation in American democracy. More specifically, the success of this policy indicates the failure of groups to represent their members and of elected officials to represent their constituents and the public good.