Comparisons between Part D and the ACA are flawed

The Affordable Care Act’s (ACA) disastrous rollout has led to irrational comparisons, finger pointing, and partisan rhetoric about websites, cancelled plans, and cooperation across party lines. Democrats are claiming that they set aside their political opposition ten years ago when the Republicans passed the Medicare Part D program, and worked across the aisle to implement it. According to them, Republicans should return the favor now.

A brief look at the political history of Part D quickly disposes of that argument. Did those voting against the program (a camp that included Republicans and Democrats) oppose the policy to begin with? Quite the opposite. There had been both Republican and Democrat-led proposals for adding prescription drug coverage in Medicare since the program began in 1965. Notable examples are the Medicare Catastrophic Coverage Act of 1988, which added a drug benefit to Medicare but was repealed a year later in 1989 before it could take effect, as well as the Clinton health reform package in early 1990s.

{mosads}The disagreement centered on how to incorporate the new benefit, who should run it, and how much was reasonable for seniors to finance versus taxpayers. Second, this was applied to a subset of the population: Medicare beneficiaries without prescription drug coverage. Lastly, the benefit was optional; the new law would only impact Medicare beneficiaries who chose to sign up for a plan, and private companies were allowed to submit bids if they wished.

Key dissimilarities between the ACA and the Medicare Part D program include widely varied policy goals, a vast difference of scope, and the extent to which individual choice is respected. In stark contrast to Part D, the ACA creates an entirely new entitlement program with the exchange and federal subsidies. In addition, the law expands the broken Medicaid program that was already straining state budgets, imposes a mandate on all American citizens and many employers to purchase coverage, and upends the insurance market such that millions of insured Americans throughout the country are getting notices that their coverage is no longer allowable. These were not policy goals shared by Republicans. People don’t get to choose whether the ACA impacts them, but make no mistake, it will impact them.

During the Medicare Part D debate, the House Republicans had a proposal competing with the Senate Democrats’ proposal. Both achieved the same objective, but went about that in different ways substantively and financially. The Senate bill was estimated to cost double that of the House bill. Ultimately the House version prevailed, but the votes were not strictly along party lines. In the House, 204 Republicans and 16 Democrats voted for the bill while 25 Republicans, 189 Democrats and 1 Independent voted no. In the Senate 43 Republicans and 11 Democrats voted yes while 9 Republicans and 35 Democrats voted no. How does this compare to the ACA? Republicans were cut out of negotiations in the run up to its passage, and the law ultimately failed to receive a single Republican vote in either the House or the Senate.

Republicans opposed the ACA entirely; they didn’t disagree with a page here and a page there, or argue for this tweak or that tweak. In addition, even in states with Democratic led governments that did cooperate with the ACA by setting up their own exchanges and expanding Medicaid, there have been major problems with the rollout. Website glitches, delayed exchanges for small businesses, untrained Navigators and insufficient insurance plan competition in rural areas are issues that have plagued states regardless of their governor’s party affiliation.

Egan is senior Health Care Policy expert at the American Action Forum.