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The Delegated Welfare StateMedicare, Markets, and the Governance of Social Policy$
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Kimberly J. Morgan and Andrea Louise Campbell

Print publication date: 2011

Print ISBN-13: 9780199730346

Published to Oxford Scholarship Online: January 2012

DOI: 10.1093/acprof:oso/9780199730346.001.0001

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Crafting the Medicare Modernization Act of 2003

Crafting the Medicare Modernization Act of 2003

Chapter:
(p.107) 5 Crafting the Medicare Modernization Act of 2003
Source:
The Delegated Welfare State
Author(s):

Kimberly J. Morgan

Andrea Louise Campbell

Publisher:
Oxford University Press
DOI:10.1093/acprof:oso/9780199730346.003.0005

Chapter five examines the passage of the Medicare Modernization Act of 2003—a major social policy reform that delegates responsibility for a Medicare prescription drug benefit to commercial firms. The chapter argues that the Republican Congressional leadership used this form of delegated governance to reconcile competing electoral and free-market aims. Republicans faced intense pressure to address popular demands for a drug benefit but needed a policy that furthered long-term goals of marketization or even privatization of federal entitlements. To help build support for the reform, the Republican leadership enlisted interest group allies like the pharmaceutical and insurance industries, and they delegated powers to private actors with these groups in mind. They also used administrative design as a way to reconcile the competing preferences of conservatives worried about the creation of a vast new entitlement and mass public demand for a universal benefit. The result was a complex system of delegated governance, an extraordinarily complicated piece of legislation designed to meet the desires of many different factions.

Keywords:   Medicare Modernization Act, prescription drug benefit, medicare Advantage, pharmaceutical industry, Republican Party, U.S. Congress

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