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How Democrats Helped Republicans Save BushCare

October 21, 2013

President Obama held a public event on Monday to address the serious problems plaguing the federal online health care exchange serving the 34 states which refused to create their own. Echoing former Speaker Nancy Pelosi's pronouncement that the web site difficulties are "unacceptable," Obama insisted, "There's no excuse for these problems" hampering the launch of the Affordable Care Act's insurance marketplaces. Just as important, the President declared, "It's time for folks to stop rooting for its failure because hard working middle class families are rooting for its success."

Which is exactly right. After all, when President Bush's Medicare prescription drug program nearly crashed and burned in late 2005 and early 2006, Democrats in Washington and in the states stepped in to save it.
As Americans should recall, the Bush administration rollout of the Medicare drug benefit for 43 million elderly Americans was a disaster. Ohio Congressman John Boehner admitted as much to Fox News in February 2006 when he lamented that two years after its passage, "The implementation of the Medicare plan has been horrendous." As Ezra Klein recently recounted, in his rare moment of candor the future Speaker was right:

In 2006, the bill went into effect. It was a disaster. Computer systems didn't communicate with one another. Seniors were confused. Some of the poorest and sickest enrollees -- "dual eligibles" who qualify for aid under both Medicare and Medicaid -- weren't able to get their drugs. It was so bad that in his 2006 State of the Union address, Bush "said nothing about the new Medicare prescription drug program, an initiative Republicans once hoped to trumpet but has angered many seniors in its implementation," reported the Washington Post.

Much like Republican opponents of the Affordable Care Act in 2010, most Democratic Senators and almost all Democratic House members voted against Bush's Medicare Rx plan because they considered it an unnecessarily expensive, unfunded giveaway to insurance companies and pharmaceutical firms. But unlike Republican obstructionists who went to the Supreme Court, attempted to repeal and defund the law, blocked the expansion of Medicaid, refused to set up their own state health care exchanges, sought to cut-off funds for Obamacare "navigators," tried to halt spending on outreach and customer service, and even proclaimed they would refuse to answer constituent calls, Democrats at all levels helped save Bush's signature health care achievement from its disastrous roll-out. As then-Senator Hillary Clinton reasoned in 2006:

"I voted against it, but once it passed I certainly determined that I would try to do everything I could to make sure that New Yorkers understood it, could access it, and make the best of it."

When Wisconsin Senator Kohl, the ranking Democrat on the Senate Select Committee on Aging asked his colleagues "to put aside any partisan thoughts to work together to get this program running," Democratic governors were already spending billions of dollars to help out.
As the Washington Post reported in January 2006, "Two weeks into the new Medicare prescription drug program, many of the nation's sickest and poorest elderly and disabled people are being turned away or overcharged at pharmacies, prompting more than a dozen states to declare health emergencies and pay for their life-saving medicines." Roughly 6.4 million seniors who just days earlier had gotten their prescriptions for free faced the prospect of going without because of untrained pharmacists and computer glitches. By January 16th, 2006, the New York Times reported, many states (most of them led by Democrats) came to their rescue:

About 20 states, including California, Illinois, Ohio, Pennsylvania and all of New England, have announced that they will help low-income people by paying drug claims that should have been paid by the federal Medicare program.

Among the governors taking action were future Obamacare foes Tim Pawlenty and Mike Huckabee, who declared a health emergency in his state of Arkansas. The fiasco prompted the Bush administration to take drastic measures:

With tens of thousands of people unable to get medicines promised by Medicare, the Bush administration has told insurers that they must provide a 30-day supply of any drug that a beneficiary was previously taking, and it said that poor people must not be charged more than $5 for a covered drug.

It's no wonder why Paul Krugman summed up the whole catastrophe as "D for Debacle."
The headlines in late 2005 and early 2006 tell the tale. The launch of the enrollment period for 43 million seniors to use their new drug benefit to purchase prescription coverage from private insurers was met with stories like "Medicare prescription drug plan stump seniors" (USA Today) and "Officials' pitch for drug plan meets skeptics" (New York Times). In mid-October 2005, Bush administration officials delayed the launch of their new prescription drug comparison web site for a few days, ostensibly to avoid offending Jewish Americans during Yom Kippur. Almost a month later, the site was still idle, prompting the Washington Post to conclude, "The rollout of the new Medicare drug benefit has been anything but smooth." Well into 2006, the Bush administration was dogged by stories like "Medicare drug plan still not generating much enthusiasm" and "majority of Americans say drug plan is not working" (Gallup).
But the very rocky start did not spell doom for the Medicare drug program. As Sarah Kliff of the Washington Post explained earlier this year, "Part D was less popular than Obamacare when it launched":

Eight years ago, the federal government rolled out Medicare Part D, a prescription drug benefit. For the first time ever, Medicare was launching a benefit administered exclusively through private health insurance plans. The benefit was not popular: In the spring of 2005, when enrollment efforts ramped up, polls showed Medicare Part D to be less popular than the Affordable Care Act. Fewer Americans felt they understood how it worked, too...
Neither was especially popular in the months prior to their launch. Part D was even less liked: 21 percent of the public had a favorable opinion of the program in April 2005 compared to 35 percent in April 2013 for the Affordable Care Act.

Part of the reason for Part D's rebound was simple. For tens of millions of American seniors, Part D was better than the alternative: nothing. As the Bush administration's bureaucratic bungles were ironed out over time (aided in large part by governors who stepped into provide resources, support and cash), public support increased. By October 2012, the Kaiser Family Foundation reported, "Survey finds seniors satisfied with Medicare Part D." As USA Today summed up the findings from Medicare Today last fall:

A new poll sponsored by a health care group shows that 90% of seniors are satisfied with the program known as Medicare Part D, and approval has constantly risen since the plan came on line in 2006.
"Nearly seven years later, 9 in 10 Medicare beneficiaries have prescription drug coverage," says the poll. "Satisfaction among those with Medicare Part D has grown 12 points from 78% to 90%. Most are very satisfied with their coverage and say their plan offers excellent value, reasonable costs, and convenience."

In June, the reliably Republican Wall Street Journal also reported on the parallels between Medicare Part D then and Obamacare now. Reviewing an analysis by the Robert Wood Johnson Foundation (RWJF), the Journal explained:

Past efforts to design and launch a large national health coverage program suggest that the experience will be far from perfect, at least at the outset. However, the Medicare Part D experience teaches us that, when things went awry, federal and state officials were often able to identify problems and work with stakeholders to develop policy and operational solutions, so that consumers could obtain the promised benefits.

Alas, it is on that last point where the paths of Part D and Obamacare diverge. Unlike Democrats then, Republican officials at all level are trying to sabotage a health care reform designed to help millions of Americans. Rooting for its failure--precisely what was unthinkable for Democrats in 2005 and 2006--is now standard operating procedure for Republicans.


Jon Perr
Jon Perr is a technology marketing consultant and product strategist who writes about American politics and public policy.

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