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Years before "Obamacare," congressional Republicans saw political gold in expanding government's role in health care by adding a prescription drug benefit to Medicare. U.S. Rep. Ron Paul says the "Part D" drug benefit is a reminder that the GOP sometimes can't resist the temptation of big government.
"I'm not all that optimistic (about repealing the Democratic health care law) because when we did have the chance, when the Republicans were in charge, they actually expanded government health care with the prescription drug program," Paul said in a July 16, 2011, interview with the Nashua Telegraph in Derry, New Hampshire. "We've got a long way to go on that."
Because memories can be short, we thought it would be worthwhile to explore whether Paul was right that the GOP was responsible for such a big increase in government.
A bit of background: The Medicare Modernization Act of 2003 was an effort by President George W. Bush in his first term to address a major gap in the senior citizen health care program -- a lack of drug coverage. Bush's political advisers saw the drug plan as a way for Bush to broaden his appeal with seniors.
Early on, the drug benefit had bipartisan support, although many Democrats later abandoned the effort, saying it provided too big a handout to the pharmaceutical industry without requiring enough competition.
A check of the rolls confirmed that the Republicans controlled both houses of Congress at the time of the vote in 2003 and that the bill passed with strong GOP support.
According to voting records, the GOP held a 229 to 205 majority in the House at the time of the Nov. 22 vote, and of the 229 Republicans, 204 voted in favor. Across the hall in the Senate, Republicans held a 51 to 48 majority on Nov. 25 when 42 of the 51 GOP Senators supported the bill. Nine Republican Senators voted against.
In the Senate, only 11 of 47 Democrats approved the bill, with 36 against and two abstaining. And, in the House, only 16 Democrats voted in favor, with 185 against.
Of the current presidential field, Paul voted against the bill, while then-U.S. Sen. Rick Santorum, a Pennsylvania Republican, voted in favor. (We recently checked his claim that the program was coming in below projections.)
The bill had roots in previous Democratic proposals, said Jack Hoadley, a policy analyst at Georgetown University’s Health Policy Institute. But "the version of the drug benefit that passed was certainly the Republican approach -- competing private plans, no government regulation," Hoadley said. "There wasn't a lot of compromising."
So Paul is right about the Republicans being the driving force.
And how much did it expand government? Hugely. The new drug benefit was used by 34.5 million beneficiaries in 2010, and that number is projected to reach 40.5 million in 2015. (Most were already enrolled in Medicare.)
Through 2010, Medicare Part D had cost $203 billion, according to the Congressional Budget Office. The program is expected to cost another $391 billion through 2015, according to CBO projections.
"It was certainly not the first time that Congress tried to improve the system of private plans within Medicare. But it’s fair to say with the addition of the drug benefit, it was the biggest expansion of the program since the beginning," said Paul Van de Water, a senior fellow at the Center on Budget and Policy Priorities, a liberal research group.
"(It) was filling a major gap that existed since the beginning of the program," he said. "That was a real, fundamental change."
So Paul is right on both counts. It was a Republican bill that passed with strong Republican support. And it dramatically increased government. We rate his statement True.
The Library of Congress, "Bill Text, 108th Congress (2003-2004), H.R.1.ENR," 2003
Office of the Clerk, United States House of Representatives, "Final Vote Results for Roll Call 332," Nov. 22, 2003
United States Senate, "U.S. Senate Roll Call Votes, 108th Congress-1st Session," Nov. 25, 2003
Congressional Budget Office, letter from director Douglas Elmendorf to Congressman Maurice D. Hinchey, May 11, 2010
Congressional Budget Office, "March 2011 Medicare Baseline," 2011
Centers for Medicare and Medicaid Services, "2011 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds," 2011
Interview with Judith Feder, professor of public policy at Georgetown University, July 20, 2011
Interview with Robert Zirkelbach, press secretary for America’s Health Insurance Plans, July 20, 2011
Interview with Paul Van de Water, senior fellow at the Center on Budget and Policy Priorities, July 21, 2011
E-mail interview with Allison Bell, associate editor at National Underwriter, July 21, 2011
E-mail interview with Jack Hoadley, policy analyst at Georgetown University’s Health Policy Institute, July 21, 2011
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