The Medicare Prescription Drug, Improvement, and Modernization Act (Public Law No. 108-173, 117 Stat. 2066, also called "MMA legislation") is a law of the United States that was enacted in 2003.^[1] It produced the largest overhaul of Medicare in its 38-year history. President Johnson signing the Medicare amendment. ...

It was signed by President George W. Bush on December 8, 2003, after passing in Congress by a close margin. George Walker Bush (born July 6, 1946) is the 43rd and current President of the United States, inaugurated on January 20, 2001. ... Type Bicameral Houses Senate House of Representatives President of the Senate Dick Cheney, R, since January 20, 2001 Speaker of the House Dennis Hastert, R, since January 6, 1999 Members 535 plus 4 Delegates and 1 Resident Commissioner Political groups (as of January 4, 2005 elections) Democratic Party Republican Party...

One month later, the ten-year cost estimate was boosted to $534 billion, up more than $100 billion over the figure presented by the Bush administration during Congressional debate. The inaccurate figure helped secure support from fiscally conservative Republicans who had promised to vote against the bill if it cost more than $400 billion. It was reported that administration officials had concealed the higher estimate and threatened to fire government analyst Richard Foster if he revealed it.^[2] The Bush administration includes President George W. Bush, Vice President Richard Cheney, Bushs Cabinet, and other select officials and advisors. ... Conservatism is a political philosophy that generally favors free markets, traditional values and strong foreign defense. ... Richard Foster Richard J. Foster is a Christian theologian and author in the Quaker tradition, though his writings speak to a broader Christian audience. ...

Prescription drug benefit

Main article: Medicare Part D

Its most touted change is the introduction of an entitlement benefit for prescription drugs, through tax breaks and subsidies. Medicare Part D is a federal program to subsidize the costs of prescription drugs for Medicare beneficiaries in the United States. ... Entitlement is the guarantee for access to benefits because of rights, or by agreement through law. ... A prescription drug (or POM Prescription Only Medicine, in UK) is a licensed medicine that is regulated by legislation to require a prescription before it can be obtained. ...

In the years since Medicare's creation in 1965, the role of prescription drugs in U.S. patient care has significantly increased. As new and expensive drugs have come into use, patients, particularly senior citizens for whom Medicare was designed, have found prescriptions harder to afford. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA), is meant to address this problem. A prescription drug (or POM Prescription Only Medicine, in UK) is a licensed medicine that is regulated by legislation to require a prescription before it can be obtained. ... Motto: (Out Of Many, One) (traditional) In God We Trust (1956 to date) Anthem: The Star-Spangled Banner Capital Washington D.C. Largest city New York City None at federal level (English de facto) Government Federal constitutional republic  - President George Walker Bush (R)  - Vice President Dick Cheney (R) Independence from... Old age consists of ages nearing the average lifespan of human beings, and thus the end of the human life cycle. ...

The benefit is funded in a complex way, reflecting the diverse priorities of the lobbyists and constituencies whose support was needed: It has been suggested that Interest representation: Academic overview be merged into this article or section. ...

• it provides a subsidy for large employers to discourage them from eliminating private prescription coverage to retired workers (a key AARP goal; the 2005 Annual Report for IBM estimates that company will receive a $400 million subsidy during the six-year period beginning in 2006);^[3]
• it prohibits the Federal government from negotiating discounts with drug companies;
• it prevents the government from establishing a formulary, though does not prevent private providers such as HMOs from doing so.

AARP (formerly, but no longer, known as the American Association of Retired Persons) is a United States-based non-government organization dedicated to the interests of persons aged 50 and over. ... An annual report is a document which a company presents to its Annual General Meeting for approval by its shareholders. ... Big Blue redirects here. ... A Health Maintenance Organization (HMO) is a type of Managed Care Organization (MCO) that provides a form of health insurance coverage in the United States that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract. ...

Basic prescription drug coverage

Beginning 2006, a prescription drug benefit, called Medicare Part D, will be available though with substantial out-of-pocket costs. Coverage will be available only through insurance companies and HMOs. Though enrollment will be "voluntary," there will be considerable financial pressure to enroll at once. (It will be costly to enroll at a later time.) Medicare Part D is a federal program to subsidize the costs of prescription drugs for Medicare beneficiaries in the United States. ... Out-of-pocket expenses are direct outlays of cash which are not reimbursed. ...

Benefit: Enrollees will pay the following initial costs for the initial benefits described herein. A minimum monthly premium of $37.23 ($446.76 per year) (premiums may vary), a $250 annual deductible, 25% of costs up to $2,250, 100% of costs up to $5,100 (a gap of $2,850) commonly referred to as the "Donut Hole", and 5% of costs above $5,100. Within the Medicare Part D prescription drug program, the Donut Hole (or Doughnut Hole) is the phase of coverage in which all costs are covered by the enrollee rather than CMS. The term coverage gap is preferred by CMS and Prescription Drug Plans, but Donut Hole has been more widely...

Medicare Advantage plans

With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the Original Medicare plan (Parts A and B). These programs were known as "Medicare+Choice" or "Part C" plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the compensation and business practices for insurers that offer these plan changed, and "Medicare+Choice" plans became known as "Medicare Advantage" (MA) plans. In addition to offering comparable coverage to Part A and Part B, Medicare Advantage plans may also offer Part D coverage. The Balanced Budget Act of 1997, Pub. ... This Is not a good source Health insurance is a type of insurance whereby the insurer pays the medical costs of the insured if the insured becomes sick due to covered causes, or due to accidents. ...

Changes to plans

When the Medicare + Choice option was first offered, plans were established by several major health care insurers including Humana, Aetna, and the Blue Cross/Blue Shield plans. These plans were organized along traditional HMO (Health Maintenance Organization) business plans, but patients could freely switch back to traditional Medicare insurance. Some felt that these plans lacked the ability to truly manage care,^[4] and some plans did cut back their service areas and stopped enrolling new patients.^[5][6]

With the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, new Medicare Advantage plans were established with several advantages over the previous Medicare + Choice plans:

• enrollees sign on for a whole year
• care can be restricted to networks of providers
• formularies can be used to restrict prescription drug choices
• prescription coverage can be deferred to the patient or a Medicare Part D prescription plan
• care other than emergency care can be restricted to a particular region
• federal reimbursement can be adjusted according to the health risk of the enrollees

The attraction for health insurers is the large difference between normal healthcare premiums and the federal Medicare premium. Typical health insurance premiums (for someone working or healthy enough to be allowed to enroll) are generally $150 to $350 a month, depending on the level of service desired, health status, and deductibles. For a healthy Medicare-eligible enrollee, the health insurer can receive around $800 a month, more than double the premium for younger citizens. This federal premium can increase to $2000 a month through a complex risk adjustment involving the health status of the eligible enrollee.^[7] These plans are being aggressively marketed. Among other benefits, the senior gets an immediate financial boost, as many plans let them skip paying Part B and Part D premiums, waive usual deductibles, and waive copays, all while covering preventive physicals and providing a prescription drug benefit. While the insurance plan can realize immense initial profits, every single Medicare enrollee, no matter their underlying health status, can be expected to undergo between one and six life threatening major illnesses before they die. The pathology and illnesses associated with aging are innumerable and ultimately unbeatable. A copayment, or copay, is a flat dollar amount paid for a medical service by an insured. ...

The ultimate economic viability of a Medicare Advantage plan will not be known for 10 to 15 years. For seniors, the initial cost savings is balanced against insurance companies’ healthcare rationing through restrictive prescription drug formularies, requiring documentation of medical necessity for imaging studies such as CT scans and MRIs, decreasing physician access, and rationing of lab tests, and ancillary care. Medical necessity is generally considered that which is reasonable, necessary, and/or appropriate based on evidence-based clinical standards of care. ...

Other provisions

While nearly all agreed that some form of prescription drug benefit would be included, other provisions were the subject of prolonged debate in Congress. The complex legislation also changes Medicare in the following ways: Type Bicameral Houses Senate House of Representatives President of the Senate Dick Cheney, R, since January 20, 2001 Speaker of the House Dennis Hastert, R, since January 6, 1999 Members 535 plus 4 Delegates and 1 Resident Commissioner Political groups (as of January 4, 2005 elections) Democratic Party Republican Party...

• it mandates a six-city trial of a partly-privatized Medicare system (by 2010);
• it gives an extra $25 billion to rural hospitals (at the request of congressional representatives in the rural West);
• it requires higher fees from wealthier seniors; and
• it adds a pretax health savings account for working people.

One of the little known features of the 2003 legislation is that means testing for Medicare B (medical insurance) begins in 2007. The Health savings account (HSA) is the new name for the Medical savings account (MSA) plans in the United States. ...

Legislative history

The bill was debated and negotiated for nearly six years in Congress, and finally passed amid unusual circumstances. Several times in the legislative process the bill had appeared to have failed, but each time was saved when a couple of Congressmen and Senators switched positions on the bill.

The bill was introduced in the House of Representatives early on June 25 as H.R. 1, sponsored by Speaker Dennis Hastert. All that day and the next the bill was debated, and it was apparent that the bill would be very divisive. In the early morning of June 27, a floor vote was taken. After the initial electronic vote, the count stood at 214 ayes, 218 noes. Seal of the House of Representatives The United States House of Representatives (or simply the House) is one of the two chambers of the United States Congress, the other being the Senate. ... Federal courts Supreme Court Chief Justice Associate Justices Elections Presidential elections Midterm elections Political Parties Democratic Republican Third parties State & Local government Governors Legislatures State Courts Counties, Cities, and Towns Other countries â€¢ Politics Portal      The Speaker of the United States House of Representatives is the presiding officer of the lower... John Dennis Hastert (born January 2, 1942) is an American politician, and outgoing Speaker of the United States House of Representatives. ...

Three Republican representatives then changed their votes. One opponent of the bill, Ernest J. Istook, Jr. (R-OK-5), changed his vote to "present" upon being told that C.W. Bill Young (R-FL-10), who was absent due to a death in the family, would have voted "aye" if he had been present. Next, Republicans Butch Otter (ID-1) and Jo Ann Emerson (MO-8) switched their vote to "aye" under pressure from the party leadership. The bill passed by one vote, 216-215. Ernest James Istook Jr. ... Charles William Bill Young, also known as C.W. Bill Young, (born December 16, 1930), American politician, has been a Republican member of the United States House of Representatives since 1971, representing the 10th District of Florida. ... Rep. ... Jo Ann Emerson (born September 16, 1950) is a politician from Missouri, currently serving her fifth term as the Republican member of the United States House of Representatives from the states 8th Congressional district. ...

On June 26, the Senate passed its version of the bill, 76-21. The bills were unified in conference, and on November 21, the bill came back to the House for approval. Former U.S. House Majority Leader Dick Armey, an influential Republican working as Chairman of the limited government group FreedomWorks, wrote an op-ed the day of the vote in the Wall Street Journal opposing the bill.^[8] Dick Armey on NBCs Meet the Press. ... FreedomWorks is a non-partisan but decidedly conservative non-profit organization based in Washington D.C. with over 700,000 grassroots activists who recruit, educate, motivate and mobilize volunteers who desire less government, lower taxes, and more economic freedom. ... An Op-Ed is a piece of writing expressing an opinion. ...

The bill came to a vote at 3 a.m. on November 22. After 45 minutes, the bill was losing, 219-215, with David Wu (D-OR-1) not voting. Speaker Dennis Hastert and Majority Leader Tom DeLay sought to convince some of dissenting Republicans to switch their votes, as they had in June. Istook, who had always been a wavering vote, consented quickly, producing a 218-216 tally. In a highly unusual move, the House leadership held the vote open for hours as they sought two more votes. Then-Representative Nick Smith (U.S. politician) (R-MI) claimed he was offered campaign funds for his son, who was running to replace him, in return for a change in his vote from "nay" to "yea," but later recanted.^[9] Congressman David Wu David Wu (Traditional Chinese: 吳振偉; pinyin: Wú Zhènwěi; born April 8, 1955) is a Democratic member of the U.S. House of Representatives for Oregon, representing the states 1st Congressional District (map). ... John Dennis Hastert (born January 2, 1942) is an American politician, and outgoing Speaker of the United States House of Representatives. ... Thomas Dale Tom DeLay (born April 8, 1947) is a former member of the United States House of Representatives from Sugar Land, Texas. ... Nick H. Smith (born November 5, 1934), is a politician from the U.S. state of Michigan, who served as a Republican member of the United States House of Representatives from 1993 until 2005, representing from the 7th District of Michigan. ...

About 5:50 a.m., convinced Otter and Trent Franks (AZ-2) to switch their votes. With passage assured, Wu voted yea as well, and Democrats Calvin M. Dooley (CA-20), Jim Marshall (GA-3) and David Scott (GA-13) changed their votes to the affirmative. But Brad Miller (D-NC-13), and then, Republican John Culberson (TX-7), reversed their votes from "yea" to "nay". The bill passed 220-215. Trent Franks Trent Franks (born June 19, 1957), American politician, has been a Republican member of the United States House of Representatives since 2003, representing the 2nd District of Arizona (map). ... Calvin M. Dooley (born January 11, American politician, was a Democratic member of the United States House of Representatives from 1991 to 2005, representing the 20th District of California. ... James Creel Jim Marshall (born March 31, 1948) is an American politician, and has been a Democratic member of the United States House of Representatives since 2003, representing the 3rd District of Georgia (map). ... David Randolph Scott (born June 6, 1932) a former NASA Astronaut, was one of the third group of astronauts named by NASA in October 1963 and is one of only twelve men who have walked on the moon. ... Ralph Bradley Brad Miller (born May 19, 1953) is an American politician from North Carolina, representing the states Thirteenth District in the U.S. House of Representatives. ... John Abney Culberson (born August 24, 1956), American politician, has been the Republican congressman representing the Texas 7th congressional district (map) in the U.S. House of Representatives since 2001. ...

The Democrats cried foul, and Bill Thomas, the Republican chairman of the Ways and Means committee, challenged the result in an empty gesture to satisfy the minority. He subsequently voted to table his own challenge; the tally to table was 210 ayes, 193 noes. Bill Thomas For other people named William Thomas, see William Thomas. ...

The Senate's consideration of the conference report was somewhat less heated, as cloture on it was invoked by a vote of 70-29.^[10] However, a budget point of order raised by Tom Daschle, and voted on. As 60 votes were necessary to override it, the challenge was actually considered to have a credible chance of passing. In parliamentary procedure, cloture (pr: KLO-cher) (also called closure, and sometimes a guillotine) is a motion or process aimed at bringing debate to a quick end. ... Thomas Andrew Daschle (born December 9, 1947), known as Tom Daschle, was a U.S. Senator from South Dakota and the Senate Majority Leader. ...

For several minutes, the vote total was stuck at 58-39, until Senators Lindsey Graham (R-SC), Trent Lott (R-MS), and Ron Wyden (D-OR) voted in quick succession in favour to pass the vote 61-39.^[11] The bill itself was finally passed 54-44 on November 25, 2003, and was signed into law by the President on December 8.^[12] Lindsey Olin Graham (born July 9, 1955) is an American politician from South Carolina. ... Chester Trent Lott (born October 9, 1941 in Grenada, Mississippi) is a United States Senator from Mississippi and a member of the Republican Party. ... Ronald Lee Wyden (born May 3, 1949) to German American parents, is Oregons senior United States Senator. ...

See also

• Citizens' Health Care Working Group
• Medicaid
• Medicare (United States)
• Medicare dual eligible
• Medicare Part D
• National pharmaceuticals policy
• Pharmaceutical company
• Pharmacology
• Prescription drug prices in the United States

The Citizens Health Care Working Group (CHCWG) is charged with listening to the opinions of the general public about how the government can make health care work better for all Americans. ... Medicaid is the US health insurance program for individuals and families with low incomes and resources. ... President Johnson signing the Medicare amendment. ... This article or section is in need of attention from an expert on the subject. ... Medicare Part D is a federal program to subsidize the costs of prescription drugs for Medicare beneficiaries in the United States. ... A National Pharmaceuticals Policy is one that aims at ensuring that people get good quality drugs at the lowest possible price, and that doctors prescribe the minimum of required drugs in order to treat the patients illness. ... A pharmaceutical company, or drug company, is a company licensed to discover, develop, market and distribute drugs. ... Pharmacology (in Greek: pharmacon (φάρμακον) meaning drug, and logos (λόγος) meaning science) is the study of how substances interact with living organisms to produce a change in function. ... Prescription drug prices in the United States are significantly higher than in Canada and other countries, many of which have price controls. ...

References

1. ^ http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/01_Overview.asp
2. ^ http://dir.salon.com/story/news/feature/2004/04/05/medicare/index.html
3. ^ Notes to Consolidated Financial Statements, p. 95 (from IBM's 2005 Annual Report)
4. ^ "Starting Medicare Advantage Plan Brings Special Set of Problems", Managed Care Magazine, April 2005.
5. ^ "The Failure of Medicare+Choice", Geriatric Times, March/April 2003.
6. ^ "More HMOs Exit Medicare", South Florida Business Journal, July 11, 2000.
7. ^ Fact Sheet:Federal Payment Methodology to Medicare Health Plans.
8. ^ Armey, Dick (November 21). Say 'No' to the Medicare Bill. Retrieved on November 26, 2006.
9. ^ http://www.foxnews.com/story/0,2933,104954,00.html
10. ^ http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=108&session=1&vote=00457
11. ^ http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=108&session=1&vote=00458
12. ^ http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=108&session=1&vote=00459

Big Blue redirects here. ...

External links

Medicare

• Centers for Medicare & Medicaid Services (CMS)
  • Medicare Modernization Act — includes PDF file of the actual text of the law.
• Medicare.gov — the official website for people with Medicare
  • Medicare Modernization Act at Medicare.gov
  • Prescription Drug Coverage homepage at Medicare.gov — a central location for Medicare's web-based information about the Part D benefit
    • Enroll in a Medicare Prescription Drug Plan at Medicare.gov — the web-based tool for enrolling online in a Part D plan
  • Medicare Plan Choices at Medicare.gov — basic information about plan choices for Medicare beneficiaries, including Medicare Advantage Plans
  • Prescription Drug Information Medicare Information — Web-based information about the Part E benefit
    • Medicare Personal Plan Finder at Medicare.gov — more detailed information about Medicare Advantage Plans; includes ability to do tailored searches based on specified criteria
  • Landscape of plans — state-by-state breakdown of all plans available an area, both Stand-alone Part D plans, as well as Medicare Advantage plans
  • Official Medicare publications at Medicare.gov — includes official publications about current Medicare benefits
    • Medicare & You handbook for 2006 at Medicare.gov — includes information about current Medicare benefits
  • Information about the 1-800-MEDICARE helpline from Medicare.gov — a 24X7 toll-free number where anyone can call with questions about Medicare
• Read Congressional Research Service (CRS) Reports regarding the Medicare Prescription Drug Act

A toll-free telephone number (or Freephone number in the UK) is a special telephone number, in which the calling party is not charged for the call by the telephone operator. ...

Other articles

• "The Great Society Meets the 21st Century", by Michael Johns, Orthopedic Technology Review, January 2004.
• "Medicare Q&A Weekly Column", The Kaiser Family Foundation.