Punishing the Pioneers: The Medicare Modernization Act and State Pharmacy Assistance Programs

William G. Weissert and Edward Alan Miller

Publius: The Journal of Federalism, 2005, vol. 35, issue 1, 115-141

Abstract: The adoption of the new Medicare prescription drug benefit in 2003 added yet another iteration to the action-reaction or interactive style of federalism that has characterized this complex policy area for three decades. Though the federal government benefited from state-level policy learning, it penalizes states that were most generous and innovative in their experimentation with pharmaceutical assistance by making them pay for much of the program's costs. The federal government will administer the new benefit, leveling many state-to-state differences in drug coverage, but at the price of standardizing the program under federal rules and punishing pioneering states for their initiative. This precedent may come back to haunt federal-state relationships by discouraging risk taking that might lead to similarly adverse outcomes for innovative states in the future. Copyright 2005, Oxford University Press.

Date: 2005
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