Going Federal: The Launch of Medicare Part D Compared to SSI

This essay compares early experience with implementing two strongly centralizing acts in the field of social welfare, one the Supplemental Security Income program in1974 and the other Medicare Part D, the prescription drug program for the aged and disabled, in 2006. It contrasts the admin-istrative chaos that characterized the launch of SSI with a smoother transition in Part D, arguing that there was less dislocation in the assignment of key administrative responsibilities in the later case. The main findings for federalism are common to the cases: both culminated in a residual, purely supplemental role for the state governments, which the federal government treated as ‘‘subordinately useful.’ ’ Yet, individual state governments were able to negotiate successfully with federal administrative agencies for favorable treatment within the new regime. At first glance, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which was one of the leading legislative achievements of President George W. Bush’s first term, does not have much to do with federalism. The principal purpose of the act was to expand the federal government’s Medicare program to include coverage of prescription drugs for the elderly and disabled. The principal issues over the new Part D of Medicare had to do with scope of coverage