Commentary: Big Tent Ideas

The Bill Is Coming Due For Democrats’ Medicare Overhaul

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Democrats have made affordability a central theme of their midterm campaign. In these closing weeks before the election, Republicans should hold them to account for the unsustainable costs of the Medicare prescription drug overhaul they passed in 2022 without a single Republican vote.

The Inflation Reduction Act promised lower prescription costs and savings for taxpayers. Its cap on seniors’ out-of-pocket spending helped patients with expensive medicines. But the remaining costs did not disappear. They landed elsewhere in the program, and the promised federal savings have turned into projected losses.

The Trump administration can correct flaws in how the law is being implemented. Congress must address the financing problems written into the statute. Democrats should not be left to campaign on affordability unopposed while refusing to address the higher costs their own law helped create.

The Congressional Budget Office (CBO) originally estimated that the law’s drug-price negotiations, inflation rebates and benefit redesign would reduce federal deficits by $129 billion between 2022 and 2031. It now projects that those same provisions will increase deficits over that period. The promised savings from negotiation and rebates fell short, while the cost of Democrats’ changes to Part D’s coverage and financing blew past projections. Democrats promised to reduce federal deficits. Their overhaul is now projected to increase them.

The spending forecast is worse. CBO now projects that Part D will cost about $700 billion more from 2026 through 2035 than previously estimated. Roughly $550 billion of that increase reflected new information from insurers’ 2026 bids. CBO identified Democrats’ benefit overhaul as the leading driver of those higher bids, although it could not isolate the overhaul’s share of the overall spending increase.

Seniors are also losing choices. The number of stand-alone prescription drug plans, which serve beneficiaries in traditional Medicare, fell from 766 in 2022 to 360 in 2026. More than half disappeared in four years. Low-income beneficiaries in Florida and Texas had just one benchmark plan available without a premium in 2026. For seniors trying to find affordable coverage for their prescriptions, fewer plans mean fewer places to turn.

The remaining plans are also covering fewer medicines in some drug classes. A study of 59 brand-name drugs in competitive classes found that the average share of stand-alone plan enrollees with coverage for those medicines fell from about 47% in 2024 to 36% in 2026. Seniors face fewer plan choices and narrower drug coverage. They are also being asked to pay more before their plans pick up the tab.

The average stand-alone plan deductible rose from $425 in 2024 to $544 in 2026. Seniors subject to those deductibles must pay more at the pharmacy counter before their plans begin sharing the cost.

Washington, meanwhile, has helped stave off premium increases by sending more of the bill to taxpayers. Before offsets, the law’s premium-growth cap increased direct subsidy costs by $33 billion during 2024–2026. A separate stabilization program added $10.7 billion during 2025–2026.

Those subsidies buy time but leave taxpayers footing a bigger bill. Repairing Part D will require action from both the Trump administration and Congress.

The Trump administration should start by using its rulemaking authority to change how the Drug Price Negotiation Program sets prices, including excluding generic prices from the calculation of negotiated drugs’ Maximum Fair Prices.

But the administration cannot rewrite the statute through rulemaking. Congress must address how Part D divides costs among the government, insurers and manufacturers. The goal should be to protect seniors from catastrophic prescription expenses while preserving competing plans and limiting taxpayers’ exposure.

Getting that done in a lame-duck session is a long shot. Democrats would have to help change a law they are still selling as a success. Republicans should make Democrats explain that refusal to voters.

Republicans should put Part D’s higher costs and shrinking plan choices before voters now, while ballots are being cast, and demand that every Democrat campaigning on affordability commit to helping repair the program when Congress returns.

Democrats sought the credit for overhauling Part D. They should help provide the votes to repair it.

John Czwartacki, former senior advisor at the White House Office of Management and Budget, is co-founder and principal of Public Policy Solutions.

The views and opinions expressed in this commentary are those of the author and do not reflect the official position of the Daily Caller News Foundation.