[3] The MMA's most touted feature is the introduction of an entitlement benefit for prescription drugs, through tax breaks and subsidies.

As new and expensive drugs have come into use, patients, particularly senior citizens at whom Medicare was targeted, have found prescriptions harder to afford.

With the MMA, new Medicare Advantage plans were established with several substantive differences from the previous Medicare + Choice plans, including: The MMA created a new Health Savings Account statute that replaced and expanded the previous Medical Savings Account law by expanding allowable contributions and employer participation.

[5][6] While nearly all agreed that some form of prescription drug benefit would be included, other provisions were the subject of prolonged debate in Congress.

Under the new legislation, the Fiscal Intermediaries (FIs) and carriers would be replaced by Medicare Administrative Contractors (MAC's), serving both Parts A and B, and would be consolidated into fifteen Jurisdictions:[8] Four "Specialty MAC Jurisdictions" were also created to handle durable medical equipment and home health/hospice claims: Finally, the underlying contracts would be subject to competition, and would also be subject to the requirements of the Cost Accounting Standards and the Federal Acquisition Regulation.

"Billy" Tauzin, the Louisiana Republican who chaired the Energy and Commerce Committee from 2001 until February 4, 2004, was one of the chief architects of the new Medicare law.

[12] It's a sad commentary on politics in Washington that a member of Congress who pushed through a major piece of legislation benefiting the drug industry, gets the job leading that industry.House Democratic leader Nancy Pelosi said,[10] I think if seniors want to know why the pharmaceutical companies made out so well at their expense, all they have to do is look at this.

This is a conflict of interest.The bill was debated and negotiated for nearly six months in Congress, and finally passed amid unusual circumstances.

Next, Republicans Butch Otter (ID-1) and Jo Ann Emerson (MO-8) switched their vote to "aye" under pressure from the party leadership.

Speaker Dennis Hastert and Majority Leader Tom DeLay sought to convince some of dissenting Republicans to switch their votes, as they had in June.

Then-Representative Nick Smith (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."

[14] The Democrats cried foul, and Bill Thomas, the Republican chairman of the Ways and Means committee, challenged the result in a gesture to satisfy the concerns of the minority.

[21] Oregon Representative Peter DeFazio said, "We could provide a much more meaningful benefit if we negotiated lower prices as other nations have done," and his Maine colleague Tom Allen (Maine politician), remarked on the absurdity, "that the government will not be able to negotiate lower prices," for the drugs on which it plans to spend $400 billion in the next decade.

[23] In 2022, the Inflation Reduction Act removed this ban and allowed Medicare to begin negotiating drug prices starting in 2026.