Abstract
Previous efforts by Congress to expand the role of private plans in Medicare have met with limited success. Although the same fate may befall Medicare Advantage (MA), authorized by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, the political environment has changed, and powerful political interests now support Medicare privatization. Only time will tell whether these interests—and the policies they are pursuing—will be sufficient to offset the barriers that historically have limited the role of private plans in Medicare.

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