Close observers of politics surrounding the Medicare Prescription Drug, Improvement
and Modernization Act (MMA) of 2003 offer different explanations for this odd reversal. But
perhaps the most common story is that the health care industry, allied with the Republicans in
Congress whose campaigns they helped finance, were able to rewrite the expansion of the
elderly’s safety net in a way that favored corporate interests. For example, Representative Peter
Stark of California, the ranking Democrat on the Ways and Means Committee, has claimed that
the law “was written by insurance company lobbyists with the help of pharmaceutical company
Such is good muck for the muckraker, the kind often splattered at politicians by critics
and cynics and by politicians at their colleagues on the opposite side of the aisle. But is it true?
To what extent did the private sector interests shape the behavior of legislators in MMA
deliberations through monetary means? Despite the charges, no systematic evidence has been
brought to bear on this question. More generally, the social scientific evidence that campaign
contributions affect health policymaking is thin.
We begin to sort out the effects of the health industry’s campaign contributions in the
debate over the Medicare prescription drug bill. Unlike previous studies, we focus on what we
take to be the proximate political objective of such contributions, namely, to gain access to the
offices of the legislative recipients.
We ask, in the MMA debate, who got access to whom and why? In answering this
question, we examine the effects of political action committee (PAC) contributions, and we
provide the first test of soft money’s impact on the access of lobbyists to legislators. Often
reaching millions of dollars, the unlimited contributions to party campaign committees were
thought especially harmful to democratic processes prior to their ban in 2002. If their access was
for sale, the 2003 MMA was the last chance for partisans in Congress to pay back their party’s
soft money benefactors from the health care industry. At the same time, the abolition of soft
3
Freudenheim, Milt, “A Benefit for Insurers; Medicare Drug Plan Feeds More Profitable Managed Care.”
New York Times, March 31, 2006.
2
Convention