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 in 1974 and the other Medicare Part D, the prescription drug program for the aged and disabled, in 2006. It contrasts the administrative 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. Copyright 2007, Oxford University Press.