Medicare plus Choice: An interim report card

While the aim of Medicare+Choice (M+C) was to expand choice, the choices av ailable to Medicare beneficiaries have diminished since its inception: Exis ting plans have withdrawn from M+C, few new plans have entered the program from among the newly authorized plan types, greater choice has not develope d in areas that lacked choice, and the inequities in benefits and offerings between higher- and lower-paid areas of the country have widened rather th an narrowed. Operational constraints probably explain the most immediate de clines in M+C enrollment, but Congress's ability to foster success for M+C will ultimately depend on the way in which historical tensions related to c ompeting goals and ideologies for the Medicare program are resolved.