Medicare+Choice: an interim report card.

While the aim of Medicare+Choice (M+C) was to expand choice, the choices available to Medicare beneficiaries have diminished since its inception: Existing plans have withdrawn from M+C, few new plans have entered the program from among the newly authorized plan types, greater choice has not developed in areas that lacked choice, and the inequities in benefits and offerings between higher- and lower-paid areas of the country have widened rather than narrowed. Operational constraints probably explain the most immediate declines 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 competing goals and ideologies for the Medicare program are resolved.