ELIMINATE MEDICARE PART D

Ralph Bristol

by Ralph Bristol, Facebook, June 5, 2026 - If the next Republican president wants a first big move, he or she should rescind Medicare Part D, one of the Republican Party’s biggest mistakes. That was the only addition to a major entitlement created and passed almost entirely with Republican support, and I would argue that it’s not working, for either most enrollees or for taxpayers.

FIRST, THE COST

Medicare Part D — the federal prescription drug benefit — covers roughly 56 million Americans. 

The federal government spends approximately $140 billion per year on Part D benefits (net of premiums), representing about 11% of all Medicare spending. This is funded primarily through general tax revenues.

On top of the federal cost, enrollees pay their own monthly premiums, totaling an estimated $21–30 billion per year across all enrollees. The average monthly premium was around $45 in 2024, but plan costs have been surging: bid amounts jumped 42% in 2025 and 35% in 2026, driven largely by the Inflation Reduction Act's redesign of Part D cost-sharing. Republicans created Part D. Democrats “enhanced” it. 

Beyond premiums, enrollees pay out-of-pocket at the pharmacy. Total enrollee cost-sharing is estimated at roughly $22 billion per year (2024).  That’s after President Biden’s Inflation Reduction Act reduced this burden — introducing a $2,000 annual out-of-pocket cap in 2025 and eliminating the "donut hole" — saving enrollees an estimated $7.4 billion annually.

ADDING IT UP

Component Estimated Annual Cost

Federal government (net of premiums) ~$140 billion
Enrollee premiums ~$21–30 billion
Enrollee copays / cost-sharing ~$22 billion
Total gross spending ~$190 billion

Divided across 56 million enrollees, that works out to roughly $3,393 per enrollee per year — about $283 per month.

About 25% of Medicare Part D enrollees pay no additional premium. They are called LIS enrollees. LIS enrollees have heavily subsidized copays, not zero — but they're nominal:

In 2025 LIS enrollees paid:

• $4.90 for generic drugs
• $12.15 for brand-name drugs
• $0 for those in nursing homes or receiving Medicaid (full dual-eligibles pay nothing at all)

There are zero peer-reviewed studies on the question of how many Medicare Part D enrollees would be better off without Part D, and that is what one of my A-I assistants identified as a “policy blind spot.” 

Why the blind spot?  As AI assistant, Claude, explained to me, “The stakeholders who fund research on Part D — CMS, insurers, pharma — all have interests in robust enrollment. Independent consumer-oriented research ("should you personally enroll?") doesn't have a natural funder. Academic researchers tend to study program-level outcomes rather than individual value propositions.”

How convenient. 

Ralph Bristol is the former long-time morning talk radio host broadcasting on Supertalk 99.7 WTN. He was one of the less provocative and bombastic of conservative radio personalities, more thoughtful and grounded in conservative ideas. He left talk radio in 2018 and retired. He lives in Nashville. 

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