President Trump can reduce the damage
The Inflation Reduction Act promised lower costs and better care. Four years later, seniors are losing choices, taxpayers are paying more, and Biden’s architects remain influential in executing a plan that is hurting President Trump politically from the inside.
For millions of America’s seniors, Joe Biden’s Inflation Reduction Act promises are colliding with a wildly different outcome: fewer plans, shrinking prescription drug coverage, and higher costs. And nowhere is the damage more apparent than across rural America, like many of the communities right here in Ohio and across the Midwest, particularly for President Trump’s most dedicated supporters.
With Medicare open enrollment beginning in October, the consequences are becoming impossible to ignore, and it’s causing maximum pain right before the Midterm elections in areas Republicans need the most.
MarketWatch reported that 181 counties will have no Medicare Advantage plans available in 2027, up from 67 counties with no plans in 2026. New research from KFF paints an even worse picture: 193 counties will have no Medicare Advantage prescription drug plans available for general enrollment, leaving roughly 638,000 Medicare beneficiaries without that option.
For seniors in rural communities here in Ohio, losing an insurance plan can be calamitous. It can mean losing access to trusted physicians, traveling further for basic care, and scrambling to find coverage for necessary medications. In many ways, it’s Barack Obama's own manifestation of “if you like your plan, you can keep your plan."
And that disruption is disproportionately rural. KFF found that rural beneficiaries represented just 14 percent of Medicare Advantage prescription drug enrollment in 2025 but 23 percent of those affected by plan terminations entering 2026.
Four years into the Inflation Reduction Act, the broader Medicare prescription drug system is showing unmistakable signs of distress.
Consider what Joe Biden and Democrats promised when they passed the Inflation Reduction Act in 2022.
The Congressional Budget Office originally projected that its drug “negotiation,” inflation rebate, and Part D redesign provisions would reduce federal deficits by $129 billion through 2031.
Four years later, CBO has reversed that projection, now suggesting those same provisions will increase deficits massively.
The law’s Part D reforms have been particularly costly. CBO cited it as the leading driver of unexpectedly high insurer bids, with projected federal Part D spending increasing dramatically.
Meanwhile, Medicare beneficiaries have watched stand-alone prescription drug plans plummet from 766 in 2022 to 360 in 2026. The average deductible skyrocketed from $425 in 2024 to $544 in 2026, while coverage of brand-name medications in competitive drug classes has declined.
This is what happens when Washington tries to dress up government price-setting gimmicks as cost-cutting. Costs don’t simply disappear. They shift to taxpayers, insurers, and ultimately patients.
Which raises an uncomfortable question for those serving in President Trump’s Centers for Medicare and Medicaid Services: Why are some in his administration still operating so much of Biden’s Medicare drug-pricing machinery even as it hurts so many of President Trump’s most ardent supporters in states like Ohio?
A Washington Reporter investigation identified Kristi Martin, a former senior Biden CMS official, as a key architect of the program. While Martin may have departed before Trump returned to office, the report describes continued direction by Biden-era officials with far-left ties and political activity, including Daniel Heider and Lara Strawbridge.
What’s more, staff in the Trump administration have advanced the program rather than fundamentally fixing the problems it created, proposing a permanent negotiation framework and continuing additional rounds of implementation.
The President campaigned on reversing Biden’s costly policies. He correctly called out this terrible scheme of Democrats taking billions from seniors to fund his green tax credits in stump speeches.
But the bureaucracy responsible for one of Biden’s signature healthcare initiatives continues implementing much of the same agenda.
The political consequences already appear devastating.
Days before the midterms, rural seniors are receiving notices about disappearing plans, changing benefits, and increasing costs. Democrats created the IRA, but Republicans now control the agencies responsible for administering it.
There is no evidence this disruption was deliberately engineered to sabotage Trump. But politically, the effect could hardly be more convenient for Democrats: Biden’s policy failures becoming President Trump’s election-year headache.
President Trump and Health and Human Services Secretary Kennedy should demand an immediate review of the IRA’s Medicare drug provisions, replace Biden holdovers responsible for perpetuating failed approaches, and direct CMS to prioritize patient access, rural plan availability, and genuine competition.
Rural seniors across America deserve better than Joe Biden’s failed promises. They deserve affordable medicine, dependable coverage, and actual choices, and President Trump has the tools and the team to fix it.
Ken Blackwell is the President of the Council for National Policy, Chairman of the Conservative Action Project and an adviser to the America First Policy Institute.
Editor’s Note: Do you enjoy Townhall’s conservative reporting that takes on the radical Left and woke media? Support our work so that we can continue to bring you the truth.
Join Townhall VIP and use promo code FIGHT to receive 60% off your membership.
Join the Conversation
VIP members get the ability to comment on articles.