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As if to underscore that point, the new health care bill ends two cost-savings measures included in the 2003 prescription drug law.

First, the bill fills in the “doughnut hole” in drug coverage from the 2003 law, which means more Medicare beneficiaries will have more drug costs covered.

Second, the health care law officially ends pilot programs that the 2003 law put into place to force Medicare to compete with private plans.

The pilot programs were all that were left of a once-ambitious goal of forcing all of Medicare to compete against private insurers. Republicans in 2003 had to give up the broader language in order to win passage of the bill.

But the pilot programs were critical to keeping enough Republicans on board to pass the bill.

Under the law, the pilot programs were slated to go into effect this year, but the Centers for Medicare and Medicaid Services discarded the effort three years ago, well before the law was overturned.

Donald McLeod, a CMS spokesman, said the children’s health insurance expansion that Congress approved in 2007 included language to repeal the Medicare pilot programs. That bill was vetoed by Mr. Bush, and the pilot programs remained on the books until Mr. Obama signed his health care law earlier this year. CMS said it saw the writing on the wall and had already stopped work.

“Its complicated, but thats the way it was,” Mr. McLeod said. “We didnt want to proceed with something that was never going to happen.”

The pilot programs were the brainchild of Bill Thomas. The California Republican was chairman of the House Ways and Means Committee and wrote much of the prescription drug law.

Mr. Thomas did not respond to repeated requests for comment.

One reason the 2003 bill has come in under budget is that fewer people are signing up for the voluntary program.

Initial projections anticipated more than 43 million beneficiaries by 2009, but actual figures from the Medicare trustees’ annual report, released earlier this month, showed just 33.4 million took part last year.

Still, that accounts for only part of the lower cost. Both sides in the debate say the rest of the credit goes to market forces, and to a slower demand for prescription drugs than was projected in 2003.