Medicare Bill’s Risky Politics

Republican leaders are touting their sweeping bill to expand and reshape Medicare as a political coup for their party and a significant domestic policy accomplishment for President Bush, challenging decades of Democratic charges that the GOP is hostile to the interests of seniors.

Approved by the House in a contentious vote early Saturday, the legislation is now before the Senate. During debate in an unusual Sunday session, Sen. Dianne Feinstein (D-Calif.) announced that she would support the bill.

But the legislation, which is expected to go to a vote in the Senate today, also poses political risks for Bush and his Republican allies. Some Republicans see a potential backlash from senior citizens when they discover that the prescription drug benefit is far less than they expect, want or need.

By embracing this major expansion of a Great Society program, Bush also risks alienating his party’s conservative base, which is already disheartened by the growth of government spending under Bush and by Republican leaders’ failure to muscle conservative judicial nominations through the Senate.

“I worry that Republicans are stepping into a political minefield with this bill,” said Steve Moore, head of Club for Growth, a conservative political group. As a result, he said, Republicans could lose seats in Congress in next year’s elections.

All but 25 of the House’s 229 Republicans voted for the Medicare bill anyway, calculating that those risks paled in comparison to the consequences of failing to fulfill their promise to provide a prescription drug benefit for seniors, one of the most powerful voting blocs in the country.

But those cross-pressures underscore the problem facing members of both parties: The politics of the Medicare bill are almost as complicated and unfathomable as the bill itself. Polls have found that senior citizens overwhelmingly support the idea of expanding Medicare to cover prescription drugs, but that the more they learn about the bill before Congress, the less they like it.

That raises unnerving memories of the political imbroglio that followed the 1988 enactment of a bill to provide catastrophic health insurance coverage for seniors. Like this year’s Medicare bill, that one was endorsed by AARP, the powerful senior citizens lobby then known as the American Assn. of Retired Persons.

After the bill took effect, many seniors rebelled against the new fees and taxes they had to pay, and Congress was forced to repeal the law. The backlash was dramatized memorably when angry senior citizens in Chicago swarmed the car of Rep. Dan Rostenkowski (D-Ill.), then the chairman of the House Ways and Means Committee, to protest the bill he sponsored.

“That’s the ghost looming over this issue,” said GOP pollster Glen Bolger. “Where are the politics on this? Everyone is scrambling to figure that out.”

Democrats have problems of their own navigating the political cross-currents. Democratic presidential contenders have almost unanimously concluded that there is little to lose among primary voters -- and potentially much to gain -- by opposing the bill. Many congressional Democrats have been more cautious, however, cringing at the prospect of having to explain a vote against a bill endorsed by the national leadership of the AARP. But some take comfort that their local AARP chapters oppose the bill.

“It’s going to take a little bit of explaining,” said Rep. Adam Smith (D-Wash.). “But I don’t think it’s the political slam-dunk Republicans are envisioning it to be.”

Democratic leaders are pursuing a strategy -- both for protecting their own members and for attacking Republicans -- that spotlights the limits and loopholes in the new prescription drug benefit. For one thing, the full benefit would not take effect until 2006. And beneficiaries who chose to participate in the plan would still have to pay substantial sums in premiums, deductibles and expenses that would not be covered at all.

“When seniors see what’s in this, they are not going to be happy about it,” said House Minority Leader Nancy Pelosi (D-San Francisco).

That is a rare point of agreement between the liberals and the conservative Republicans who are opposing the bill. Moore’s group, Club for Growth, released a poll last week showing that 31% of seniors opposed the bill when they knew little about it. But once it had been described in more detail, 54% opposed it, the poll found. An AFL-CIO poll reported similar findings.

The Club for Growth poll also suggested that the Medicare bill addressed an issue that was not generally regarded as a problem: More than 80% of those surveyed were satisfied with the drug coverage they already had. Conservatives also oppose the bill as a huge expansion of government.

“The politics are being read completely wrong,” said Rep. Mike Pence (R-Ind.), a leading conservative opponent of the bill in the House. The best way to reelect Bush and a Republican-controlled Congress, he said, is by “staying true to the Republican vision of limited government.”

Divisions within the GOP are personified by the split between Newt Gingrich, speaker of the House from 1995 to 1998, and the Texan who was his majority leader, Dick Armey.

Gingrich, the Georgia representative who led the movement that in 1994 put the House in GOP hands for the first time in 40 years, embraced the bill and urged House Republicans to vote for it as the first step toward a “revolution” in health-care financing.

But Armey, writing Friday in the Wall Street Journal, called the bill a “fig leaf” for Republicans’ failure to enact real reform and warned that it was infuriating party activists. “The conservative free-market base in America is rightly in revolt.”

Some Republicans argued that passing even a limited prescription drug benefit would be a political plus, giving the party fresh credibility with senior voters who could be crucial to the outcome of the 2004 election.

“It’s a no-brainer,” said Rep. Thomas M. Davis (R-Va.). “The public overwhelmingly wants this benefit.”

Others warn that Republicans would be punished by the voters if they did not manage, with control of Congress and the White House, to make good on their long-promised drug bill.

David Winston, a Republican pollster, suggested that the failure to enact a drug bill last year was a big factor in Democratic losses in the 2002 election.

“The lessons Republicans should learn from that is, ‘Failure is not an option,’ ” he said.