After a one-on-one meeting with President Bush, William D. Novelli, executive director of AARP, emerged from the White House late Monday afternoon with a broad grin on his face.
Only a few hours earlier, the nation's largest seniors group, 35 million members strong, had endorsed the Republican-drafted plan to revamp Medicare. Now, Novelli had been praised, in person, by the president for the important role he and his group were playing to make the legislation a reality.
But with his support of the bill, he also became one of the most vilified people in Washington; even many members of his own group turned on him. Still, critics and supporters agreed on this much: The AARP stamp of approval made the legislation more likely to become law.
Novelli is unabashed about his rarefied position as a private citizen with considerable say over the fate of public policy. In fact, he says, the chance to help wield the colossal influence of AARP, previously known as the American Assn. of Retired Persons, was why he took the job.
"My great personal goal in life is to make contributions to solving important social problems," Novelli said in an interview Wednesday. His job at AARP, he said, was providing him with "by far the biggest" opportunity yet to live out his dream of being a catalyst for social change.
AARP's endorsement was a huge win for the president and other Republican leaders, who used it to show that the package was a good deal for seniors and would not, despite its critics, undermine Medicare. But on Capitol Hill, as the details of the bill were being considered Wednesday by a conference committee, GOP leaders worked to shore up support. They brought in former House Speaker Newt Gingrich (R-Ga.) to urge conservatives -- wary of a huge expansion of a government program -- to sign on.
Democrats said Novelli's move carried the risk that AARP members would rebel. At the impetus of Rep. Lynn Woolsey (D-Petaluma), 85 House Democrats planned to sign a joint letter canceling their AARP memberships.
Rep. Marion Berry (D-Ark.) said calls from constituents to his office were running 10-to-1 against the bill.
"They know a bad deal when they see one," Berry said.
Also on Wednesday, AARP and the American Medical Assn. began multimillion-dollar advertising campaigns designed to build support for the bill. AARP ads ask people to tell Congress to pass the bill. It isn't perfect, the ads acknowledge, "but millions of American can't afford to wait for perfect."
Novelli said that although the bill fell short of the organization's hopes, he did not want to pass up a chance to get an additional $400 billion over 10 years for Medicare.
"Perfect isn't in the cards," he stressed.
Novelli's next challenge is to use the ads, AARP's state organizations, the group's publications and other resources to convince members, their children and legislators that the positives of the bill outweigh the negatives.
For AARP to take such a leadership role in trying to craft and then sell public policy shows the influence Novelli has had on the group in the last four years, since he took its helm. Since a 1988 fiasco over a catastrophic-illness benefit law, which was endorsed by the organization but was so fervently opposed by seniors that it was repealed the year after it was passed, AARP had been reticent to exert its influence.
Novelli "has made the AARP a more powerful force for social change," said John Rother, the organization's policy and strategy director and a 20-year veteran of the group. "He's not hesitant to use the power we do have through our credibility and our reach to get these things through."
For Novelli, using the powers of communication to make societal changes is nothing new. As a co-founder of worldwide public relations giant Porter Novelli, he represented clients who were working for such causes as fighting cancer, promoting the use of seat belts and encouraging charitable donations for the developing world.
He took that experience when he quit the corporate world to become executive vice president of CARE, the world's largest private relief agency, and later to fight against tobacco companies as the president of the Campaign for Tobacco-Free Kids.
He is drawing on all that as he tries to turn AARP into a formidable force for social change. "I feel that all of that background and training has been to train me for this," he said.
Novelli said he was "accountable" for AARP's endorsement of the bill because he strongly influenced the board to support it.
He stressed that AARP did not give its blessing until the organization had helped win changes to the legislation, such as incentives for employers to continue providing benefits to retirees and a rollback -- from a national program to a six-region demonstration -- of competition between traditional Medicare and private health plans that would receive government subsidies to take on Medicare patients.
Ron Pollack, executive director of Families USA, a national advocacy group for health care consumers, does not back the legislation, but he praised the thoughtful, energetic role Novelli played in trying to shape it to benefit seniors. "I have deep admiration for what Bill Novelli is doing at AARP and the constructive role he played throughout this legislative process," Pollack said. "Bill has felt strongly about the importance of action
But other players in the Medicare debate attacked Novelli for compromising too much.
Senate Minority Leader Tom Daschle (D-S.D.) and House Minority Leader Nancy Pelosi (D-San Francisco) wrote to him Wednesday expressing "profound concern" about his decision to endorse the bill, which they said would force many seniors to pay higher health care premiums and more for prescription drugs.
Rep. Henry A. Waxman (D-Los Angeles) contended that Novelli had been "co-opted" in a past compromise to such an extent that he no longer served the interest of his constituency.
Waxman said that in 1997, as president of Campaign for Tobacco-Free Kids, Novelli supported a deal between tobacco companies and states that would have given the companies some protection against lawsuits in exchange for $368 billion in reimbursements to the states for smoking-related health costs.
Many of the other leaders of the anti-smoking coalition were "furious" about the proposed settlement, Waxman recalled.
"It drove a wedge in the anti-tobacco coalition," he said. Eventually, that proposal fell apart.
"I see a pattern of a guy who doesn't have good judgment," Waxman said. "He gets co-opted by the other side and talks himself into a bad deal."
But Novelli defended AARP's decision, which was made by its board of directors Sunday evening.
The bill before Congress, he said, was the best deal that could be made now to address one of the biggest challenges facing seniors -- paying for prescription drugs.
And the reason for his wide smile when he was leaving the White House, he said, was his sense that victory was at hand.
"I think we are on the verge of getting this," Novelli said. "I think the stars are aligning."
However, he said, there is still work to do to assure passage.
On Capitol Hill, AARP advisor Gingrich tried to win the support of conservative House members by drawing lawmakers' attention to a tax-free savings measure buried in the bill.
"He said this was the first step in revolutionizing the way we provide health care," said Rep. Rob Portman (R-Ohio), adding Gingrich was greeted with a standing ovation.
Pelosi, hoping to stiffen her rank-and-file members' spines, made it clear in a caucus Wednesday she regarded opposition to the Medicare bill as a core party principle that she expected members to uphold.
And pollster Guy Molyneaux told Democratic lawmakers that a public opinion survey he had conducted for the AFL-CIO found that the more seniors learned about what was in the bill, the less likely they were to support it.