Only months ago, congressional Republicans thought the new Medicare prescription drug benefit would help them make political inroads among traditionally Democratic senior citizens. Instead, they are facing a potentially damaging backlash among members of that crucial voting bloc, their families and even conservative activists dismayed over the program's bungled launch.
Georgia Rep. Jack Kingston, a member of the GOP leadership, held at least 10 workshops to help his elderly constituents navigate the complex drug plan, and he implored his Republican colleagues to do likewise.
"There's a tremendous opportunity for members of Congress to go out there and be the white knights -- to listen, answer questions and get in the weeds with their constituents," he said. "But for members who feel they don't want to bother, they are going to hear from those voters in November."
"It's no windfall politically," said Rep. Phil Gingrey (R-Ga.), a physician who voted for the program. "It could hurt us, but sometimes doing the right thing does hurt."
Some Republicans think the problem will blow over once the inevitable kinks are worked out. Recent opinion polls cast doubt on such optimism. They suggest that, even among Republicans, support for the program has eroded.
Democrats on Thursday stepped up their criticism of the program, which they said benefited big drug and insurance companies at the expense of the elderly. They also called for congressional action on the many start-up problems. Hundreds of thousands of seniors -- mostly low-income -- have had trouble getting their medicines, and many have been overcharged. About 20 states, including California, have jumped in with emergency assistance.
"This Medicare bill is the biggest government fiasco in recent memory," said Sen. Charles E. Schumer (D-N.Y.), chairman of the Democratic Senatorial Campaign Committee.
Republicans also are facing criticism from the conservative activists who opposed the program's creation in the first place. They see it as an emblem of how the GOP, after a decade in power, has betrayed the traditional conservative commitment to small government.
"The fallout is likely to be huge," said an aide to a prominent conservative member of Congress who spoke on condition of anonymity because he was not authorized to speak for his boss. "It's likely to anger seniors, while reminding the conservative base about the biggovernment approach that Republicans took to healthcare."
Thus far, polls show no stampede of elderly voters to the GOP. Polling by the Pew Research Center on People and the Press shows that the portion of conservative Republican voters who approved of the drug plan dropped from 66% in December 2003 to 54% in December 2005; approval by moderate Republicans declined from 74% to 56%.
"It hasn't been the big political plus they hoped for. The question is whether it will be a minus," said Drew E. Altman, president of the nonprofit Kaiser Family Foundation, which conducts research and analysis on healthcare issues. "That is what is at stake in this early implementation period, which is not going so well so far."
Congress voted in 2003 to expand Medicare to cover prescription drug costs, but delayed the implementation of the plan until Jan. 1, 2006, to allow time to set up the complex program. Most Medicare recipients were given until May 15 to sign up for the program, which is voluntary. But several million Medicare recipients who also qualify for Medicaid, which serves the poor, were automatically moved into the new program Jan. 1. The number of people involved in the one-day transition has contributed to many start-up problems.
Many senior citizens have been overwhelmed by the complexity of the program. Medicare's information lines are jammed. Because of data errors, pharmacists have been unable to determine in many cases whether low-income beneficiaries are covered. The poorest beneficiaries have faced the biggest problems.
Democrats sense a political opportunity, especially at a time when the GOP is dealing with ethics scandals, internal squabbling and a leadership shake-up in the House.
The drug benefit issue has been used against some congressional Republicans in their reelection campaigns. Democrat Christopher S. Murphy is campaigning against Rep. Nancy L. Johnson (R-Conn.) by criticizing her leading role in creating the program.
"This is nothing but a massive giveaway to the drug industry," Murphy said on his campaign website. "Every senior citizen and hardworking American family should be offended that our government is giving away our healthcare system to the multibillion-dollar drug industry."
Rep. Rahm Emanuel (D-Ill.), chairman of the Democratic Congressional Campaign Committee, predicted that complaints about the program would intensify as seniors bumped up against a limitation on benefits known as the "doughnut hole" -- a gap in coverage of drug expenses. "If you think they are mad now, you ain't seen nothing yet," Emanuel said.
Senate Democrats proposed legislation Thursday to address the start-up problems.
One bill would provide federal reimbursement to the states that are stepping in with emergency funding for low-income seniors. The Bush administration has said states must look to private insurance companies for reimbursement, although Washington would support such recovery efforts. A second bill proposes longer-term fixes, including having trained Medicare employees at sign-up locations and improving the agency's telephone hotline.
Although the bill to compensate states drew two Republican cosponsors, Sens. Olympia J. Snowe of Maine and Norm Coleman of Minnesota, other Republicans have taken a wait-and-see attitude, arguing that the federal agency that runs Medicare should try to solve the problems administratively before Congress acts.
"It's too early to commit to any legislative options," said Senate Finance Committee Chairman Charles E. Grassley (R-Iowa). Still, he acknowledged the seriousness of the problems besetting the program.
"It's unacceptable that some of the poorest, sickest people are having the most trouble, and it's not what Congress intended," Grassley said.
Republicans have a huge stake in the program's success because they have called it one of the biggest domestic accomplishments of Bush's presidency -- one that they hoped would make it harder for Democrats to mount their traditional attack on Republicans for being hostile to the concerns of the elderly.
That is why Republican congressional leaders have been urging their rank and file to talk up the benefit to constituents. House leaders are offering rewards -- a bust of Ronald Reagan -- to lawmakers who make extra efforts to reach out to their constituents and explain the program in town hall meetings, mailings and more.
Kingston, the Georgia lawmaker, publicized his Medicare workshops through recorded phone announcements to elderly voters. He said his constituents were baffled and had urged him to support legislation to postpone the May 15 enrollment deadline.
"We're kind of past the yelling stage," he said of his district. "But if you think you can hold just four town hall meetings and explain this, you'll never get past the yelling stage."
The big test of the program may not come till later in the year, after people see what is and is not covered.
"I don't know that the rocky start is as important as what people see at the end of the day," said Tony Fabrizio, a GOP pollster. "The real rubber meets the road when they see what their expectations were versus what they actually get."
Times staff writer Maura Reynolds contributed to this report.