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Special coverage: Medicare

Medicare fallout: From win-win to watch out

Some Republicans fear the problem-plagued Part D drug benefit, once deemed a political plus, may haunt the party.

By BILL ADAIR
Published January 23, 2006

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WASHINGTON - When Congress was considering the Medicare drug plan two years ago, Republicans called it a win-win proposition: Seniors would get cheaper drugs, and the party would win their votes on election day.

Ken Mehlman, then-director of the Bush-Cheney re-election campaign, declared that "Good policy makes good politics" for his party. After the bill passed, President Bush hailed it as "the greatest advance in health coverage for America's seniors since Medicare was founded."

But in its first three weeks, the Medicare program known as Part D has been a tangled mess of computer glitches and management mistakes, raising the prospect of double trouble for the Republicans.

The Medicare problems have prompted many complaints against the Bush administration and they threaten to drive a wedge in the party, because many conservative Republicans didn't want to create the entitlement program in the first place.

"It was really a big blunder on our part," said Rep. Jeff Flake, an Arizona Republican who opposed the program. "We may have gotten some intermediate political benefit in the last election. But a lot of us predicted from the beginning this would haunt us."

State Sen. Mike Fasano, R-New Port Richey, said senior voters are frustrated because the program is so complex and the government has not done a good job explaining it. "Choice is great," he said. "But when you give somebody so many choices, it gets confusing."

Democrats, meanwhile, are licking their chops, hopeful the backlash will help them in the November election.

The program "is a loser for the administration; it's a loser for the Republicans, and it's a loser for the people it was supposed to help," said Democratic consultant Anita Dunn.

The problems have been so widespread a few states have declared public health emergencies. The most needy seniors - known as "dual eligibles" because they qualify for Medicare and Medicaid - have been denied their discount drugs because pharmacists can't verify they are eligible for a special subsidy. These seniors also had difficulty because the government randomly assigned them to health plans without checking to see if those plans covered their particular drugs.

Federal officials are scrambling to fix problems and have asked companies offering the health plans to provide a month's supply of drugs in the meantime. More than 20 states have stepped in to pay for the drugs until federal problems are fixed, but Florida officials have said such action is not yet necessary.

"We feel it's more urgent to focus on the root cause of the problems, and help (federal Medicare officials) solve them," said Alan Levine, secretary of Florida's Agency for Health Care Administration, in an e-mail message to the St. Petersburg Times. "Masking the problem by offering a temporary solution does not solve the problem."

Levine said two state officials have been working in pharmacies so they can see firsthand what needs to be fixed.

A broader problem is the program's complexity. To win more Republican votes, the GOP leadership structured the program to be run by private health plans on the premise that competition among the companies would push prices down. But with so many programs involved - 43 in Florida alone - and each one covering different packages of drugs, seniors have been confused by the array of choices.

U.S. Sen. Bill Nelson, a Florida Democrat, heard lots of complaints at recent town hall meetings. "Senior citizens were literally begging and crying for help," he said. "Let's just hope we don't have a death as a result of a senior citizen not getting the lifesaving medicine they have come to expect."

U.S. Rep. Rahm Emanuel, D-Ill., said the problems indicate the Republicans designed the program to help drug companies more than senior citizens. "Seniors are angry and complaining - and pharmaceutical companies are smiling," he said.

The massive size of the program - about 42-million seniors are eligible - has always been a sore point with conservative Republicans. They don't believe the government should offer such a big entitlement.

The White House and Republican leaders in Congress have urged the conservatives to give the program a chance, but Flake and many others say the early problems illustrate how their party has gone astray from its small-government principles.

"How are we the party of fiscal responsibility?" Flake asked.

To make matters worse, many seniors will reach the cap on benefits and have to start paying from their own pockets before the November election, Flake said. "Just what you want - a bunch of mad seniors right before the midterms," Flake said. "And they are not going to blame the Democrats."

Rep. Ginny Brown-Waite, R-Brooksville, is more upbeat. "Most Americans utilizing the program are grateful that they have access to prescription drug coverage," she said. "Any time you have a new program, there are always going to be concerns about a selection."

But Fasano, the Republican state senator, is concerned about the political impact.

"If they can get this resolved in the next 30, 60, 90 days and people realize the great benefits, it will have zero effect" on the GOP, he said. "But if we go into the summer and the fall and this still has not been rectified, I believe you are going to see a major backlash from our senior community - and rightly so."

Information from Knight Ridder Newspapers was used in this report.

[Last modified January 23, 2006, 13:36:27]