Conflict Batters Medicare Bill

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Conflict Batters Medicare Bill

By Sarah Lueck, the Wall Street Journal

February 10, 2004

The Medicare drug-benefit bill was supposed to be a major political victory for President Bush, a health-care achievement he could tout during his re-election campaign.

But just two months after he signed it, the legislation is at the center of a political storm.

At every opportunity, Democratic presidential candidates charge that the bill is a giveaway to the health-insurance and pharmaceutical industries. Labor unions and consumer-advocacy groups are picking it apart. Members of Congress, in both parties, have complained that the administration's cost estimates for the benefit, which were released only recently, are far higher than Congress was predicting when the bill was passed. A few accuse the administration of deliberately downplaying the difference to win passage, a charge it denies.

Overall, as much as one-third of the public views the Medicare bill negatively, according to recent polls. The legislation, passed in November, for the first time extends drug coverage to Medicare's 40 million elderly and disabled beneficiaries, with extra help for low-income people.

It expands the role of private health plans in Medicare, which the Bush administration contends will contain the federal program's costs in the future. But Democrats say the law was constructed to lure private health plans to the Medicare market and limit price pressure on the drug industry, reducing the benefit's generosity and leaving many beneficiaries to continue pay high drug bills. Many seniors simply find the details confusing.

Republicans concede that they have been slow and ineffective in selling the benefit change to Medicare, and that their list of credible spokesmen on the issue doesn't go much beyond Senate Majority Leader Bill Frist of Tennessee , a heart-transplant surgeon, and Health and Human Services Secretary Tommy Thompson.

"The Democrats have just had a field day," says a Republican lobbyist. "There's a recognition now that if they don't get out there and start defining the bill that it could turn into a negative 'Mediscare' campaign."

Not that the administration isn't trying. It recently hired Julie Goon, formerly a lobbyist at the health-insurance industry's trade association, to coordinate Medicare outreach activities. And last week, it launched an ad campaign about the changes. "Same Medicare. More benefits," is the slogan.

Democrats pounced, saying the federally funded campaign is political, not educational. They noted that National Media Inc., the company that bought television time for the $12.6 million campaign, also is working on the Bush re-election effort.

Sen. Edward Kennedy (D., Mass.) asked Congress's investigative arm, the General Accounting Office, to examine the legality of using federal funds for the ads. House Democrats wrote to Mr. Thompson, demanding details about how the campaign was developed. The Alliance for Retired Americans, an advocacy group that draws its members largely from organized labor, said taxpayers should be reimbursed for the cost of the advertising. Even the conservative National Taxpayers Union called it "a political and fiscal insult to taxpayers."

HHS spokesman Bill Pierce dismisses the criticism, saying that the department is required to inform beneficiaries about changes to the program. National Media, he notes, has been handling Medicare television advertising for the last two years. "What you're seeing here is those who oppose the bill in a very cynical and partisan way attacking this educational campaign that's simply trying to get information out," he says.

In a measure of how the mood has shifted, some lawmakers who supported the bill now are urging changes. Sens. Ron Wyden (D., Ore.) and Olympia Snowe (R., Maine) have proposed permitting the government to negotiate for lower prices directly with drug makers and to allow importation of medications from Canada . AARP, the retirees' group whose backing clinched passage of the bill, supports those changes, too.

Boosters of the legislation also must contend with the legions of activist seniors and grassroots organizations that Democrats can mobilize at a moment's notice for rallies and protests. Right after Congress passed the Medicare bill in November, Jean Friday, a 70-year-old U.S. Steel Corp. retiree in Belle Vernon, Pa., helped Democratic lawmakers round up activists for a Capitol Hill protest that wound up on the evening news.

Armed with an address book containing nearly 900 names, mostly seniors, Mrs. Friday and two other members of the Steelworkers Organization of Active Retirees helped fill two buses for the trip to Washington from western Pennsylvania .

Leisure World, a sprawling retirement community in the Washington suburb of Silver Spring , Md. , is another place Democrats tap to build crowds. Just after the Medicare bill passed, 74-year-old Louise Armentrout, president of the Democrats group at Leisure World, got calls from aides to Sen. Kennedy and Rep. Chris Van Hollen Jr. and from her county's Democratic committee. At their behest, she gathered about 50 seniors to take a bus to Washington for a rally. "I don't know of a single person, Democrat or Republican, who supports it," Ms. Armentrout says of the mood in the minicity where she lives.

This kind of discontent has been a big problem for the 35 million-member AARP. Since it endorsed the legislation, more than 45,000 people have quit the group. Among them is Augustus Kuhner, 68, from Tell City , Ind. , who says AARP was editing his critical postings on the organization's Web site. He has since started a separate Internet discussion group, now with 29 members, called SAARP (for "stop AARP"). Among the activities, he and about 10 others in the high-rise building where he lives tear out the reply cards from their AARP Modern Maturity magazines, write "traitor" on them and send them back.

An AARP spokesman says the group's policy is to edit or remove postings on its message boards only if they contain vulgarities or something inappropriate.

Proponents of the Medicare bill say many beneficiaries have negative feelings about the bill because they don't understand it. The Bush administration hopes to change that with its advertising campaign, which steers people to a toll-free number to get more information. It also is gearing up for more town meetings around the country with HHS Secretary Thompson and other officials to discuss details of the legislation. The administration also hopes for positive publicity as private health plans beef up Medicare benefits and new drug-discount cards become available in June -- two changes set in motion by the bill.

But Mr. Bush has an uphill battle. Many seniors have already formed strong opinions that will be hard to shake. Ms. Armentrout, for one, is worried about cutbacks in the drug coverage she now gets as a University of Maryland retiree. Several prescriptions cost her only co-payments of $3 to $10 each. Democrats frequently say that millions of retirees will lose such generous coverage once the benefit is available. Republicans counter that the bill has billions of dollars in subsidies to encourage employers to keep offering coverage for retirees.

Still, says Ms. Armentrout: "It is sort of a scam job as far as I'm concerned."