There are 3 million Floridians on Medicare and about roughly half of them are signed up for the program’s prescription-drug benefit, according to the most recent official federal tally.
Indeed, during a debate in Boca Raton Wednesday night – a debate partly underwritten by the seniors’ lobby AARP – the candidates did not field a single question about Medicare. The Republican primary in Florida will be held on Tuesday.
McCain has long argued that the bill that created the Part D prescription-drug benefit in 2003 went too far, covering too many people and putting too great a burden on taxpayers. McCain believes the drug benefit should only be available to low-income beneficiaries. He voted against the bill to create the program, even participating in a filibuster to attempt to block it from coming to a vote.
Of the roughly 1.5 million Floridians enrolled in the drug benefit, only about 570,000 are considered “low income” under Medicare’s current definition. Beneficiaries with incomes up to 150 percent of the federal poverty level can qualify for generous additional subsidies under the drug benefit.
During his run for the White House, McCain has not obscured his view that the drug benefit needs to be scaled back, indeed even bragging about it at times.
In an October speech in Des Moines, Iowa, McCain said, “I strongly opposed adding another unfunded entitlement to the fiscal train wreck that is Medicare by providing all seniors with a costly drug benefit, even those, like me, who can more than afford to pay for their medicine.”
In 2005, McCain joined a group of Republican senators seeking to delay the full implementation of the Medicare drug benefit by two years as a way to pay for the costs of hurricane relief for the Gulf Coast states.
McCain’s Republican rivals have different views, most notably former Arkansas Gov. Mike Huckabee, who believes the drug benefit should be left as it is, and Rep. Ron Paul (Texas), who wants to repeal the benefit entirely. Former Massachusetts Gov. Mitt Romney and former New York City Mayor Rudy Giuliani have not spelled out their positions on whether all Medicare beneficiaries should qualify for the drug benefit but have indicated concern about the program’s costs.
But McCain is not worried about taking a political hit in Florida because of his position on the drug benefit, a campaign adviser said. Indeed, recent polls in Florida show McCain either leading the pack or just slightly behind Romney.
As McCain has campaigned in Florida, voters who want to talk about healthcare are interested in issues such as costs and access to medical care, not Medicare, said Douglas Holtz-Eakin, a former director of the Congressional Budget Office who now advises McCain.
“I don’t think the drug benefit stands out. Healthcare comes up all the time,” Holtz-Eakin said.
Inevitably, placing income limits on Part D would cause many Floridians to lose their Medicare drug coverage. A candidate campaigning on scaling back Medicare Part D would be committing “political suicide,” remarked Susan MacManus, a political science professor at the University of South Florida.
Echoing Holtz-Eakin, however, MacManus said that Florida’s Republican primary voters are focused on other matters.
“With the prescription-drug coverage bill that was passed and a lot of people doing better because of it,” MacManus said, voters’ attention is focused elsewhere and, therefore, so are the candidates. Taxes, the mortgage crisis, gasoline prices and other pocketbook issues have risen to the fore, she said.
“People want to hear about new things. The economic issues that are pushing things right now is not [Medicare],” she said.
Talking about Medicare can be tricky for Republicans, especially in Florida. Conservative voters who view President Bush’s role in creating the drug benefit as a low point of his presidency will want to hear that the Republicans seeking to succeed him will rein in, not add to, the entitlement spending burden. Older voters, on the other hand, are not likely to respond kindly to a candidate who promises to reduce their Medicare benefits.
Statements from the other Republican presidential candidates on the Medicare drug benefit illustrate that the GOP is not of one mind about the program.
Paul, a vehement opponent of entitlement-program spending, would seek to completely repeal the drug benefit. Like McCain, Paul voted against the 2003 Medicare drug bill, which he has dubbed “HillaryCare, Republican Style,” likening the program to the health reform plan promoted by Sen. Hillary Rodham Clinton (D-N.Y.) when she was first lady in the 1990s.
Huckabee, by contrast, endorsed the popular drug benefit in its current form. “The governor strongly supports the Medicare prescription-drug benefit and he does not believe it should be limited to low-income Americans. Congress considered that option [in 2003] and quite properly rejected it,” a spokeswoman said in a written statement.
During a Fox News interview Wednesday, Romney said, “I think the Medicare Part D program should have been part of a broader Medicare reform program, and so that for me was something which I was concerned about. It added a multi-trillion dollar obligation to the balance sheet of our country. That gives me concern.” Romney’s campaign did not respond to requests for comment.
The Giuliani campaign made a similar statement to The Hill Friday: “Mayor Giuliani believes Medicare Part D has had pluses and minuses. It has been a successful program because of the free market principles which support it allowing seniors to get access to affordable prescription drugs. At the same time, the program has been too expensive and contributed to the fiscal problems which our nation faces in the coming decades. The mayor would seek to implement changes that allow greater free market access and increase competition, while lower the overall cost.”