It was supposed to be a crucial part of President Bush’s legacy, a way of succeeding where Democrats had failed and winning over an important constituency for the Republican Party.
Trouble is, the party’s rising standard-bearers don’t seem very interested in it.
The creation of the Medicare prescription-drug benefit stands alongside No Child Left Behind and his tax cuts as Bush’s signature domestic policy achievements, but the men seeking to take the president’s place so far don’t have much nice to say about it — when they say anything at all.
Leading Republican candidates such as former New York Mayor Rudy Giuliani, former Massachusetts Gov. Mitt Romney, former Sen. Fred Thompson (Tenn.) and Sen. John McCain (Ariz.) haven’t made Medicare a major issue in their campaigns so far, but statements they have made underscore the uncertainty among Republicans about how to talk about the program.
Calls and e-mails, made over the course of several months, to the campaigns of Giuliani, Romney, Thompson and McCain were not returned.
With Democrats hammering away on the message that the drug benefit isn’t good enough, and with Medicare headed inexorably toward a fiscal cliff, all the presidential candidates eventually are going to have to answer difficult questions about Medicare and its costly new benefit.
The Republican presidential candidates aren’t alone in their reluctance to tout the drug benefit. During the midterm congressional elections last year, few Republican candidates went out of their way to claim credit for the votes they cast to bring the drug benefit into being.
Republican lawmakers were cajoled by the White House to support the president and this component of his “compassionate conservative” agenda, with the promise that passage would bring unprecedented support among older Americans for the GOP, helping to sustain the dream of a “permanent majority.”
But though opinion polls show at least three-quarters of people on Medicare like their new drug benefit, Republican candidates have been hesitant to remind fiscal conservative base voters that their party midwifed the largest increase in entitlement spending since Lyndon Johnson signed the bill creating Medicare in 1965.
“Any sophisticated voter or activist remembers that vote and remembers that’s one of the reasons they got angry at the Republican Party,” said David Keating, executive director of the conservative Club for Growth. Those happen to be the same voters candidates need to win primaries.
Originally estimated to cost $400 billion over 10 years, Medicare now projects that the cost of the drug benefit is approaching $800 billion over that time span. The program launched in January 2006.
Presidential candidates must take care to reassure base voters that they don’t support big spending increases without alienating those who benefit from the drug program, GOP pollster Kellyanne Conway said. “I think they’ll tailor their message depending on what their audience is,” said Conway, who runs The Polling Company Inc.
For these candidates, “It’s a no-win situation,” Keating said.
Criticisms from the Republican presidential field of candidates have focused on the cost issue.
Romney has sought to simultaneously praise the president for taking the lead on adding drug coverage to Medicare while disparaging the program’s price tag. “We should have reformed Medicare and Medicaid to pay for it … rather than add in a huge new entitlement,” Romney said on Fox News in January 2006.
Likewise, Thompson recently told Washington Post columnist David Broder that he would have voted against the Medicare drug benefit, calling it a “$17 trillion add-on to a program that’s going bankrupt.”
As the Senate prepared to vote on a different Medicare drug bill in 2002, Thompson spoke on the floor in opposition. “I am concerned that this body is ignoring some very serious issues, namely the cost of what we are doing and whether we can afford to take this action given the current budget situation,” he said.
Thompson’s Senate voting record supports these statements. In 2000 and 2002, he voted against Democrat-sponsored Medicare drug benefit bills. In 2001 and 2002, however, Thompson voted in favor of procedural motions filed by Sen. Chuck Grassley (R-Iowa) to advance GOP-sponsored drug-benefit bills, one of which would have set aside $300 billion for the program.
McCain actually did vote against the 2003 legislation. In August, he explained to PBS’s Charlie Rose that he opposed it, “One, because it was supposed to originally be for people who couldn’t afford it — now it’s everybody — but mainly because it was an unfunded liability of $800 billion to $1 trillion.”
Like Thompson, McCain voted for the 2001 and 2002 procedural motions.
In 2003, McCain was among those critics who predicted that Congressional Budget Office estimates that the program would cost $400 billion were off the mark. “For anyone who believes this bill will cost a maximum of $400 billion over the next 10 years, I have some oceanfront property in Gila Bend, Ariz., to sell you,” McCain said the day the Senate voted on its version of the bill.
Giuliani has a comparatively bare public record regarding his views on the Medicare drug benefit.
In an April 2006 interview with The Kansas City (Mo.) Star, Giuliani offered some praise for the program. The article states, “Giuliani said he thinks that the new Medicare prescription drug benefit will help in making sure [prescription] medicines are available to those who need them. For one thing, he said, the new program ‘has seniors writing down all their meds. It gets them organized’ so they have more control over what they’re doing.”
During his 2000 Senate campaign, Giuliani hinted that he supported some form of drug coverage for Medicare beneficiaries, which at the time was a priority for President Clinton. “I think it’s something you have to try to strive for,” Giuliani said on MSNBC. “I don’t know if it can be done for everyone, or if it can be done in every single case,” he added.
Former Arkansas Gov. Mike Huckabee has been the most complimentary of the candidates when it comes to the drug benefit. In a February 2006 interview with National Public Radio’s Diane Rehm, Huckabee said the drug benefit is a “great idea, and it’s going to eventually work out to the benefit of most Americans [on Medicare] who need prescription drugs.”
Huckabee also endorsed an idea that has become a major priority for the Democratic Congress: direct government negotiations of drug prices. Conservatives decry this proposal as price-setting, but Huckabee told Rehm that “I do have a problem with” the government being prohibited from bulk negotiations.
As a governor responsible for his state’s Medicaid program, Huckabee said that “we would like to have had the ability, as the largest purchaser of prescription drugs, to negotiate for at least a price equal to the lowest price they gave someone else.”
But on Tuesday, Huckabee backed away from this stance in a written statement to The Hill.
“With respect to Medicare Rx, I support the drug benefit, but do not support price-negotiating authority for the government.
The Veterans Administration negotiates drug prices, and many drugs aren’t allowed, especially the newer and more expensive ones. While the VA has about 1,400 drugs, Medicare now has about 4,300 drugs. That choice will go down if prices are negotiated. People will be forced to accept drugs that may be less effective or have side effects for them,” Huckabee said.
The House this year passed a bill to allow Medicare to negotiate drug prices, but the measure failed in the Senate over the objections of many Republicans and the White House. McCain and Sen. Sam Brownback (Kan.), another GOP presidential contender, missed that vote. McCain would have voted with the Democrats and Brownback with the Republicans, they later told The New York Times.
Among the other lower-tier GOP candidates, support for the Medicare drug bill was mixed. In 2003, Brownback and Rep. Duncan Hunter (Calif.) voted for the legislation, while Reps. Ron Paul (Texas) and Tom Tancredo (Colo.) opposed it.
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