A Last-Minute Save

By rescuing the Medicare drug benefit, agency chiefs prevented 2006 from being even worse for the GOP.

When Congress passed the Medicare Part D prescription drug benefit in November 2003, Republican strategists viewed it as a politically transformative event, perhaps the first step toward a "permanent majority." The way they saw it, the first federal prescription drug benefit would bolster the party going into the 2004 campaign and, equally important, cut into the traditional Democratic advantage among senior citizens. If Republicans could earn credibility among seniors through the expansion of Medicare benefits, then they would have political cover for their efforts to reform Social Security. Thus, the thinking went, the party would have a foothold among a grateful elderly population and also among a younger generation of voters who would recognize the GOP as the party that saved Social Security.

Yet things didn't turn out the way President Bush and congressional Republicans envisioned. Three years after Congress passed the legislation, Democrats ousted the Republican House and the Senate majorities after a 2006 midterm election rout in which it was hard to find a single race where the prescription drug benefit carried a GOP candidate to victory, but easy to point to a handful where it played a central role in an incumbent's defeat.

While the drug benefit might not have provided Republicans with the lift they expected, they can take solace from the fact that the results could have been much worse, if not for the efforts of Health and Human Services Secretary Mike Leavitt and Center for Medicare and Medicaid Services Administrator Mark McClellan.

Going into 2006, the complex drug benefit had all the makings of a potential political calamity. The HHS secretary and CMS administrator who were in office when the bill passed, Tommy Thompson and Thomas Scully, were no longer around in January 2006, when it came time to actually implement the plan. As late as December 2005, a Kaiser Family Foundation poll found that 50 percent of seniors had an unfavorable impression of the federal drug benefit compared with just 28 percent who had a favorable impression.

Then there was the troubled rollout, which led to widespread Republican panic since senior citizens tend to vote in higher numbers than other groups and are the last constituency politicians want to alienate.

The negative publicity surrounding early enrollment problems also provided ammunition for Democrats who fiercely opposed the plan as inadequate. During the February recess, congressional Democrats held more than 100 events and town hall meetings to attack the GOP plan and to present their alternatives. By then, the smell of fear had permeated the campaign trail.

But by summer, the precarious politics of Medicare Part D stabilized, largely due to Leavitt and McClellan. The chaotic and confusing enrollment process became a little less so after the 1-800-MEDICARE staff was bolstered by additional customer service representatives. The number of call centers was tripled-the average wait time dropped from four-and-a-half minutes in January to less than 30 seconds in March. Extensive congressional hand-holding helped assuage skittish GOP legislators. And a public outreach tour encouraged seniors to enroll before the May deadline-more than 2 million signed up in the final two weeks.

In June 2006, Leavitt reported that 32.8 million Americans, or 90 percent of all Medicare beneficiaries, had attained prescription drug coverage. That same month, a Kaiser poll found that 81 percent of seniors enrolled in Medicare drug plans were satisfied.

But the greatest political testament to Leavitt and McClellan's work came from the subtle change in the terms of the debate. Over time, the plan itself faded from Democratic campaign attacks, replaced by a separate, though related, issue-Republican ties to the pharmaceutical industry.