Recent news reports indicate that the Medicare prescription drugs bill continues to get a tepid-to-hostile reaction from the public, especially seniors, the intended beneficiares of the bill. To understand this poor reception, it’s instructive to review how public opinion evolved on the bill. Such a review shows that the current political problems of the bill were foreshadowed every step of the way by public opinion as the bill moved toward passage.

July, 2003

In a July Gallup report on attitudes toward Medicare reform, seniors opposed, by 69 percent to 24 percent, an effort to shift most Medicare recipients into managed care plans. And, by 63 percent to 20 percent, seniors believed the new Medicare bills then being considered by Congress would not do enough to help pay the cost of prescription drugs.

Another Gallup report in the same month showed that Bush’s job approval dropped twelve points among seniors in the last half of June, a period when coverage of the Medicare prescription drug bills was particularly intense.

October, 2003

As the Medicare bill continued to move toward passage, an October CBS News/New York Times poll showed that Bush’s approval rating was just 41 percent among those 65 and older, a fall of 22 points since May of that year.

An October Washington Post poll showed that Bush’s approval rating on prescription drugs for seniors was an abysmal 35 percent and his approval rating on the cost, availability and coverage of health insurance was a dreadful 31 percent with 60 percent disapproval.

November, 2003

According to a poll taken right before passage of the bill by Peter Hart Research for the AFL-CIO, almost two-thirds of voters 55 and older thought Congress and the White House should work for a better Medicare prescription drug plan than the one on offer. Just 19 percent wanted Congress to pass the bill under consideration.

The same poll found that 65 percent of these voters viewed the drug plan unfavorably and the same number viewed the subsidies for private HMOs unfavorably. Also, 64 percent opposed the bill’s provisions to ban importation of drugs from Canada and an overwhelming 78 percent said the bill didn’t do enough to protect retirees now covered by employer-provided prescription drug plans.

Another poll taken around the same time by the University of Pennsylvania’s Annenberg Public Policy Center found that, based on a carefully neutral description of the bill, the public as a whole opposed the bill 42 percent to 40 percent, registered voters opposed it 44 percent to 39 percent, those over 50 opposed the bill 49 percent to 36 percent and those over 65 opposed it 49 percent to 33 percent. And, interestingly, those holding a favorable opinion of AARP, which of course endorsed the bill, opposed its passage 45 percent to 38 percent.

December, 2003

When the ink was barely dry on the bill, the Washington Post found that strong pluralities of both seniors (47 percent to 26 percent) and those 55-64 (46 percent to 32 percent) disapproved of the Medicare changes voted by Congress. These findings led nonpartisan pollster Andrew Kohut to say, “This is a surprisingly tepid reaction to this big legislation.”

More evidence of seniors’ dismay was provided by a Gallup poll released about the same time. Seniors just barely said (46 percent to 39 percent) that they favored the new prescription drug benefit for Medicare recipients. That’s amazing for a group that had just received a new benefit.

And, by 44 percent to 38 percent, they said they opposed the changes made in Medicare coverage. Moreover, 85 percent said they were very (56 percent) or somewhat (29 percent) concerned that the Medicare changes won’t go far enough in helping seniors pay for their prescriptions; 78 percent said they were very (58 percent) or somewhat (20 percent) concerned that these changes “benefit prescription drug companies too much”; and 73 percent said they were very (48 percent) or somewhat (25 percent) concerned that the changes will force some Medicare recipients into HMOs.

Finally, by a lop-sided 59 percent to 28 percent margin, seniors thought the new Medicare plan will do more to benefit prescription drug companies than Medicare recipients.

January-February, 2004

A January Gallup poll found that 62 percent of seniors (compared to 53 percent among the population as a whole) said that the new presciption drug benefit did not go far enough. And in February an Ipsos-Associated Press (AP) poll found that, by 71 percent to 26 percent, the public thought that the government should negotiate with drug companies for lower drug prices, rather than allow drug companies to set their prices without government interference. The poll also found that, by more than to 2:1 (65 percent to 32 percent), the public thought the government should make it easier to important drugs from Canada. Finally, after all the GOP’s efforts on the prescription drugs issue, the poll found that the public strongly favored the Democrats over the Republicans (52 percent to 33 percent) as the party most likely to make prescription drugs more affordable.

Also in February, a poll by the Kaiser Family Foundation found that seniors, by more than 3:1 (55 percent to 17 percent), had an unfavorable impression of the new law. Moreover, among those who knew the law had been passed and signed into law (just one-third of seniors), an overwhelming majority (73 percent) had an unfavorable impression of the new law.

These data suggest a couple of key areas of vulnerability for the GOP around this bill: inadequate coverage and no curbs on prices.

Of the two, inadequate coverage presents the most glaring vulnerability. As the data above suggest, seniors already see the benefit, in a general way, as not going far enough. And, once seniors are informed of the specifics of the coverage, particularly the “doughnut hole” in coverage between $2250 and $5100 in out-of-pocket costs, it really sends them through the roof, according to both news stories and focus group research.

This is just not what seniors had in mind when they envisioned a prescription drug benefit. As nonpartisan analyst Charlie Cook presciently observed back in July of last year, when negative sentiment about the impending bill was starting to become obvious:

Even the most cursory look at polling data and reports from focus groups indicates that senior citizens have very specific ideas of what they expect in a prescription drug benefit. What they have in mind is something resembling what a Fortune 500 company provides (or used to provide) employees: A modest premium, minimal co-pay, no gaps, no restrictions on what drugs physicians can prescribe and unlimited coverage.

Cook concluded, given that the drug benefit likely to be passed didn’t look anything like this:

If the prescription drug benefit is a factor in next year's election, it will be as an albatross around the necks of Republicans and the Bush administration.

Exactly. Seniors just aren’t getting anything close to what they had in mind and this discrepancy, so vividly encapsulated in the doughnut hole, is potentially a very, very serious problem for the GOP.

But the issue of no curbs on prices is also very important. The AP data indicate that the public overwhelmingly favors the use of government negotiating power to lower drug prices. And, as with the doughnut hole in coverage, reports from the field indicate that seniors are outraged to learn that the bill expressly prohibits the government from doing so.

The issue of failing to curb prices gains additional force from its relation to the generic problem of escalating health care costs. Poll after poll shows that the most serious overall health care worry for voters is costs and that, in fact, concern about health care costs is either at the top or near the top of voters' economic worries. The general perception is that these costs are out-of-control and are more likely than any other factor to suddenly bankrupt or impoverish a family. Failure to control drug prices is just one more example of this critical problem that the GOP, in the public's eyes, has done little to address.

These two broad areas of vulnerability suggest that the GOP in 2004 may have a hard time defending their greatest programmatic achievement in the domestic area.