The lessons of the 1998 and 2000 elections may encourage action on a Medicare prescription drug benefit in 2002, Republican pollster Bill McInturff said during the National Health Policy Conference in Washington, D.C., Jan. 16.

"If I had to pick today, I would still" expect Medicare drug coverage to be "the one healthcare issue we will deal with," Public Opinion Strategies Partner McInturff said.

"The common view is that nothing will happen in Washington. There is no money, partisan deadlock, etc. I actually don't think that's quite true," he said.

Republicans have learned from the last two elections that action on major health bills is good for incumbents, he said.

House Republicans passed an HMO reform bill in 1998 and a prescription drug benefit in 2000, while the Senate passed neither. "For two cycles in a row, the House [Republican] members have said...we did something and U.S. senators had nothing to say."

As a result, House Republicans did better in elections, and "we're down now to 49 members when we predicted the year 2002 would be 55-56 members."

McInturff maintained that "the disaster about the Clinton healthcare plan...was not that they did the proposal, it was [that] the Democrats let us off the hook by not having a single floor vote on any issues after two years of dialogue."

Both parties are gearing up for a return of healthcare reform as an important political issue heading into the 2002 elections.

"I believe that the American people across the political spectrum are ready for national health reform," Sen. Edward Kennedy (D-Mass.) declared during a Jan. 16 National Press Club appearance.

"We can and should take two major steps this year: pass the patients' bill of rights and pass prescription drug coverage for all senior citizens," Kennedy said. Kennedy listed three other steps Congress could take in 2002: (1) expand the Children's Health Insurance Program to include coverage for the parents; (2) enact legislation to provide insurance to families with disabled children; and (3) pass legislation requiring employers with more than 100 workers to provide health benefits.

"If you're a Democrat, healthcare has to play a major role in your calculations because it is one of the issues where Democrats have the biggest advantage and one of the few issues where Democrats have a large advantage over George Bush," Democratic pollster and Lake Snell Perry President Celinda Lake told the National Health Policy Conference.

Democrats in Congress have a 15-point advantage over the President and congressional Republicans on healthcare issues, Lake said.

"I think that healthcare will play a much bigger issue in the fall elections than we might imagine. It's tied to the recession," she predicted.

"With unemployment and the recession," voters "think they will be able to get another job, but they are extremely concerned about healthcare benefits. And they are extremely concerned about both their wages and their coverage keeping up with the rising costs" of healthcare, she said. The current recession is "a benefits and pocketbook recession even more than a jobs recession."

McInturff agreed with Lake's assessment, noting that "we're back over 30% of Americans saying they want 'radical' change" in the healthcare system. "Radical" change had fallen off the political radar, the Republican strategist said, dropping to the low twenties after reaching an all-time high of 45% during the Clinton attempt to overhaul the system.

McInturff suggested that the key demographic driving the healthcare debate is women aged 35-54.

They "are the key healthcare decision-makers, the key healthcare consumers," McInturff said. "When they drift back to radical change, our political system tends to respond because it is those women who are the keystone voters. Our political culture responds because now we have a specific subgroup that is core to both parties," which is "up for grabs,...telling us they want healthcare change."

There appears to be bipartisan agreement that the correct approach to healthcare reform is "incrementalism" - although there may be disagreements about what constitutes an incremental step.

Kennedy declared himself to be an "incrementalist" during the National Press Club appearance.

Asked what had changed since the 1993-94 healthcare debate, Kennedy replied that "there's an inevitability about healthcare. This is a core concern to families across this nation, every family in this country. And it isn't going to go away."

"I happen to be now an incrementalist," he said, noting that the bills he favors would ensure coverage for all children, the elderly and most workers.

Centers for Medicare & Medicaid Administrator Tom Scully also declared support for an "incrementalist" approach during the National Health Policy Conference.

However, for Scully, incrementalism is an argument in favor of the Bush prescription drug discount card plan, which could serve as a "building block" to a more comprehensive prescription drug benefit (¹ Also see "Rx Card Plan Remains On White House Agenda; House Hearing Set For Oct. 3" - Pink Sheet, 24 September, 2001., p. 3).

"Most people believe that if you create a Medicare drug benefit, the people that have to run it are CMS. We don't have a clue," Scully said.

"If you want to have a drug benefit in 2006 or 2005, you have to get started now by setting up the infrastructure that now doesn't exist," he said. "It will take at least three or four years to get the mechanism up to how we pay at the pharmacy counter."

Rather than focus on whether a Medicare drug benefit can pass in 2002, policy makers need to think about "how do we get one in eight or nine years that works, that doesn't blow up the system," he suggested.

McInturff and Lake agreed that the key to approaching healthcare reform is to focus on individual issues where progress can be made, rather than an all-encompassing bill.

"Our political culture can only withstand one healthcare debate a cycle," McInturff said.

The new budgetary realities also work to ensure that only one healthcare issue will be addressed, he said. "The money is gone," McInturff explained. "To the extent that there is any money left, we've got to give it to somebody and you're going to give it to the 22% of people over 65 who make up our electorate...who are very, very upset about the cost of their drugs."

"Watch for the parties to target senior voters with a healthcare message," Lake said. Democrats may be "willing to make the issue an even bigger issue later on in the game, because it is an issue that we have an advantage on."

Unlike education, healthcare is an issue that "Bush is perceived to be not that interested in," Lake added.

Kennedy's National Press Club address may be an early test of some of those themes.

"Some say that in light of the budget projections, this nation cannot afford prescription drug coverage," Kennedy noted. "But just as a family budget is a statement of a family's priority, a national budget is a statement of national priorities, and our national priorities are profoundly wrong if we continue to force senior citizens to choose between prescriptions and their food, or their heat, or a decent home."

"This effort and this plight of the elderly must not become the pretext for a partisan plan which disguises yet another attempt to privatize Medicare," Kennedy declared. "So I am here today to say that we will not rest, we will not give up, we will not stop, until our senior citizens have a genuine Medicare prescription drug benefit that works well for all of them."

Kennedy proposed paying for the drug benefit (and numerous other policy initiatives) by rescinding $350 bil. of the tax cuts enacted by Congress in 2001.

"Future additional tax breaks for the wealthy do not deserve higher priority than strengthening education, covering prescription drugs under Medicare, or protecting social security, or meeting other urgent national priorities," he maintained.

Kennedy's address did not include any reference to pending FDA legislation under his jurisdiction. That may be a sign that the Prescription Drug User Fee Act reauthorization process will proceed out of the election year limelight.

Healthcare Reform Returns To Political Agenda Heading Into 2002 Elections

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