WHEN HOUSE REPUBLICAN LEADERS met on September 6, giddiness reigned. House members had not been brutalized at town meetings during the August recess, as some had feared, over GOP plans to save $ 270 billion in Medicare spending (and thus balance the budget in seven years). The town meetings held by most House Republicans had gone swimmingly, with few protests over Medicare. Declared House Speaker Newt Gingrich: “By the end of August, it is fair to say that on the core questions — does Medicare need to be saved and do you want to see somebody do something about Medicare? — we had won.”
In the Senate, Republicans aren’t so sure. Before the recess, even conservative senators like Trent Lott of Mississippi, the GOP whip, and Spencer Abraham of Michigan, the most influential of the Republican freshmen, were privately proposing to trim the $ 270 billion target, make a deal with President Clinton, and take Medicare off the table as a hot political issue. Now, they are less squeamish. Abraham was scarcely asked about Medicare at all while in Michigan. But others remain anxious, especially Pete Domenici of New Mexico, chairman of the Senate Budget Committee. And Majority Leader Bob Dole is ambivalent. In his September 5 speech to the Economic Club of Chicago, Dole promised “this will not be an autumn of compromise,” then contradicted himself by asking Clinton “for the good of the country [to] agree to take Medicare out of the realm of politics.” Sounds like pre-emptive surrender, said Rep. John Linder of Georgia, a Gingrich confidant. Dole insisted it wasn’t.
The Medicare strategy, as devised by Gingrich, is to win three simultaneous battles: for public opinion, the activist groups, and substance. It will begin in mid-September with what Tony Blankley, Gingrich’s flack, calls “a two-week rollout campaign” that includes a speech to the nation, TV ads, town meetings, and congressional hearings.
On the public opinion front, Republicans have already achieved a level of success that amazes even them. “Who’d have thought six months ago,” asks Rep. Bill Paxon of New York, that the public would come to believe Medicare must be reformed? Polling substantiates exactly that. A national survey in August by Frank Luntz found only 36 percent agreed that “if balancing the budget requires cuts in Medicare or slowing Medicare spending, I’d “ather not balance the budget.” (Fifty-six percent disagreed.) Also, 52 percent disagreed that Republicans “want to cut Medicare spending to find money to pay for their tax cut for the rich.” More striking still was a pll for the RNC showing the public trusts Congress more than Clinton (57 percent to 30 percent) to rescue Medicare.
For now at least, activist grotlps have been neutralized. Republicans appeased the major concerns of con- servative and free-market groupS, particularly that the reform plan would force old folks into HMOs, not simply encourage them to give up traditional fee-for- service care. The Democratic National Committee launched attack ads on TV, and ihe American Association of Retired Persons, a reliable ally of Democrats, conducted town meetings. But neither of these August offensives frightened Republicaris or aroused the public. The mud thrown by DemoCrats in their 13-state advertising campaign either dit.n’t stick or, in South Dakota, backfired. When a TV s ot charged that “Republicans are wrong to want to c t Medicare benefits,” Democratic Rep. Tim Johnson Of South Dakota urged the ad be withdrawn there. “I simply cannot support this type of partisan activity,” he said in an August 18 letter to Sen. Chris Dodd, chairman of the Democratic National Committee. Dodd pulled the ad.
Republicans aren’t home free yet on Medicare, however. Gingrich isn’t worried, but other Republicans fret over what will happen when the specifics are presented publicly. The worst case is that Democrats, the AARP, and other liberal groups will click with their attacks on the substance of the Medicare proposal. To prevent a sustained attackRepublicans have delayed, until the last minute, releasing the contents of the Medicare bill. They don’t want it nitpicked to death like Clinton’s health care plan was last year.
The GOP plan is to acce1rate consideration of Medicare reform (a vote is expected in early October), leaving opponents with only two weeks to mount criticism. Some foes are ready. AFSCME, the state and local government employee union, scheduled its $ 2 million print, television, and radio ampaign to begin just before the GOP unveiled its Medicare proposal. Other opponents are expected to weigh in heavily. At the least, the onslaught will exceed anything Republicans experienced at home during the August recess. On their side, roughly $ 10 million worth of advertising will support the GOP Medicare effort, much of it funded by the Coalition for Change, an amalgam of conservative and business groups.
The key to success will be getting out of the gates quickly, says Tom Scully of the Federation of American Health Systems. Indeed, Republicans will be in hot water unless they immediately define what they’re doing on their own terms. So far, they’ve done a good job of this. Case in point: Rep. Dan Miller, whose southwestern Florida district has a higher ratio of senior citizens (35 percent) than any congressional district in the country. When Medicare was raised at his trailer park town meetings in June and July, the anger was not so much with the GOP but with “the system” for letting the financing get out of control.
This fits perfectly with the Republican strategy of framing their plans for Medicare reform as bold action needed to avert bankruptcy rather than spending restraint required to balance the budget and cut taxes. To the extent this message has gotten across to the public, it’s been for three reasons. First, in true Gingrich style, Republicans were prepared for a fight. Just this year, the House has held 29 hearings, and the Senate nine hearings, on Medicare. When House Republicans left Washington for the August recess, they received a blue briefing book that detailed the lessons learned from the hearings. The book was composed of 20 overhead slides, answers to likely questions, and a Medicare primer prepared by Gail Wilensky, a former administrator of the Health Care Financing Administration.
Members were told to emphasize the $ 270 billion figure is not a “cut,” but a “reduction in the rate of growth,” and that much of the savings can be made up through controls on fraud and abuse. They were given a slogan — “preserve, protect and strengthen” — to describe their goal for Medicare (“improve” was dropped from the slogan after polling found senior citizens didn’t believe the idea of improving Medicare was credible). On the PR front, Wilensky gave presentations in senior-heavy districts, and some House Republicans, such as Jim Kolbe of Arizona and Jon Fox of Pennsylvania, established Medicare task forces. The Republican National Committee issued daily press releases in August on “Medicare Fact vs. Medicare Fiction” and ran radio ads in 11 Democratic congressional districts charging that the targeted member was “ignoring Medicare’s looming bankruptcy.” The second reason for Republicans” preliminary success is they took some of the sting out of their plan by presenting it as bipartisan or even nonpartisan.
While this is a stretch, the GOP had a couple of valuable allies. The authors of the Medicare trustees report, which predicted last April that the trust fund would go broke in 2002, were three Clinton administration Cabinet secretaries: Robert Reich, Donna Shalala, and Robert Rubin. Many Republicans distributed summaries of this report at their town meetings. Also aiding the Republicans was Ross Perot. He testified before the Senate Finance Committee on August 29, and his new book, Intensive Care: IVe Must Save Medicare and Medicaid Now, lays out ideas in rough agreement with those being talked about by the GOP.
The third element was that Republicans persuaded themselves that something must” be done about the financing of Medicare and that the public agreed. In a Times Mirror poll in August, 87 percent said they’d heard about Medicare’s serioufinancial problems.
Another poll showed 76 percen! back “fundamental” change in how Medicare works.
While there were no major explosions over the re- cess, a few brush fires needed tnding. On August 7, Gingrich had to delay an appearance at a Congressional Institute Medicare forum in Atlanta after Democratic Rep. John Lewis led over 100 union members in a demonstration. A few days later, a House Ways and Means committee draft Medicare proposal, outlining dramatic increases in monthly Medicare premiums and the exclusion of medical savings accounts, was leaked to the Washington Post. This prompted grumblings from the right, and op-eds started appearing in the Washington Times and Human Events, warning of a return to “ClintonCare.” Nineleen conservative activists-Gary Bauer, Phyllis Schlafiy, Paul Weyrich, etc.-complained to Gingrich in a letter. Peter Ferrara, a free-market health guru at the Washington-based National Center for Policy Analysis, conferred with key House Republican aides. And on September 6, a number of conservative and free- market groups met with Sheila Burke, Bob Dole’s chief of staff, to discuss Medicare. Conservative grumbling quieted some.
To put it mildly, Republicans have a lot riding on the Medicare fight. Gingrich told the Washington Times: “If we win the Medicare debate… we have established a framework for a conservative majority for a generation.” What he didn’t say is that if they lose, the rest of the Republican agenda, plus the party’s prospects in 1996, is in jeopardy. So for Republicans, winning is practically everything.
by Matthew Rees
