By David Baumann
NationalJournal.com
Thursday, June 3, 2004

Back home in Indiana the past few weeks, senior citizens were talking about more than who was going to win the 500-mile road race. (The answer, it turned out, was Arizonan Buddy Rice.) Many older Hoosiers were instead worried about something far more practical -- their Medicare prescription drug benefits.

"Out here in heartland America, there's not a lot of enthusiasm for the politics of entitlements."

Starting this month, seniors nationwide are able to obtain prescription drug discount cards -- their first experience with the new Medicare benefits, which will be phased in over the next few years. And southern Indiana's two House members were at home attempting to quell concerns and confusion -- even though both voted against the measure for vastly different reasons.

Republican Rep. Mike Pence opposed the bill because it created a new huge entitlement program. Democratic Rep. Baron Hill voted "nay" because he believed the measure did not provide sufficient benefits. The two also took vastly different approaches to their meetings with seniors. Hill held open forums on the prescription drug benefits, while Pence held what he called "discount card fairs" to explain the first benefit.

"I didn't have one person say they liked the bill," said Hill, echoing his own assessment of the legislation. And it's not just a case of confusion, Hill said: "A lot of the seniors -- I didn't have to explain it to them. They knew about it." He did allow, however, that there are questions "about what type of card they're going to get." For the record, seniors can receive a discount card that provides them various price breaks on certain prescriptions. A online questionnaire can be completed at www.Medicare.gov to help individuals determine which of the dozens of cards best suit their drug needs.

Hill also said, "they don't understand why the legislation was written the way it was." Many seniors complained about the so-called "donut hole" in the legislation. Here's the way the bill works: After seniors meet a $250 deductible, the government will cover 75 percent of their drug bills up to $2,250. They are responsible for costs between $2,250 and $3,600, at which point the federal government will assume 95 percent of the cost. "When Congress decided it wasn't going to spend more than $400 billion, that's the way it was written," Hill said. Of course, since that cost estimate was made, costs have ballooned. Hill also said that "it's pretty hard to come up with reasons" why most benefits do not kick in until 2006.

Pence, meanwhile, said he concentrated on the one aspect of the bill that does take effect now -- the prescription discount card, which is also the one part of the bill he favors. And as a Republican, he no doubt also wanted to tout a benefit that kicks in immediately because a Republican president signed the Medicare bill.

"I did my best impersonation of Phil Donahue," said Pence, who before being elected to Congress was a radio talk show host. He also brought along officials from state agencies and a private company to answer specific questions. "I've had little old ladies come up to me and shake my hand and say they feel so much better" after the sessions, Pence said. "The complexity of the program has created some confusion about the program."

Pence said he tried to limit complaints about the measure. "I start each forum saying that if you came to complain about the bill, I want to remind you that I voted against it," he said. He instead encouraged complainers to talk with him after each session. Some seniors said they were worried that prescription drug benefits they now have might end.

He said some in his audience opposed the overall bill. "Out here in heartland America, there's not a lot of enthusiasm for the politics of entitlements," Pence said.

Members of Congress are likely to continue to have meetings explaining the complicated legislation, which many constituents misunderstand. They will hold those meetings not only to listen, but also to solve problems, according to Pence, who said bureaucrats are not doing the job. "We've gotten a tremendous amount of phone calls [from people] for whom the phone number 1-800-MEDICARE has been a curse word," he said.

That may be all they can do with it this year, however. If Pence and Hill are any indication, voters still have plenty of questions about the new Medicare bill. That may mean it will be a difficult issue to explain to voters -- and very tricky to run either on or against it. And the president, for his part, may be happy that the bulk of the legislation does not become effective until after the 2004 presidential election.

David Baumann, a NationalJournal.com contributing editor, covers Congress for National Journal magazine. His e-mail address is dbaumann@nationaljournal.com.

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