Quotes of the Day

Republicans hope it isn't so, but the new Medicare prescription drug program may be having more than just start-up problems. Top officials at the Health and Human Service Department and its Centers for Medicare and Medicaid Services are scrambling to fix computer snafus that have resulted in many of the some 6.4 million low-income seniors being turned away or overcharged as they are forced to shift from Medicaid drug coverage to the confounding new prescription drug program. And no one hopes more that they'll be fixed than George Bush and Congressional Republicans, who two years ago rammed through the bill setting up the new Medicare Part D program that began Jan. 1. GOP lawmakers insist that once the kinks are worked out, seniors will eventually appreciate the measure they passed. They're counting on that, because if seniors haven't forgotten the initial nightmares of the drug plan by November's midterm elections, Republicans could end up feeling much of their pain.

Don't bet on it, say some health care experts. "These problems are not small 'glitches' that will be worked out in time," the Center for Medicare Advocacy warned in a report last week. "Problems with Part D will change over time and they will get worse." The center, a nonprofit organization helping older people and the disabled get access to health care, says in its report: "We anticipate that problems will be worse than they are today as systemic problems in Part D become increasingly visible." The center warns, for example, that many beneficiaries will discover their prescription drug plans don't cover all their prescriptions. "They will have to change drugs or, if their physicians are willing to help, pursue exceptions and appeals." Drugs that are covered by the plan at the beginning of the year may be dropped later by the plan, or the plan may offer the drug but may initiate cost-cutting measures "that make it difficult or impossible for beneficiaries to get the drugs," the center warns.

Another dark cloud for the GOP is the plan's so-called "doughnut hole." Under the standard benefit, seniors will get 75% of their drug costs covered by Medicare until their total drug spending reaches $2,250. Beneficiaries then pay all drug costs until their bills reach $5,100. That $2,850 gap in coverage has been nicknamed the "doughnut hole" when seniors must pay for drugs with their own money—as well as continuing to have to pay their average monthly premium of $32—and Democratic political strategists calculate that most seniors will bear the brunt of it around late summer or fall. "Many of them will realize they have to pay premiums the rest of the year and won't be receiving any benefits," says Richard Fiesta, director of government and political affairs for the Alliance for Retired Americans, an organization with 3 million members that advocates for issues affecting seniors. GOP strategists point out that the low-income elderly won't get slapped with the doughnut hole charge, removing one potential bloc of angry voters. But Republicans should be more worried about grumbling among middle- and upper-middle-income seniors who aren't even dealing with the current Medicaid to Medicare transition woes. They have leaned more Republican than Democratic in the past, and come November, they might be sick enough of the plan to vote for a different remedy.

• Douglas Waller/Washington
• The initial furor over the controversial drug plan may be just the beginning—and it could spark a senior rebellion at election time