The discounts, which went into effect Tuesday, have been met with confusion, skepticism and only a small amount of lukewarm enthusiasm. So far, voluntary enrollment has amounted to only about a half-million people -- far less than the 7 million the Centers for Medicare and Medicaid Services had anticipated. More than 2 million Medicare Advantage members were automatically enrolled in cards sponsored by their health plans but it is difficult to tell if they really want to participate.
The administration staunchly defends the cards and the discounts they offer -- and has said time and again it is making every effort on a local and national basis to present information to seniors. The government has spent -- and is spending -- millions of dollars advertising the discount cards and its toll free call center handles tens of thousands of calls from seniors daily.
It does not seem to be enough, though. The question remains, in a program slated to last only 18 months, is there enough time to get the kinks ironed out and make seniors happy? In 2006, the discount cards fade away and an even more contentious and complex permanent Medicare drug benefit takes effect.
This should be a real concern to the White House. At this point, President Bush needs to be able to declare the drug cards a victory on the campaign trail. But he cannot do so without seeing the Democrats pounce on the issue, pointing to current polls showing unhappy or indifferent seniors and lagging enrollment data.
Also, health policy experts are beginning to analyze the 2006 permanent drug benefit and are talking to seniors about it -- adding to the background noise at a time when Medicare beneficiaries need clarity.
The Kaiser Family Foundation this week released a report that contains surveys of seniors in Kansas City, Mo., Pittsburgh and Washington. It found significant senior concern about the drug cards -- on a zero to 100 scale with zero being very unfavorable the senior reactions netted a mean score of 31.
"It is definitely a confusing new world," Democratic pollster Geoff Garin, of Peter D. Hart Research Associates said during a Kaiser Webcast on the survey Thursday. "What we heard over and over again in the 10 focus groups is that people know very little about the substance of the benefit, they find the process of learning about it itself to be quite confusing, difficult to navigate."
The report said seniors who were queried in early May expressed puzzlement about the discounts, costs and benefits -- although seniors who took part in a second round of focus groups later in the month appeared to have somewhat greater knowledge of the program basics.
"You could already see in Kansas City there was more information," said Republican pollster Bill McInturff of Public Opinion Strategies. "Americans are consumers and markets work. People acquire information as they need it."
Though the overall reaction was negative, it moved to a more positive reading when seniors were asked about the program's extra $600 in benefits, on top of the discounts, for low-income recipients.
"I'm just comfortable that over time people get the information that they need to make good consumer decisions and that will happen here," McInturff said.
Though CMS maintains a special Web site to help seniors make drug price comparisons among the discount cards, Kaiser's survey finds only 31 percent in the focus groups had ever used the Internet and that dropped to 15 percent of seniors with incomes below $20,000.
"I would say of all things, word of mouth is probably most important (information tool) and not particularly helpful or reliable at the moment," Garin said.
Garin said outside the Washington Beltway "there is not a big sense among seniors that Medicare has done them a big favor" with the drug discount cards or the 2006 permanent prescription benefit program. He said seniors do not think politicians understand how they live or what they can and cannot afford.
McInturff, who had said earlier that the drug cards would be a political victory for Bush, was more neutral now in his predictions.
"Today I can't say it's a big positive for Bush -- neither would I say it was a big negative," he said.
If the president wants to claim victory with seniors in November, that must change -- and change quickly. He needs to find a way to get seniors on board -- perhaps with an additional push from the seniors group known as AARP, which has been trying to educate its members about the program.
Democrats seem bent toward revenge -- trying to snatch back Medicare as an issue from the Republicans who, they feel, stole it from them last year by pushing through the Medicare Modernization Act, which mostly was carved from a GOP mold.
What happens in the next few weeks will depend on whether the Bush team can prevail on Medicare -- and do not count them out.
The senior vote, though perhaps not decisive enough to give John Kerry the election, could help Democrats in Congress pick up some needed seats toward winning back majorities -- thereby setting the stage for more changes in the Medicare law as those amendments take effect in 2006.