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If elected president, Sen. John McCain (R-Ariz.) would pursue reforms to Medicare that could lead to hundreds of thousands of Florida seniors losing their current prescription drug coverage. But McCain's campaign is not worried that his views on the popular program will hurt him in the Sunshine State.
There are 3 million Floridians on Medicare and about roughly half of them are signed up for the program's prescription-drug benefit, according to the most recent official federal tally.
Nevertheless, the state's voters and the Republican presidential candidates don't appear much interested in talking about the controversial entitlement expansion.
Indeed, during a debate in Boca Raton Wednesday night - a debate partly underwritten by the seniors' lobby AARP - the candidates did not field a single question about Medicare. The Republican primary in Florida will be held on Tuesday.
McCain has long argued that the bill that created the Part D prescription-drug benefit in 2003 went too far, covering too many people and putting too great a burden on taxpayers. McCain believes the drug benefit should only be available to low-income beneficiaries. He voted against the bill to create the program, even participating in a filibuster to attempt to block it from coming to a vote.
Of the roughly 1.5 million Floridians enrolled in the drug benefit, only about 570,000 are considered "low income" under Medicare's current definition. Beneficiaries with incomes up to 150 percent of the federal poverty level can qualify for generous additional subsidies under the drug benefit.
During his run for the White House, McCain has not obscured his view that the drug benefit needs to be scaled back, indeed even bragging about it at times.
In an October speech in Des Moines, Iowa, McCain said, "I strongly opposed adding another unfunded entitlement to the fiscal train wreck that is Medicare by providing all seniors with a costly drug benefit, even those, like me, who can more than afford to pay for their medicine."
In 2005, McCain joined a group of Republican senators seeking to delay the full implementation of the Medicare drug benefit by two years as a way to pay for the costs of hurricane relief for the Gulf Coast states.
McCain's Republican rivals have different views, most notably former Arkansas Gov. Mike Huckabee, who believes the drug benefit should be left as it is, and Rep. Ron Paul (Texas), who wants to repeal the benefit entirely. Former Massachusetts Gov. Mitt Romney and former New York City Mayor Rudy Giuliani have not spelled out their positions on whether all Medicare beneficiaries should qualify for the drug benefit but have indicated concern about the program's costs.
But McCain is not worried about taking a political hit in Florida because of his position on the drug benefit, a campaign adviser said. Indeed, recent polls in Florida show McCain either leading the pack or just slightly behind Romney.
As McCain has campaigned in Florida, voters who want to talk about healthcare are interested in issues such as costs and access to medical care, not Medicare, said Douglas Holtz-Eakin, a former director of the Congressional Budget Office who now advises McCain.
"I don't think the drug benefit stands out. Healthcare comes up all the time," Holtz-Eakin said.
Inevitably, placing income limits on Part D would cause many Floridians to lose their Medicare drug coverage. A candidate campaigning on scaling back Medicare Part D would be committing "political suicide," remarked Susan MacManus, a political science professor at the University of South Florida.
Echoing Holtz-Eakin, however, MacManus said that Florida's Republican primary voters are focused on other matters.
"With the prescription-drug coverage bill that was passed and a lot of people doing better because of it," MacManus said, voters' attention is focused elsewhere and, therefore, so are the candidates. Taxes, the mortgage crisis, gasoline prices and other
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