Medicare Becomes Political Hot Potato

— Harry Scull Jr./The Buffalo News/AP

May 24, 2011: New York Democrat Kathleen Hochul declares victory in the 26th district's special Congressional election.

The biggest issue so far for the 2012 political campaign? Medicare.

All it took was one special election in upstate New York, where a combustible proposal from Rep. Paul Ryan, R-Wis., to remake the Medicare system into a voucher program reshaped the political landscape in the traditionally conservative New York district outside of Buffalo.

See also: Senate rejects GOP's Medicare proposal.

Democrat Kathy Hochul's victory in a historically Republican district, which had never elected a Democrat, was fueled in large measure by older voters energized by the Medicare proposal. Preelection polls showed likely voters over 55 favored Hochul, a dramatic shift from the 2008 election in which John McCain swamped Barack Obama.

While Democrats are happy to keep the political spotlight on the Medicare debate, Republicans were shaken, and some began having second thoughts. Most Republican lawmakers, starting with House Speaker John Boehner of Ohio, are sticking with Ryan's prescription for Medicare, which would change it from a government-sponsored health insurance plan to a government subsidized purchase plan for private insurance. House Republicans voted overwhelmingly for the Ryan budget plan, including Medicare.

But fissures in the party are beginning to show.

A test vote in the Democrat-controlled Senate on the Ryan plan didn't pass, and there were five GOP defectors. Each showed a specific reason that could make Republicans vulnerable in the 2012 election. (All Democrats voted against it.) The GOP five were Sens. Scott Brown (Mass.), Susan Collins (Maine), Olympia Snowe (Maine), Lisa Murkowski (Alaska) and Rand Paul (Ky.).

Brown is facing a probable Democratic challenge next year in liberal-leaning Massachusetts. Snowe is likely to pick up a Tea Party challenger in the Republican primary, but appeared to be looking toward the general election in the more moderate state of Maine, as was Collins, who is not up next year but often burnishes her middle-of-the-road credentials. Murkowski owes her election to independents in Alaska, and her votes lately have showed it. Only Paul was an outlier, saying he voted "no" because the Ryan budget didn't make a large enough dent in the $14.3 trillion federal debt.

Congressional Democrats are delighted to see the focus on Medicare. Having lost control of the House last year, their majority in the Senate is tenuous, with 23 of the 33 Senate seats now held by Democrats at stake in 2012.

Impact on presidential politics

Presidential candidates are wobbly too. Former Minnesota Gov. Tim Pawlenty, pressed by reporters to support or criticize the Ryan plan, hedged only slightly in supporting it. He said he would sign it "if I can't have my own plan as president."

Former Utah Gov. Jon Huntsman also says he would have voted for the Ryan budget, including the Medicare provision. But former Massachusetts Gov. Mitt Romney, whose own health care plan for his state resembled President Obama's Affordable Care Act, said Ryan's plan is "not identical" to what he will propose. However, Romney praised Ryan's effort as going in the right direction. Rep. Ron Paul, R-Texas, also used the "right direction" phrase, but he said he does not "fully endorse it."

Next: What's the next step in the Medicare overhaul? >>

Former House Speaker Newt Gingrich made the biggest splash in early May by criticizing the Ryan plan as "social engineering," then backtracking, apologizing to Ryan and calling on Democrats not to use his words against him. That's a call unlikely to be heeded, particularly since Democrats believe the Medicare issue is what propelled Hochul to victory in New York.

"Medicare, Medicare, Medicare" were the reasons for the victory given by Rep. Steve Israel, D-N.Y., chairman of the Democratic Congressional Campaign Committee. There was also a third party candidate who took about 9 percent of the vote, and the Republican candidate, Jane Corwin, was slow to pick up on the fact that her race had been nationalized and become a magnet for big Democratic Party money.

Republicans, who admittedly did a poor job of explaining the Ryan Medicare proposals, have their work cut out for them as they begin an extended Memorial Day recess. They will be trying to put the Medicare proposal in the larger context of budget cutting while returning to economic issues, which put Democrats on the defensive.

Boehner, however, is in the position of defending his House Republicans who voted for the plan, even though the plan has no chance of becoming law. As the recess began, Boehner sought to turn the tables, saying that the Ryan plan was the only one out there that would save Medicare because without radical changes Medicare will go broke in the next decade.

"The Democrats' plan is to do nothing," he said, adding that the Medicare and Social Security Trustees report released in May said that "doing nothing means the Medicare plan will go bankrupt and seniors' benefits will be cut."

Democrats dispute this, saying they would not let Medicare fail, though they have sought to attack Republicans rather than prescribe a solution of their own. Ironically, it was Republicans who attacked Democrats in the 2010 midterm elections, which brought them to power in the House, saying that the Obama health care overhaul will cut $500 billion out of Medicare. Democrats dispute the figure, saying that the $500 billion figure refers to future savings projected by the Obama health plan and limited to the Medicare Advantage plans.

Elaine S. Povich is a veteran Washington reporter.