WASHINGTON -- President Bush signed the bill adding a prescription drug benefit to Medicare last December in a Constitution Hall packed with seniors thrilled by the prospect of the federal government stepping in to help them cope with the soaring cost of medicine.
White House aides seized on the image of a Republican president demonstrating his oft-noted compassionate conservatism and asserting some credibility on an issue Democrats had long used to their political advantage.
But when Bush traveled to Ohio and Tennessee and talked about the prescription drug bill last week, some political observers were surprised -- because he has talked about it so infrequently during the past five months. A Globe survey of Bush's and Vice President Dick Cheney's remarks indicate 22 mentions in December and January, four in February, five in March, one in April, and three in May.
The reason seems clear: The Medicare expansion, once viewed as a crucial link between Bush and seniors, is now a subject of intense scorn among many seniors. Some health-care specialists and members of Congress, including some Republicans, say the law is a bad piece of legislation that could do the president more harm than good as he campaigns for support among older voters, whose higher turnout makes them a critical part of the electorate.
Representative Gil Gutknecht, a Minnesota Republican who resisted lobbying from his party's congressional leadership in voting against the bill, said seniors in his district don't like the law.
''I think it's somewhere between confused and clunker," Gutknecht said in describing their depictions of the law, which does not take full effect until 2006.
A CNN/USA Today/Gallup poll released in April indicated that seniors have gone from supporting the changes Bush signed into law to opposing them. In December, 46 percent of those 65 and older said they supported the law and only 39 percent were opposed. By late March, those numbers had switched to 48 percent opposing the changes with 36 percent favoring them.
When Bush opened his Florida campaign with a massive rally in Orlando on March 20, the prescription drug bill was not included among the list of administration achievements he rattled off to the excited crowd. Laura Bush did not bring up the prescription drug bill during a recent campaign swing, focusing instead on her husband's faith-based initiative, his tax cuts, and his No Child Left Behind education plan.
Conservatives in Bush's party never liked the idea of adding a prescription drug benefit to Medicare, believing such a move to be an unwise expansion of an already bloated federal government. Their anger was heightened when the Bush administration's cost estimates for the bill over 10 years rose dramatically from $400 billion to $540 billion.
The inspector general of the Department of Health and Human Services has launched an investigation into whether the Bush administration broke any laws in keeping the higher cost estimates from Congress.
Bush-Cheney campaign officials say the president is not downplaying the prescription drug bill. The war in Iraq and the economy have dominated the presidential campaign, and the travel schedule and speeches of Bush and Cheney reflect the focus on world events.
''There's always a time and place" for a discussion on the prescription drug bill, said Kevin Madden, a spokesman for the campaign. ''The campaign is very proud of this accomplishment. For years, there's been a lot of talk in Washington about reforming Medicare, and this president got it done. It's a record of accomplishment that this president is proud to run on."
But even Bush seemed to acknowledge the doubters when he told an audience at Youngstown State University in Ohio that, ''Medicare reform is going to work, and it's going to work well."
Most aspects of the law don't start until 2006, but seniors were invited in May to sign up for drug discount cards that become effective next month.
There are 73 different types of cards available, though not all are available in every part of the country. The cards offer different discounts based on what types of medicines are purchased and where they are purchased. The cards are perhaps the biggest example of the confusion within the law, which is spread out over 700 pages.
Millions of seniors called special hot lines set up by the Centers for Medicare and Medicaid Services, or CMS, which administers those programs, but quickly ran up against long waits. Then, many reported being unable to find out which cards offered the best deals on their particular medications, and how they could go about getting them.
Don McCleod, a spokesman for CMS, said the number of telephone operators has been increased from 1,200 earlier this year to about 4,000 now, allowing them to get to seniors after they've been on the line from 2 to 5 minutes.
Representative Sherrod Brown, an Ohio Democrat who voted against the prescription drug bill, said he has held numerous forums with seniors in his district, many of whom travel to Canada to buy medicine for a lower price than they can find in this country.
''People are puzzled by it," Brown said of the law. ''There is an intuitive understanding that this bill was written by the drug and insurance industries."
Carroll Doherty, editor of the Pew Research Center Poll, said the confusion many seniors have about the law gives the president an opportunity. ''The fact that a lot of seniors don't know about the law means there is some opportunity for the White House to get the message out and to change perceptions," Doherty said.
But to do so, Bush would have to make it a bigger focus of his stump speech, which he has not chosen to do. And there is evidence that as seniors learn more about the law, they like it less.
A Pew poll taken in early May indicated that Bush was trailing the presumptive Democratic nominee, Senator John F. Kerry of Massachusetts, by a 50 percent to 45 percent margin. Among those 65 and older, however, Bush was losing by a 54 percent to 40 percent margin.
Doherty said the edge Kerry has over the president among seniors is notable because exit polls indicated that seniors preferred Al Gore over Bush in 2000 by only four percentage points.
Families USA, a health-care advocacy group that opposed the prescription drug bill, recently went on what it called a ''Medicare Roadshow" to learn what seniors knew about the prescription drug bill.
''What we've learned from this experience is, the more seniors learn about the new Medicare law, the more unhappy they are," said Ron Pollack, executive director of Families USA.
Pollack said seniors are stunned and angry, for instance, when they learn that the new law prohibits Medicare from negotiating on their behalf for lower drug costs, as the Veterans Affairs Administration is able to do for veterans.
Drug companies lobbied hard against allowing Medicare, which includes much of their customer base, to negotiate lower prices. The companies said Medicare would become so powerful, it could virtually dictate prices.
Another source of anger from seniors is that once they sign up for the drug cards, they are locked in to the benefits and limitations their cards offer until an open enrollment period begins in November. Companies that sponsor the drug cards, however, are free at any time to change the discounts offered on particular drugs. Card sponsors are also not required to pass on to seniors the savings they negotiate with drug companies.
''The president and the reelection campaign clearly felt that the enactment of this new law would be tremendously helpful in getting support from seniors," Pollack said. ''But this has clearly become a political boomerang."