SIGNS OF AN UPRISING

By John Greenwald

FOR ALL THEIR VAUNTED POLITICAL clout, elderly Americans responded with an odd silence last summer when Republicans announced that they planned to whack $270 billion out of anticipated Medicare spending over the next seven years. That is partly because the G.O.P. had contrived until recently to keep the details secret. But now the proposals are real, and lawmakers such as freshman Republican Michael Flanagan last week found the docility wearing off when they returned to their districts. In Chicago outraged seniors parked a steamroller in front of Flanagan's office to symbolize G.O.P. efforts to rush the cuts through Congress. In Connecticut, an elderly caller to a talk-radio show gave Republican Congressman Christopher Shays an earful. Asked the caller: "Why can every other civilized country take care of its senior citizens without all these changes and hassles?"

As if such warnings were not enough, voter surveys have also detected apprehension over the Republican race to reform Medicare. By 58% to 38%, Americans surveyed in a Washington Post/ABC News poll last week said leaving Medicare alone is more important than balancing the federal budget. And when the Times Mirror Center for the People and the Press asked seniors to choose between the Republicans and President Clinton on the Medicare issue, the seniors preferred Clinton by better than 2 to 1. The President's plan would curb spending by $124 billion over 10 years.

Such forebodings could reshape the national debate over Medicare just as the House G.O.P. plan comes before the Ways and Means Committee for a critical vote this week. While approval there seems certain, the low-level alarm building outside Washington could force Republicans to rethink the plan and decide to pare back Medicare outlays by far less than $270 billion. Rising qualms among voters could also lead the Senate, whose Finance Committee passed a companion Medicare measure in September, to scale back provisions of the bill when it reaches the Senate floor.

Some Republican leaders have already shown signs of backing away from their party's determination to rein in Medicare spending while handing a $245 billion tax cut to beneficiaries that include wealthy individuals and large corporations. In a scarcely veiled bow to those G.O.P. critics, Senate majority leader Bob Dole indicated last week that he was willing to reconsider the hefty tax break. But after presidential rival Phil Gramm and other prominent Republicans blasted Dole's remarks, the Kansan described the $245 billion cut as his unswerving goal.

The anxiety over Medicare has hardly gone unnoticed by the powerful American Association of Retired Persons. The A.A.R.P. has so far had little to say about the G.O.P.'s Medicare plans, including provisions that would raise monthly premiums from $46.10 to about $87 by 2002, largely because party leaders were smart enough to consult the organization as they were drafting the proposal. But now that the cuts are on the table, the A.A.R.P. is expected to launch attack ads as early as this week. The A.A.R.P. assault would come on top of the mini one launched last week by the American Medical Association, which fretted through a spokesman that the Republican plans would drive many patients into managed-care programs, which pay smaller doctors' fees.

The full wrath of seniors has been descending on Flanagan, who defeated 18-term Democratic Representative Dan Rostenkowski last November and vowed in April to leave Medicare untouched. "He said he would stand with us, but now they have gotten to him," says Eleanor Gnoza, 76, a retired factory worker. "If they lower Medicare, where do they think we are going to get the extra money from?" Some voters, however, have been less combative. After hearing out Flanagan, a reassured Loretta Brania, 78, said she no longer feared losing her Medicare benefits under the Republican plan.

But many misgivings cannot be dispelled so easily. "There is a tremendous feeling of insecurity," says Edith Serke, executive director of the Southwestern Agency on Aging in Norwalk, Connecticut. Even though Serke supports the idea of reforming Medicare to keep it solvent, she notes, "I'm very concerned about the abrupt changes being proposed." While a guest on a radio show last week, Shays heard a wide range of concerns--from whether Medicare recipients can continue to use their fee-for-service doctors to worries that pre-existing health problems could shut seniors out of revised programs.

The extent of such fears has given Clinton an opening to try to wrest control of the Medicare debate. Democrats duly launched an advertising campaign last week that charged, among other things, that less than half the Republicans' $270 billion in savings would reach the Medicare trust fund--a reference to the financial drain of the $245 billion tax cut. At the same time, White House chief of staff Leon Panetta said Clinton would veto the G.O.P. Medicare proposals. That tough talk suggests the battle for Medicare may be the one that casts Clinton in the role his pollsters ache to see--as the hero in the way of a brutal Republican juggernaut.

--Reported by Nina Burleigh/Chicago, Stacy Perman/Bridgeport and Karen Tumulty/Washington

With reporting by NINA BURLEIGH/CHICAGO, STACY PERMAN/BRIDGEPORT AND KAREN TUMULTY/WASHINGTON