By Andy Sullivan
PALM HARBOR, Florida (Reuters) - There's one small-government idea that Republican presidential candidates are reluctant to discuss in this retiree-heavy state: their plans to rein in health care costs for the elderly.
Newt Gingrich and Mitt Romney, front-runners for the Republican nomination to face Democratic President Barack Obama on November 6, both support reforms to the Medicare government health insurance program for the elderly that could help set federal spending on a sustainable course.
But the idea risks alienating the elderly voters who dominate the party's nominating process and are happy with the current program.
"The last thing that I would do if I was campaigning in Florida is even hint that something might happen to Medicare," said Mark Brewer, a political science professor at the University of Maine. "The word wouldn't even cross my lips."
In Florida, where the average Republican primary voter is 66 years old, that appears to be the case in the weeks leading up to the state's primary on Tuesday.
AARP, a senior citizens group that counts 37 million members over the age of 50, has dispatched volunteers to try to get Romney and Gingrich to offer details of their proposed reforms at campaign stops. They've had little success.
"Given the age of the primary voter, we're a little surprised that they haven't addressed these issues more fully and more directly," said Nancy LeaMond, the organization's executive vice president.
That the candidates are circumspect on the issue points to a fundamental tension within the Republican Party. Voters over 65 years old are the electorate's most reliably Republican segment, but their enthusiasm for scaling back government wanes when it comes to programs that directly affect them.
"They'd like to see things remain the same in terms of Social Security and Medicare," said Pam McAloon, president of the North Pinellas Republican Club, which represents a retiree-heavy stretch of suburban Tampa.
A DEFINING ISSUE
As the campaign heats up, Democrats and Republicans face strong incentives to campaign against one another's health-reform plans.
Public unease over the cost and scope of President Barack Obama's 2010 healthcare overhaul helped Republicans win control of the House of Representatives later that year, thanks to strong support from voters over 65 years old. Democrats hope to win them back this year by hammering a Republican plan that would gradually turn Medicare into a voucher program.
Both sides have played fast and loose. The nonpartisan watchdog group PolitiFact awarded its "Lie of the Year" in 2011 to Democrats for mischaracterizing the Republican plan. Republicans got the 2010 award for distorting Obama's plan.
The issue also presents a clash between demographics and ideals. Younger voters, the most reliably Democratic segment, are more likely to back private retirement accounts and other market-based plans floated by Republicans, according to the Pew Research Center. Older voters, the most reliably Republican, are least likely to support those ideas.
Given older voters' outsized role -- they made up 13 percent of the population but 21 percent of the electorate in 2010 -- politicians must tread carefully.
"It is a fundamental problem for American politics," said Andrea Louise Campbell, a political science professor at the Massachusetts Institute of Technology. "The need to attract seniors is a barrier for elected politicians."
Enactment of the Social Security pension in the 1930s and Medicare in the 1960s under Democratic presidents for decades made elderly voters a reliably Democratic voting bloc.
That has shifted in recent years as voters who share the small-government ideals of Republican President Ronald Reagan neared retirement. Retirees backed Republican presidential candidate John McCain in 2008, while voters under 65 backed Obama. Seniors voted Republican by a wider margin in the 2010 congressional elections.
Democrats see an opportunity to make inroads with senior voters this year, but they have their own baggage. Retirees worry that Obama's healthcare reform could weaken their Medicare coverage, and the public remains sharply divided over the law's merits.
Obama is downplaying his health care accomplishments as he ramps up for the November 6 election. The landmark law, which achieved the goal of near-universal health coverage that had eluded every Democratic president since Harry Truman, merited two brief mentions in his State of the Union address this week.
Fortunately for the candidates, voters of all ages remain overwhelmingly focused on the shaky U.S. economy. Health care and other issues are second tier as retirees watch their children struggle with unemployment and foreclosure.
"I see what happened to the America we had," said Anthony Incantalupo, 70, a retired police officer whose son is declaring bankruptcy because he has not been able to find enough construction work to pay his mortgage. "It's just not fair to the younger generation."
This dynamic helped launch the grassroots Tea Party movement in Florida, said University of South Florida political science professor Susan McManus, and will ensure that the economy remains the top concern in the state's Republican primary.
Republican retirees who describe themselves as small-government conservatives see Medicare and Social Security as distinct from food stamps or other benefits aimed at the poor.
Because they are funded through a special tax on workers' paychecks, recipients feel that they have earned those benefits.
"Sometimes the government does things well," Incantalupo said.
Republican candidates face a countervailing force from the party's fiscal hawks who want to roll back the federal government's role in everything from pensions to education.
They found a hero last year in U.S. Representative Paul Ryan, who crafted a budget plan that called for gradually replacing Medicare's defined benefit with a subsidy to help retirees purchase private health insurance.
Budget experts across the political spectrum say the government could face a European-style debt crisis in coming decades if it does not rein in Medicare and other health programs.
Conservatives said Ryan's plan would help contain government costs by encouraging competition. The nonpartisan Congressional Budget Office found that citizens would be required to pay much of the difference, as particpants' out-of-pocket costs would more than double to $12,500 per year by 2022.
Gingrich in May initially criticized Ryan's plan as "right-wing social engineering" but quickly retreated under withering criticism from fellow Republicans.
Since then, Gingrich and Romney have released plans of their own that would allow retirees to choose between traditional Medicare or a privately run program. Ryan has since modified his plan to allow participants to remain in Medicare if they wish.
EXPERTS WEIGH IN
That squares broadly with an approach first floated by Ryan and Democrat Alice Rivlin, a respected budget expert.
Rivlin said she could not assess the merits of Ryan's new plan, or those of Gingrich and Romney, because they contain few details.
"If you're writing a bill you have to have specifics. If you're campaigning for president, you don't," she said.
Even these relatively mild approaches could prompt some retirees to turn back toward Democrats, experts say, stirring up fears that Republicans at their core want to do away with the popular benefit programs. Democratic officials point to research that shows voters in battleground districts are more likely to be swayed by attack ads that focus on Medicare than the economy, the federal budget, or taxes.
"There's damage definitely done on this," said Jim Kessler, vice president for policy at Third Way, a center-left think tank.
Romney discussed his Medicare reform plan on a fall visit to Miami, according to a campaign official, but has spent much of the past week criticizing Gingrich and Obama.
Romney faces another challenge among conservatives, as the health reform he signed into law as Massachusetts governor bears many similarities to the law Obama signed several years later. As a presidential candidate, Romney has said that health reform should be handled by states, not the federal government.
Gingrich, too, has until recently backed the idea that individuals should be required to buy health insurance, a central element of Obama's plan.
(Editing by Marilyn W. Thompson and Doina Chiacu)