Survey Finds People With Medicare More Negative Than Positive Toward New Drug Law, But Want It Fixed, Not Repealed

Most People On Medicare Do Not Believe The New Drug Benefit Will Help Them Personally; Few Currently Plan To Enroll But Most Don't Know Enough To Say

Issue To Influence Congressional Elections More Than Presidential Race

WASHINGTON, DC-(August 10, 2004)- Many more people on Medicare have an unfavorable than a favorable impression of the new law that adds a drug benefit to the program, but most want Congress to fix rather than repeal it, according to a new survey of the opinions of people on Medicare released today. The survey found that, as of July 2004, nearly twice as many people on Medicare have an unfavorable view of the law (47%) as have a favorable view (26%), and one in four (25%) say that they don't know enough to offer an opinion.

Overall, two out of three people on Medicare (66%) say that lawmakers in Washington should work to fix problems in the law. Much smaller numbers favor repealing the law (10%) or leaving the law as is (13%), according to a national survey of 1,223 seniors and people with disabilities who receive Medicare conducted from June 16 to July 21. The survey, Views of the New Medicare Drug Law: A Survey of People On Medicare, was conducted jointly by the Kaiser Family Foundation and the Harvard School of Public Health to provide insight into the opinions of the 41 million Americans on Medicare, including the 6 million people on Medicare under age 65 who have permanent disabilities.

"Fifteen months from implementation, seniors are mostly negative and very confused, but there is little evidence of a large scale backlash," said Drew Altman, President and CEO of the Kaiser Family Foundation. "This survey suggests that there will be big debates in the future about the prescription drug law, but they will be about improving it, not repealing it."

Will I Benefit?

The majority of people on Medicare think the new law will be helpful for most people on Medicare, but most don't think the law will be helpful to them personally. About three in 10 view the new law as very (9%) or somewhat (19%) helpful to them personally.

The groups most likely to be helped by the new law - those with low incomes and those low who currently have no drug coverage - are not significantly more likely than others to think the law will help them personally.

A third (33%) of people on Medicare with incomes under $20,000 annually, and three in 10 people on Medicare with no drug coverage (31%), say the new law will be very or somewhat helpful for them personally.

With the full Medicare drug benefit set to take effect in January 2006, most people on Medicare (62%) say they haven't yet heard enough to decide whether they will enroll in a Medicare drug plan when the benefit becomes available in 2006, while 16% say they will enroll, and 21% say they will not enroll. More of those who currently have no prescription drug coverage (23%) say they will enroll in the benefit in 2006, but 11% say they will not enroll, and nearly two thirds (65%) say they haven't yet heard enough to decide.

Among the 47% of people on Medicare who have an unfavorable impression of the law, the most frequently cited reason is that it does not provide enough help with drug costs for people on Medicare (81% of those with an unfavorable impression, or 39% of people on Medicare overall, say this is a major reason). Other major reasons include that the law is too complicated for people on Medicare to understand (34% overall) and that it will benefit private health plans and pharmaceutical companies too much (33% overall). Fewer people on Medicare cite the long-term cost of the law to government as a major reason for their unfavorable view (16% overall).

The 26% of people on Medicare who say they have a favorable impression of the law cite several major reasons for their view, including that the law will help pay many of the drug bills for people on Medicare (78% of those with a favorable impression, or 20% overall, say this is a major reason), that it the law will help low-income people on Medicare (20% overall), that it will be helpful for people with high drug bills (20% overall), that it allows people on Medicare to choose a drug plan that best meets their needs (17% overall), and that it is a good start and can be improved over time (15% overall).

Whether positive or negative, however, views about the law are moderate in tone. Just 2% say they are "enthusiastic" about the law, and 10% say they are angry; 31% say they are "satisfied, but not enthusiastic," and 41% say they are "dissatisfied, but not angry."

The negative views toward the new Medicare law are in sharp contrast to how seniors and disabled people view the Medicare program itself. The survey found that three out of four people on Medicare (73%) say they have a favorable opinion of Medicare, compared with one in four (26%) who say they have a favorable opinion of the new Medicare law.

Impact On Elections

When asked about November's elections, nearly three in 10 seniors and people with disabilities on Medicare (28%) say the passage of the new law will have an effect on their vote for president. A significantly larger number - nearly four in 10 (38%) -- say it will have an effect on their vote for Congress.

The issue appears to favor Democrats in the Congressional elections at this point in time. Among those who say that the law will impact their vote in Congressional races, more than twice as many say it will make them more likely to vote for a Democrat (53% of those who say law will impact their vote, or 20% overall) than say it will make them more likely to vote for a Republican (21% of those who say law will impact vote, or 8% overall).

"The Medicare issue could be a decisive factor in a close Presidential election and in some House races," said Robert J. Blendon, Sc.D. Professor of Health Policy at the Harvard School of Public Health.

Among those who say that the law will impact their vote for President, more than twice as many say that it makes them more likely to vote for Democratic challenger John F. Kerry (44% of those who say they law will impact their vote, or 12% overall) than say it makes them more likely to vote for President George W. Bush (18% of those who say law will impact vote, or 5% overall). People on Medicare are nearly evenly divided on whether they trust Sen. Kerry (39%) or President Bush (34%) more when it comes to handling prescription drug benefits for people on Medicare.

The poll shows that to date the law has not been a political plus for Republicans, but the number of seniors likely to switch their vote from one candidate to another because of the law is modest, with any benefit likely going to the Democrats.

Medicare-approved drug discount cards

More than half of all people on Medicare (53 percent) say that the Medicare-approved drug discount cards "aren't worth the trouble because they don't do enough to help people with their drug costs, and they are too confusing to use," while about a third (34 percent) say they are "worthwhile because they give people on Medicare immediate help before the full prescription drug benefit is available in 2006, and they provide another way to cut their drug costs."

The survey found that 9% of people on Medicare say they have signed up for a Medicare-approved drug discount card, and another 17% say they plan to sign up for a card this year.

Six in 10 people on Medicare (60%) say they don't have a card and don't plan to sign up for one. Many of those who don't plan to sign up say that they already have other drug discount cards or coverage (63%) and that they do not think the card will save them money (41%). Fewer say they won't sign up because they were worried about how the cards would affect other prescription drug coverage they have (21%) or because it was too difficult to choose among the variety of cards offered (14%). About one in eight (13%) who did not sign up say the reason was that they did not know about the cards.

Reimportation and negotiation

People on Medicare also overwhelmingly support two legislative changes that have been debated in Washington.

Eight in 10 (79%) say they favor changing the law to allow Americans to buy prescription drugs from Canada if they think they can get a lower price. Two thirds (66%) agree that the change will make medicines more affordable without sacrificing safety or quality. Large majorities disagree with arguments put forward by the opponents of reimportation. About seven in 10 (71%) disagree that this will lead U.S. drug companies to do less research and development, and about six in 10 (62%) disagree that it will expose Americans to unsafe medicines from other countries.

Similarly, eight in 10 people on Medicare (80%) say they favor changing the law to allow the federal government to use its buying power to negotiate with drug companies to try to get a lower price for prescription drugs for people on Medicare. Large majorities agree with arguments for government negotiation, including that it makes sense because other governments currently negotiate drug prices (80% agree), it will make medicines more affordable for people on Medicare (76% agree), and it makes sense because the government already negotiates lower prices for the Defense Department and Veterans Administration (69% agree). When it comes to arguments against government negotiation, six in 10 (61%) disagree that it will lead U.S. drug companies to do less research and development. Half (53%) agree that it will mean government price controls on prescription drugs.

Outreach efforts

People on Medicare say that they get information about Medicare and prescription drugs from various sources. Four in 10 (42%) say they saw any television advertisements about the Medicare law in the previous month, and a similar number (41%) say they saw news coverage about the new Medicare law in the previous month. Among those who have seen TV ads, more say the ads were positive (34%) than negative (9%) towards the new law, while nearly half (47%) say they were mixed.

Six in 10 (60%) say they have gotten information in the mail about the new Medicare-Approved Drug Discount Card Program. They say that this information comes from a variety of sources, including the government and private companies selling discount cards.

Six in 10 people on Medicare (60%) say they have heard of 1-800-MEDICARE, and 16% of these (10% overall) say they have called the toll-free number. More than one in eight (14%) say they have heard of the Medicare.gov web site, though only 4% overall say they have visited the site. A quarter of people on Medicare (25%) say they have ever been online to use the Internet or e-mail.

The survey showed that disabled people under age 65 who receive Medicare are more likely to use these resources than seniors. Disabled people under age 65 who are on Medicare are significantly more likely than seniors to be online (33% vs. 24%), to have visited Medicare.gov (10% vs. 4%), and to have called 1-800-MEDICARE (16% vs. 9%).

METHODOLOGY

The Kaiser Family Foundation/Harvard School of Public Health Views of the New Medicare Drug Law: A Survey of People on Medicare was designed and analyzed by researchers at the Kaiser Family Foundation and Harvard School of Public Health. The Kaiser/Harvard survey research team included Mollyann Brodie, Ph.D., Tricia Neuman, Ph.D., Elizabeth Hamel, and Michelle Kitchman from the Kaiser Family Foundation; and Professor Robert Blendon, Sc.D., and John Benson, M.A., of the Harvard School of Public Health.

Fieldwork was conducted by telephone by ICR/International Communications Research between June 16 and July 21, 2004, among a sample of 1,223 total respondents. The survey included a nationally representative random sample of 973 respondents 65 years of age and older, including an oversample of African American respondents in this age group (a total of 203 African American respondents ages 65 and older were interviewed). A separate sample of 250 respondents ages 18-64 with physical and/or mental disabilities who receive Medicare was also interviewed. The disabled sample was drawn from a nationally representative survey of households contacted between June 2002 and January 2003 that was screened to identify households with an adult, aged 18-64, who receives disability payments through the SSI or SSDI program and/or considers him or herself disabled. This sample was then re-screened to include those people with disabilities who are covered by Medicare. Results for all groups have been weighted to reflect the actual distribution in the nation.

The margin of sampling error for the survey is plus or minus four percentage points for total respondents; for respondents age 65 and older it is plus or minus four percentage points; and for non-elderly respondents with disabilities it is plus or minus 10 percentage points. For results based on subsets of respondents the margin of error is higher. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll.

The topline results and the survey report are available online at www.kff.org.

The Kaiser Family Foundation is a non-profit, private operating foundation dedicated to providing information and analysis on health care issues to policymakers, the media, the health care community, and the general public. The foundation is not associated with Kaiser Permanente or Kaiser Industries.

Harvard School of Public Health is dedicated to advancing the public's health through learning, discovery, and communication. More than 300 faculty members are engaged in teaching and training more than 800 students in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world.