Filling the need for trusted information on national health issues…

Two Studies Draw Different Conclusions on State of Black America

In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses how studies with conflicting views of progress and problems for African Americans can both be true, and why African Americans may feel the problems more than the progress.

Column/Op-Ed Read Post

Partisanship’s Grip On The Affordable Care Act

In this Wall Street Journal’s Think Tank column Drew Altman analyzes data from an upcoming Kaiser poll and discusses how partisanship is the dominant factor shaping views of the Affordable Care Act for Republicans and Democrats enrolled in marketplace plans.

Column/Op-Ed Read Post

Clinton-Sanders Contest Fuels Democratic Support for Expanding Obamacare

In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses how the debate between Hillary Clinton and Bernie Sanders about how to get to universal coverage has generated more support among Democrats for expanding the Affordable Care Act (and less support for the law as is).

Column/Op-Ed Read Post

Obamacare? Zika? Which Health Stories Americans Actually Follow

In this column for The Wall Street Journal’s Think Tank, Drew Altman analyzes the Kaiser Health Policy News Index to determine which health stories in the news have broken through to the public the most in the last year. One conclusion: it wasn’t the Affordable Care Act.

Column/Op-Ed Read Post

What Paul Ryan’s Stance on 2016 Means for Health Care

In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses the implications of Paul Ryan’s decision to rule out being drafted as a Republican presidential candidate for the 2017 health care agenda and how it could focus greater attention on proposals to change Medicare and Medicaid along with the Affordable Care Act.

Column/Op-Ed Read Post

How Health Care Factors Into the Presidential Campaign

In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses how health care issues have cooled in the election season but matter more for certain voting groups than others, and for “health care voters” encompass more than the Affordable Care Act.

Column/Op-Ed Read Post
ES_WP_Query Object
(
    [es_map:protected] => Array
        (
            [post_meta] => meta.%s.value.raw_lc
            [post_meta.analyzed] => meta.%s.value
            [post_meta.long] => meta.%s.long
            [post_meta.double] => meta.%s.double
            [post_meta.binary] => meta.%s.boolean
            [post_meta.date] => post_meta.%s.date
            [post_meta.datetime] => post_meta.%s.datetime
            [post_meta.time] => post_meta.%s.time
            [post_meta.signed] => post_meta.%s.signed
            [post_meta.unsigned] => post_meta.%s.unsigned
            [term_id] => taxonomy.%s.term_id
            [term_slug] => taxonomy.%s.slug
            [term_name] => taxonomy.%s.name.raw_lc
            [term_tt_id] => terms.%s.term_taxonomy_id
            [category_id] => category.term_id
            [category_slug] => category.slug
            [category_name] => category.name.raw
            [category_tt_id] => terms.%s.term_taxonomy_id
            [tag_id] => tag.term_id
            [tag_slug] => tag.slug
            [tag_name] => tag.name.raw
            [tag_tt_id] => terms.%s.term_taxonomy_id
            [post_author] => author_id
            [post_date] => date
            [post_date.year] => date_token.year
            [post_date.month] => date_token.month
            [post_date.week] => date_token.week
            [post_date.day] => date_token.day
            [post_date.day_of_year] => date_token.day_of_year
            [post_date.day_of_week] => date_token.day_of_week
            [post_date.hour] => date_token.hour
            [post_date.minute] => date_token.minute
            [post_date.second] => date_token.second
            [post_date_gmt] => date_gmt
            [post_date_gmt.year] => date_gmt_token.year
            [post_date_gmt.month] => date_gmt_token.month
            [post_date_gmt.week] => date_gmt_token.week
            [post_date_gmt.day] => date_gmt_token.day
            [post_date_gmt.day_of_year] => date_gmt_token.day_of_year
            [post_date_gmt.day_of_week] => date_gmt_token.day_of_week
            [post_date_gmt.hour] => date_gmt_token.hour
            [post_date_gmt.minute] => date_gmt_token.minute
            [post_date_gmt.second] => date_gmt_token.second
            [post_content] => content
            [post_content.analyzed] => content
            [post_title] => title
            [post_title.analyzed] => title
            [post_excerpt] => excerpt
            [post_password] => post_password
            [post_name] => post_name
            [post_modified] => modified
            [post_modified.year] => modified_token.year
            [post_modified.month] => modified_token.month
            [post_modified.week] => modified_token.week
            [post_modified.day] => modified_token.day
            [post_modified.day_of_year] => modified_token.day_of_year
            [post_modified.day_of_week] => modified_token.day_of_week
            [post_modified.hour] => modified_token.hour
            [post_modified.minute] => modified_token.minute
            [post_modified.second] => modified_token.second
            [post_modified_gmt] => modified_gmt
            [post_modified_gmt.year] => modified_gmt_token.year
            [post_modified_gmt.month] => modified_gmt_token.month
            [post_modified_gmt.week] => modified_gmt_token.week
            [post_modified_gmt.day] => modified_gmt_token.day
            [post_modified_gmt.day_of_year] => modified_gmt_token.day_of_year
            [post_modified_gmt.day_of_week] => modified_gmt_token.day_of_week
            [post_modified_gmt.hour] => modified_gmt_token.hour
            [post_modified_gmt.minute] => modified_gmt_token.minute
            [post_modified_gmt.second] => modified_gmt_token.second
            [post_parent] => parent_post_id
            [menu_order] => menu_order
            [post_mime_type] => post_mime_type
            [comment_count] => comment_count
        )

    [es_args] => Array
        (
            [filter] => Array
                (
                    [and] => Array
                        (
                            [0] => Array
                                (
                                    [terms] => Array
                                        (
                                            [post_type] => Array
                                                (
                                                    [0] => perspective
                                                    [1] => page
                                                )

                                        )

                                )

                            [1] => Array
                                (
                                    [terms] => Array
                                        (
                                            [post_status] => Array
                                                (
                                                    [0] => publish
                                                )

                                        )

                                )

                            [2] => Array
                                (
                                    [or] => Array
                                        (
                                            [0] => Array
                                                (
                                                    [term] => Array
                                                        (
                                                            [meta.kff_author.value.raw_lc] => 49507
                                                        )

                                                )

                                            [1] => Array
                                                (
                                                    [term] => Array
                                                        (
                                                            [meta.included_on_page.value.raw_lc] => 105174
                                                        )

                                                )

                                        )

                                )

                        )

                )

            [sort] => Array
                (
                    [0] => Array
                        (
                            [date] => desc
                        )

                )

            [fields] => Array
                (
                    [0] => post_id
                )

            [from] => 42
            [size] => 6
        )

    [es_response] => Array
        (
            [results] => Array
                (
                    [total] => 178
                    [max_score] => 
                    [hits] => Array
                        (
                            [0] => Array
                                (
                                    [_index] => kaiserfamilyfoundation.wordpress.com-9
                                    [_type] => post
                                    [_id] => 50276312-p-188333
                                    [_score] => 
                                    [fields] => Array
                                        (
                                            [post_id] => 188333
                                        )

                                    [sort] => Array
                                        (
                                            [0] => 1463145947000
                                        )

                                )

                            [1] => Array
                                (
                                    [_index] => kaiserfamilyfoundation.wordpress.com-9
                                    [_type] => post
                                    [_id] => 50276312-p-187989
                                    [_score] => 
                                    [fields] => Array
                                        (
                                            [post_id] => 187989
                                        )

                                    [sort] => Array
                                        (
                                            [0] => 1462867652000
                                        )

                                )

                            [2] => Array
                                (
                                    [_index] => kaiserfamilyfoundation.wordpress.com-9
                                    [_type] => post
                                    [_id] => 50276312-p-187346
                                    [_score] => 
                                    [fields] => Array
                                        (
                                            [post_id] => 187346
                                        )

                                    [sort] => Array
                                        (
                                            [0] => 1462099360000
                                        )

                                )

                            [3] => Array
                                (
                                    [_index] => kaiserfamilyfoundation.wordpress.com-9
                                    [_type] => post
                                    [_id] => 50276312-p-186817
                                    [_score] => 
                                    [fields] => Array
                                        (
                                            [post_id] => 186817
                                        )

                                    [sort] => Array
                                        (
                                            [0] => 1461580646000
                                        )

                                )

                            [4] => Array
                                (
                                    [_index] => kaiserfamilyfoundation.wordpress.com-9
                                    [_type] => post
                                    [_id] => 50276312-p-185841
                                    [_score] => 
                                    [fields] => Array
                                        (
                                            [post_id] => 185841
                                        )

                                    [sort] => Array
                                        (
                                            [0] => 1460570945000
                                        )

                                )

                            [5] => Array
                                (
                                    [_index] => kaiserfamilyfoundation.wordpress.com-9
                                    [_type] => post
                                    [_id] => 50276312-p-180583
                                    [_score] => 
                                    [fields] => Array
                                        (
                                            [post_id] => 180583
                                        )

                                    [sort] => Array
                                        (
                                            [0] => 1459959918000
                                        )

                                )

                        )

                )

            [took] => 1
        )

    [query] => Array
        (
            [post_type] => Array
                (
                    [0] => perspective
                    [1] => page
                )

            [orderby] => date
            [order] => DESC
            [posts_per_page] => 6
            [paged] => 8
            [meta_query] => Array
                (
                    [relation] => OR
                    [0] => Array
                        (
                            [key] => kff_author
                            [value] => 49507
                        )

                    [1] => Array
                        (
                            [key] => included_on_page
                            [value] => 105174
                        )

                )

        )

    [query_vars] => Array
        (
            [post_type] => Array
                (
                    [0] => perspective
                    [1] => page
                )

            [orderby] => date
            [order] => desc
            [posts_per_page] => 6
            [paged] => 8
            [meta_query] => Array
                (
                    [relation] => OR
                    [0] => Array
                        (
                            [key] => kff_author
                            [value] => 49507
                        )

                    [1] => Array
                        (
                            [key] => included_on_page
                            [value] => 105174
                        )

                )

            [error] => 
            [m] => 
            [p] => 0
            [post_parent] => 
            [subpost] => 
            [subpost_id] => 
            [attachment] => 
            [attachment_id] => 0
            [name] => 
            [pagename] => 
            [page_id] => 0
            [second] => 
            [minute] => 
            [hour] => 
            [day] => 0
            [monthnum] => 0
            [year] => 0
            [w] => 0
            [category_name] => 
            [tag] => 
            [cat] => 
            [tag_id] => 
            [author] => 
            [author_name] => 
            [feed] => 
            [tb] => 
            [meta_key] => 
            [meta_value] => 
            [preview] => 
            [s] => 
            [sentence] => 
            [title] => 
            [fields] => 
            [menu_order] => 
            [embed] => 
            [category__in] => Array
                (
                )

            [category__not_in] => Array
                (
                )

            [category__and] => Array
                (
                )

            [post__in] => Array
                (
                )

            [post__not_in] => Array
                (
                )

            [post_name__in] => Array
                (
                )

            [tag__in] => Array
                (
                )

            [tag__not_in] => Array
                (
                )

            [tag__and] => Array
                (
                )

            [tag_slug__in] => Array
                (
                )

            [tag_slug__and] => Array
                (
                )

            [post_parent__in] => Array
                (
                )

            [post_parent__not_in] => Array
                (
                )

            [author__in] => Array
                (
                )

            [author__not_in] => Array
                (
                )

            [ignore_sticky_posts] => 
            [suppress_filters] => 
            [cache_results] => 
            [update_post_term_cache] => 1
            [update_post_meta_cache] => 1
            [nopaging] => 
            [comments_per_page] => 50
        )

    [tax_query] => ES_WP_Tax_Query Object
        (
            [es_query:protected] => ES_WP_Query Object
 *RECURSION*
            [queries] => Array
                (
                )

            [relation] => AND
            [table_aliases:protected] => Array
                (
                )

            [queried_terms] => Array
                (
                )

            [primary_table] => 
            [primary_id_column] => 
        )

    [meta_query] => ES_WP_Meta_Query Object
        (
            [es_query:protected] => ES_WP_Query Object
 *RECURSION*
            [queries] => Array
                (
                    [0] => Array
                        (
                            [key] => kff_author
                            [value] => 49507
                        )

                    [1] => Array
                        (
                            [key] => included_on_page
                            [value] => 105174
                        )

                    [relation] => OR
                )

            [relation] => OR
            [meta_table] => 
            [meta_id_column] => 
            [primary_table] => 
            [primary_id_column] => 
            [table_aliases:protected] => Array
                (
                )

            [clauses:protected] => Array
                (
                    [meta-clause] => Array
                        (
                            [key] => kff_author
                            [value] => 49507
                            [compare] => =
                            [type] => 
                        )

                    [meta-clause-1] => Array
                        (
                            [key] => included_on_page
                            [value] => 105174
                            [compare] => =
                            [type] => 
                        )

                )

            [has_or_relation:protected] => 1
        )

    [date_query] => 
    [posts] => Array
        (
            [0] => WP_Post Object
                (
                    [ID] => 188333
                    [post_author] => 36621681
                    [post_date] => 2016-05-13 13:25:47
                    [post_date_gmt] => 2016-05-13 17:25:47
                    [post_content] => 
This was published as a Wall Street Journal's Think Tank column on May 13, 2016.
In the past few weeks, one report painted a picture of real progress in the African American community with gains on many critical measures, while another – a survey my organization conducted with the New York Times – painted an alarming portrait of life for African Americans in Chicago and the prospects for African American youth there. Both the more positive and negative portrayals are accurate, but it’s very clear why statistical progress is hard for African American residents in cities like Chicago or Baltimore or Ferguson to appreciate. The more positive picture came in a New York Times story about federal data showing significant gains for black Americans in infant mortality, suicide rates, teen births, and even deaths from homicide which fell significantly, all driving gains in life expectancy for African Americans. In the story, Harvard sociologist Robert J. Sampson is quoted as saying: “ The decline in violence is a major social fact that is really reshaping society and the lived experience of kids growing up-particularly blacks.” That may seem jarring after Ferguson and Baltimore and the regular reports of violence in Chicago, to name just a few urban areas plagued by crime and tensions between the community and police.
SOURCE: Kaiser Family Foundation/New York Times Survey of Chicago Residents (conducted April 21- May 3, 2016)
SOURCE: Kaiser Family Foundation/New York Times Survey of Chicago Residents (conducted April 21- May 3, 2016)
The Kaiser Family Foundation/New York Times survey of Chicago residents shows the other side of the coin. In that survey, as the chart shows, 54% of blacks in Chicago say it is very likely for a young person in their community to end up in jail, 49% to be a victim of a violent crime, and 47% to join a gang. By contrast 36% of blacks say a young person in their neighborhood is very likely to graduate from high school and 26% expect them to graduate from college. Almost half of black residents report knowing a victim of gun violence and 41% of black men said there was a time when they felt their life was in danger. Confidence in the police is so low that 54% of black residents say that if you call the police in a dangerous situation it either won’t make things better or will make them worse. One picture, the more positive one, is the bird’s eye view of gradual changes over time, and the other is the worm’s eye view of point in time reality today. We see this in other areas as well. The economy has been gradually improving, but people don’t experience it because, until recently, wage growth has been flat. Health spending has been growing at historically moderate rates, but people don’t feel it because what they pay out of pocket for health care is going up. Similarly, as shown by Sabrina Tavernise’s excellent reporting in the New York Times, there have been gains over time for black Americans on many measures, and gaps have closed between blacks and whites on measures such as homicide rates and life expectancy. Still, reality on the ground is a far different thing. There were fifty one homicides in Chicago in January and two hundred and forty two shootings. Chicago may be an especially troubled city but it is also emblematic of problems in other urban areas. It is more than understandable why African Americans in many urban communities would have a hard time taking the bird’s eye view of statistical progress when the reality they see every day is so different – and troubling –  and why their trust in local institutions and hope for a better future for young people is fraying.
[post_title] => Two Studies Draw Different Conclusions on State of Black America [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman discusses how studies with conflicting views of progress and problems for African Americans can both be true, and why African Americans may feel the problems more than the progress. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => two-studies-draw-different-conclusions-on-state-of-black-america [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:37:36 [post_modified_gmt] => 2017-02-06 21:37:36 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=188333 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 187989 [post_author] => 36621681 [post_date] => 2016-05-10 08:07:32 [post_date_gmt] => 2016-05-10 12:07:32 [post_content] =>
This was published as a Wall Street Journal' Think Tank column on May 10, 2016.
Kaiser Family Foundation chart looking at the reaction of those enrolled in health-care plans through the Affordable Care Act marketplaces on whether they benefited from or were negatively affected by the 2010 law.
You might think that people enrolled in the Affordable Care Act’s marketplace plans would like their coverage more or less depending on whether they have a high or low deductible, or receive a subsidy to help them pay their premium. Those factors and other elements of their coverage matter, but by far the biggest difference between those in marketplace plans who say they have benefited from the ACA or been negatively affected by it is whether they are a Republican or a Democrat. That’s one finding from an analysis of a Kaiser Family Foundation survey of people covered in the non-group insurance market, which provides the clearest illustration I have seen yet of how partisanship colors people’s views of the ACA. In the Kaiser survey, which will be published next week, 29% of Republicans in marketplace plans (i.e., Obamacare) say they have benefited from the ACA compared with 75% of Democrats, a 46-point difference. There is no reason to believe that there are demographic differences between these Republican or Democratic marketplace enrollees that would explain this large of a difference in their responses. They are all purchasing coverage in the ACA marketplaces, and most members of each group are receiving premium subsidies under the law. Overall, substantially more marketplace-plan enrollees say that they benefited from the ACA (54%) than say they were negatively affected (35%).
Are Republicans more negative because they feel they were forced by the law to purchase marketplace coverage? Or perhaps because they associate it with President Barack Obama, whom they don’t like? Or because they have heard bad things about Obamacare on right-leaning talk radio or cable news? Do Democrats say they have benefited because they like the president and support the law and watch left-leaning cable news? There is no way to know for sure. What is clear, though, is that the sharpest difference between enrollees in similar ACA marketplace plans is their partisan perspective.
Many expected that as people gained direct experience with the ACA, those experiences would shape their views as the law evolved from a political symbol to a reality in their lives. Advocates of the ACA thought opinions toward the law would become more positive, and critics felt the opposite. Six years after the Affordable Care Act became law, partisan perspectives still seem to trump experience. It’s a reminder of the extent to which partisanship colors perceptions of policy and programs, including the ACA.
[post_title] => Partisanship's Grip On The Affordable Care Act [post_excerpt] => In this Wall Street Journal's Think Tank column Drew Altman analyzes data from an upcoming Kaiser poll and discusses how partisanship is the dominant factor shaping views of the Affordable Care Act for Republicans and Democrats enrolled in marketplace plans. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => partisanships-grip-on-the-affordable-care-act [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:41:24 [post_modified_gmt] => 2017-02-06 21:41:24 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=187989 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 187346 [post_author] => 36621681 [post_date] => 2016-05-01 10:42:40 [post_date_gmt] => 2016-05-01 14:42:40 [post_content] =>
This was published as a Wall Street Journal's Think Tank column on May 1, 2016.
Kaiser Family Foundation polling data of Democratic support over the past year for expansion of the Affordable Care Act or implementation of the law as it stands.
Among the most hotly debated of the issues Hillary Clinton and Bernie Sanders have taken on in the Democratic primary contest is how best to get to universal health insurance coverage. The former secretary of state favors incremental steps, and the senator calls for a single-payer system. That debate, and their focus on universal coverage as their goal, appears to have had a modest and perhaps surprising effect on attitudes toward the Affordable Care Act. The health-care law is an issue about which public attitudes seldom shift, yet the share of Democrats who want to expand the Affordable Care Act rose over the past year. As the chart above shows, a year ago 38% of Democrats supported expanding the ACA rather than implementing the law as it is–which 35% supported–and 18% supported repealing or scaling back the law. Over the past year the percentage rose by 13 points: 51% of Democrats support ACA expansion as of April. The debate moved the bar, but this does not mean health care became a driving issue in the primaries, though it was always in the mix of key topics for Democratic voters. In the recent Democratic primary in Pennsylvania, for example, exit polls show that one in five Democratic voters picked health care as an issue important to their vote. That’s about half as many as the voters who cited the economy and jobs as key to their choice.
At the same time interest grew in expanding the ACA, the share of Democrats who have an unfavorable opinion of the law also rose. It climbed six percentage points, to 25%, in the Kaiser Family Foundation’s April health tracking poll, up from 19% in March. Republican opposition toward the law remained stable over the same period.
Presidential elections have had an impact on public support for the ACA in the past. The numbers fell when Republicans blasted the law during the primary campaign in 2012. Now we are seeing support for expansion tick up as Democratic candidates debate how best to reach universal coverage. The takeaway seems to be: What the candidates talk about can sway opinion on policy, even if it doesn’t always affect how people vote.
[post_title] => Clinton-Sanders Contest Fuels Democratic Support for Expanding Obamacare [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman discusses how the debate between Hillary Clinton and Bernie Sanders about how to get to universal coverage has generated more support among Democrats for expanding the Affordable Care Act (and less support for the law as is). [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => clinton-sanders-contest-fuels-democratic-support-for-expanding-obamacare [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:44:01 [post_modified_gmt] => 2017-02-06 21:44:01 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=187346 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 186817 [post_author] => 36621681 [post_date] => 2016-04-25 10:37:26 [post_date_gmt] => 2016-04-25 14:37:26 [post_content] =>
This was published as a Wall Street Journal Think Tank column on April 25, 2016.
There has been a lot of health news over the past year, but which health stories really got through to the public? How about stories about Obamacare ranging from Republican efforts to repeal the law to stories about progress meeting enrollment targets? Or public health scares such as measles outbreaks or Zika? The scandals in VA health care? What about the stories about the political fight in Congress over Planned Parenthood funding? It turns out Obamacare, known formally as the Affordable Care Act, didn’t make the list of top health stories. The story that broke through the most? The fight over Planned Parenthood funding. Public health scares also broke through. And one health policy story with a consumer angle made the top group: rising drug prices. It matters which stories the public follows, and how closely, because the news media is an especially important source of information on health issues. For example, people report that TV, radio and newspapers are their top source of information on the ACA, ahead of their own experience and what they learn from family and friends.
 
The chart above shows the six health stories over the last 12 months that were followed “very closely” by at least 20% of the American people. The controversy surrounding federal funding for Planned Parenthood was followed very closely by 35% of the public, making it the top health story by this measure by a small margin over the measles outbreak. By comparison, 51% of the public followed the Paris attacks very closely and 43% followed the debates about gun control very closely last October after campus shootings. The data are taken from the Kaiser Health Policy News Index, a series of monthly poll-based checks on which health stories the public is following and how closely people are following them.
Two public health threats, the measles outbreak in March 2015 (33%) and the Flint, Mich., water crisis (30%) came in second and third, while the scandal in the VA health care system followed very closely by 26%. Fifth on the list, and the only health policy story to make the top list, was rising prescription drug costs. That jibes with other poll findings showing curtailing rising drug costs at or near the top of the public’s priority list for the president and congress. It was notable that no ACA story cracked the 20% mark. The top ACA story over the last year was a political story, the Republican repeal effort, followed very closely by 19%. The top ACA policy story was the coverage of ACA enrollment in the fall of 2015, at 17%. It seems safe to say that the public is less interested in the ACA political wars than the press, politicians and political insiders are. It’s easy to conclude that the public is more interested in potentially scary epidemics or scandals and political controversies than other types of stories. But we also know from polling that that the public’s priorities for action in health focus on their worries about pocketbook issues such as rising deductibles and drug costs and how health care affects them and their families. In the end, it’s hard to sort out whether the health stories the public follows most closely are more a function of public interest and human nature, or of what the media decides to emphasize in coverage.
[post_title] => Obamacare? Zika? Which Health Stories Americans Actually Follow [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman analyzes the Kaiser Health Policy News Index to determine which health stories in the news have broken through to the public the most in the last year. One conclusion: it wasn't the Affordable Care Act. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => obamacare-zika-which-health-stories-americans-actually-follow [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:48:22 [post_modified_gmt] => 2017-02-06 21:48:22 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=186817 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 185841 [post_author] => 36621681 [post_date] => 2016-04-13 18:09:05 [post_date_gmt] => 2016-04-13 22:09:05 [post_content] =>
This was published as a Wall Street Journal Think Tank column on April 13, 2016.
 Kaiser Family Foundation chart of the number of Medicare and Medicaid beneficiaries, annual spending, and beneficiaries' median annual income. 
The decision by House Speaker Paul Ryan to bow out of any attempt to draft him as the Republican presidential nominee in Cleveland and press ahead with his domestic policy agenda could be significant for health care. The next big debate might not be about Republican proposals to repeal and replace the Affordable Care Act. It might focus more on the future of the two largest public health-care programs, Medicare and Medicaid. As the chart above shows, Medicare covered 55 million and Medicaid covered 66 million people in 2015 at a cost of more than $1 trillion. Together, they represented 23% of the federal budget. It’s likely that Mr. Ryan and Republicans working on these issues in the House will put forward variations on ideas they have previously advanced, such as transforming Medicaid into block grants to the states, with capped federal funding, and converting Medicare into some form of a premium support program. Having seen these ideas crash and burn in the past, Republicans may put forward more politically palatable proposals–though Democrats and liberals are still sure to oppose them fiercely. The impact on beneficiaries and states will depend on details of the proposals. It’s likely that, honoring political promises, these proposals will be coupled to some form of plan to repeal and at least partially replace the Affordable Care Act.
A legislative agenda dealing with all of U.S. health care’s major programs is not likely to diminish attention to any of its parts. Each program has strong constituencies and proposed changes will ignite partisan battle; Medicare is likely to be at the core of the hottest debate, even more fierce than that over the ACA. Any attempt to restructure Medicare–even one phased in so as to affect only future generations–could mobilize seniors with whom the GOP has generally been doing better in recent election cycles.
Medicaid is not necessarily much easier to change. While not popular with conservatives, the program serves some 70 million Americans who are mostly pleased with their coverage, according to surveys and focus groups of beneficiaries. When it comes to cuts, the program is not as popular with the public as Social Security and Medicare are, but it is still very popular. To some degree many changes long sought by conservatives are already happening incrementally: More than half of Medicaid beneficiaries are in private managed-care plans. Almost one-third of Medicare beneficiaries are enrolled in private Medicare Advantage Plans this year, rather than the traditional program, and the share is projected to grow to more than 40% by 2026. The same is true of private health insurance. Conservatives complain about the ACA, but their preferred vision of health insurance–with high deductibles and lots of “skin in the game” plans–is dominating in the marketplace. The trend is reinforced by many of the policies being sold in the ACA’s insurance marketplaces. As House speaker, Paul Ryan will determine whether the next iteration of our national health debate is as much about Medicare and Medicaid as the ACA–or more so. Mr. Ryan’s announcement this week may ultimately leave a Republican health policy agenda laid out as a guidepost for the party regardless of who is elected in November and who future GOP candidates may be.
[post_title] => What Paul Ryan’s Stance on 2016 Means for Health Care [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman discusses the implications of Paul Ryan’s decision to rule out being drafted as a Republican presidential candidate for the 2017 health care agenda and how it could focus greater attention on proposals to change Medicare and Medicaid along with the Affordable Care Act. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => what-paul-ryans-stance-on-2016-means-for-health-care [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:51:11 [post_modified_gmt] => 2017-02-06 21:51:11 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=185841 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 180583 [post_author] => 36621681 [post_date] => 2016-04-06 16:25:18 [post_date_gmt] => 2016-04-06 20:25:18 [post_content] =>
This was published as a Wall Street Journal Think Tank column on April 6, 2016.
Kaiser Family Foundation chart showing what shares of Republicans, Democrats and independents say health care and other issues are 'extremely important' to their vote for president.
Health care has faded into the background of the election campaign as Donald Trump himself has become the issue on the Republican side and the debate between Hillary Clinton and Bernie Sanders over health care has shifted to other topics. Health wasn’t even listed among the “most important issues” Republican voters could select from in the exit poll of Tuesday’s Wisconsin primary. But that doesn’t mean health is a total non-factor in the primaries; it is a more salient issue for some voting groups than others. And a broad constellation of health issues, not only the Affordable Care Act, are likely to have traction in the general election, particularly among women. Health has traditionally been more of a priority for Democrats. The chart above shows that, although Republican candidates are all-in for repealing Obamacare, health care is a bigger voting issue for Democrats. Health ranked first as an “extremely important” voting issue for Democrats and fourth for Republicans in the Kaiser Family Foundation’s Health Tracking Poll in March. This doesn’t mean that health will be the No. 1 or No. 4 factor when Democrats and Republicans vote in November. As the chart also shows, issue priorities are closely bunched, and my experience has been that voters cast ballots in presidential elections on the basis of their overall views of the candidates rather than candidates’ specific positions on issues. When people say health care is an extremely important voting issue, they aren’t always thinking of the ACA. Among Republicans who say health is “extremely important” to their vote, about equal shares are thinking about the ACA as are thinking about issues such as access to care and health-care costs. Nor are Democrats always intending to support the ACA when they cite health as a voting issue. They are more likely to cite improving access or addressing costs generally as their reason for naming health a top voting issue.
Some demographics appear to care more about health as a voting issue than other groups do. Among registered voters, 35% of women who are independents say health will be “extremely important” to their vote, compared with 26% of men who are independents. Among Republicans the gender gap is a little wider, with 44% of women and 28% of men saying health care is extremely important to their vote.
It’s likely that the gender gap on health as a voting issue will carry over to the general election, with women forming the bloc of voters who feel strongest about health-care issues. Rising out-of-pocket costs and drug prices, reproductive health issues, opioid abuse, and other health concerns will join the ACA to form what is becoming a more multifaceted health agenda. And if big differences emerge between the Democratic and Republican candidates on Medicare, that always has the potential to drown out other health issues and activate senior voters.
[post_title] => How Health Care Factors Into the Presidential Campaign [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman discusses how health care issues have cooled in the election season but matter more for certain voting groups than others, and for “health care voters” encompass more than the Affordable Care Act. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => how-health-care-factors-into-the-presidential-campaign [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:53:40 [post_modified_gmt] => 2017-02-06 21:53:40 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=180583 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 6 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 188333 [post_author] => 36621681 [post_date] => 2016-05-13 13:25:47 [post_date_gmt] => 2016-05-13 17:25:47 [post_content] =>
This was published as a Wall Street Journal's Think Tank column on May 13, 2016.
In the past few weeks, one report painted a picture of real progress in the African American community with gains on many critical measures, while another – a survey my organization conducted with the New York Times – painted an alarming portrait of life for African Americans in Chicago and the prospects for African American youth there. Both the more positive and negative portrayals are accurate, but it’s very clear why statistical progress is hard for African American residents in cities like Chicago or Baltimore or Ferguson to appreciate. The more positive picture came in a New York Times story about federal data showing significant gains for black Americans in infant mortality, suicide rates, teen births, and even deaths from homicide which fell significantly, all driving gains in life expectancy for African Americans. In the story, Harvard sociologist Robert J. Sampson is quoted as saying: “ The decline in violence is a major social fact that is really reshaping society and the lived experience of kids growing up-particularly blacks.” That may seem jarring after Ferguson and Baltimore and the regular reports of violence in Chicago, to name just a few urban areas plagued by crime and tensions between the community and police.
SOURCE: Kaiser Family Foundation/New York Times Survey of Chicago Residents (conducted April 21- May 3, 2016)
SOURCE: Kaiser Family Foundation/New York Times Survey of Chicago Residents (conducted April 21- May 3, 2016)
The Kaiser Family Foundation/New York Times survey of Chicago residents shows the other side of the coin. In that survey, as the chart shows, 54% of blacks in Chicago say it is very likely for a young person in their community to end up in jail, 49% to be a victim of a violent crime, and 47% to join a gang. By contrast 36% of blacks say a young person in their neighborhood is very likely to graduate from high school and 26% expect them to graduate from college. Almost half of black residents report knowing a victim of gun violence and 41% of black men said there was a time when they felt their life was in danger. Confidence in the police is so low that 54% of black residents say that if you call the police in a dangerous situation it either won’t make things better or will make them worse. One picture, the more positive one, is the bird’s eye view of gradual changes over time, and the other is the worm’s eye view of point in time reality today. We see this in other areas as well. The economy has been gradually improving, but people don’t experience it because, until recently, wage growth has been flat. Health spending has been growing at historically moderate rates, but people don’t feel it because what they pay out of pocket for health care is going up. Similarly, as shown by Sabrina Tavernise’s excellent reporting in the New York Times, there have been gains over time for black Americans on many measures, and gaps have closed between blacks and whites on measures such as homicide rates and life expectancy. Still, reality on the ground is a far different thing. There were fifty one homicides in Chicago in January and two hundred and forty two shootings. Chicago may be an especially troubled city but it is also emblematic of problems in other urban areas. It is more than understandable why African Americans in many urban communities would have a hard time taking the bird’s eye view of statistical progress when the reality they see every day is so different – and troubling –  and why their trust in local institutions and hope for a better future for young people is fraying.
[post_title] => Two Studies Draw Different Conclusions on State of Black America [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman discusses how studies with conflicting views of progress and problems for African Americans can both be true, and why African Americans may feel the problems more than the progress. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => two-studies-draw-different-conclusions-on-state-of-black-america [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:37:36 [post_modified_gmt] => 2017-02-06 21:37:36 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=188333 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 178 [max_num_pages] => 30 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => [is_tag] => [is_tax] => [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => 1 [is_404] => [is_embed] => [is_paged] => 1 [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => 9915d3f4cd94929301c4a5eba4687d57 [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [stopwords:WP_Query:private] => [compat_fields:WP_Query:private] => Array ( [0] => query_vars_hash [1] => query_vars_changed ) [compat_methods:WP_Query:private] => Array ( [0] => init_query_flags [1] => parse_tax_query ) )

The Henry J. Kaiser Family Foundation Headquarters: 2400 Sand Hill Road, Menlo Park, CA 94025 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/KaiserFamFound

Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.