Key Findings

• The October KFF Health Tracking Poll finds one in five adults in the U.S. report receiving ongoing support for daily activities such as bathing, dressing, or remembering medications, and a similar share say they are providing those type of services for a close friend or family member. About one in five adults (18%) also say they or a family member need either new or additional support from paid nurses or aides beyond what they are currently getting. The most common reason why people haven’t gotten the support they need is cost. More than three-fourths of those who say they need more help (14% of all adults) say “not being able to afford the cost of the care” is a reason why they or their family member has not received the additional support from paid nurses or aides.
• Many unpaid caregivers say providing support to friends or family members has caused them to worry or stress (77%), experience worsening of their own mental health (50%), financial strain due to inability to work (42%), or worsening of their own physical health (38%). Unpaid caregivers are more likely to be racial and ethnic minorities, those with lower education, and report lower levels of household income.
• Significant shares of older adults in the U.S. report difficulty paying for various aspects of health care, especially services not generally covered by Medicare. Four in ten older adults (41%) report difficulty paying for dental care while three in ten report difficulty affording hearing or vision care (30%). Dental, vision, and hearing coverage are three benefits not generally covered by Medicare but are part of Democratic lawmakers’ proposals as part of the reconciliation spending package.
• Many older adults who are eligible for Medicare also report putting off or foregoing medical care due to costs. While Medicare helps older adults pay for routine doctor visits and hospital stays, substantial shares of lower income older adults report putting off or foregoing services not covered by Medicare. Overall, more than four in ten older adults in households earning less than $40,000 annually report delaying or going without some form of medical care over the past year due to costs (compared to 24% of older adults with household incomes over $40,000), including dental care (34%), vision care (20%), and hearing services including hearing aids (16%).
• With substantial shares of the public reporting financial strains associated with help with everyday activities for themselves or family members, and seniors reporting difficulty paying for some health care expenses, the latest KFF poll finds broad support for many of the proposals in the reconciliation package being currently discussed in Congress.

Home And Community Based Services

One in five adults, including 27% of adults 65 and older, say they are currently receiving ongoing support with everyday activities from either a family member (19%), a friend (11%), or paid nurses or aides (5%). Additionally, nearly four in ten (38%) adults say a family member gets ongoing help from at least one of these sources including another family member (30%), paid nurses or aides (16%) or  friends (12%).

About one in five adults (18%) say they or a family member need either new or additional support from paid nurses or aides beyond what they are currently getting. The most common reason why people haven’t gotten the support they need is cost. More than three-fourths of those who say they need more help (14% of all adults) say “not being able to afford the cost of the care” is a reason why they or their family member has not received the additional support from paid nurses or aides. Other reasons include not being able to find someone to provide the services (47%, or 8% of all adults)¹ , being worried about being exposed to coronavirus (40%, 7% of all adults), being afraid or embarrassed to get help (32%, 6%), or being too busy or unable to find the time to get help (20%, 4%).

With many reporting difficulty paying for cost of home and community based care, the poll also gauged support for Democratic proposals to increase funding to Medicaid to pay workers and expand home and community-based services (HCBS). Medicaid is the primary payer for long-term services and supports (LTSS), including home and community-based services (HCBS), that help seniors and people with disabilities with daily self-care and independent living needs. Majorities across partisans (79% total, 95% of Democrats, 76% of independents, 67% of Republicans) support increased funding to Medicaid to pay workers and expand home and community-based services (HCBS).

The toll On Unpaid Caregivers

With Congress discussing possible new tax credits to help with home and community based care, one in five adults (21%) say they are currently providing unpaid support with everyday activities to either a friend or family member, excluding the type of care young children need. Majorities across partisans also favor new tax credit to help people pay for such care (82% total, 94% of Democrats, 80% of independents, 73% of Republicans).

The KFF October Tracking Poll finds unpaid caregivers are more likely to be Black or Hispanic (14% and 21%) compared to those who are not unpaid caregivers (10% and 15%). About eight in ten unpaid caregivers to family and friends do not have a college degree, and about half have household incomes under $40,000.

Consistent with recent focus groups conducted by KFF, the poll finds most unpaid caregivers (85%, 18% of all adults) report experiencing at least one of several negative outcomes due to their caregiving responsibilities. Over three-fourths of unpaid caregivers (16% of all adults) say they have experienced stress or worry related to the care of the individual they are caring for, with an additional half (11% of all adults) say they have experienced a worsening of their own mental health as a result of providing this ongoing support. About four in ten (9% of total) say they have experienced financial strain, such as losing a job or having to work reduced hours. A similar share (38% and 8% of total) also say they have experienced a worsening of their own physical health.

Expanding Medicare Benefits

With Congress debating changes to the current Medicare program, eight in ten adults—and nearly all older adults—say Medicare is important to them and their family members. This includes at least seven in ten adults across partisanship, income groups, and racial and ethnic identity.

Significant shares of older adults in the U.S. report difficulty paying for various aspects of health care, especially services not generally covered by Medicare.²  Four in ten older adults (41%) report difficulty paying for dental care while three in ten report difficulty affording hearing or vision care (30%). Two in ten report difficulty affording their prescription drugs. Additionally, one-third report difficulty affording their out-of-pocket health care costs and one in five report the same about their monthly health insurance costs – shares comparable to those who report difficulty affording other household expenses such as rent or mortgage, gasoline, monthly utilities, or food and groceries.

Dental services are the most common type of medical care that people have delayed or gone without with about with about one in four (23%) of adults ages 65 and older saying they have put off dental care in the past year due to cost. This is followed by vision services or eyeglasses (15%) and hearing aids (13%). Dental, vision, and hearing coverage are three benefits not generally covered by Medicare.

Few older adults report delaying or going without a doctor’s office visit (6%), hospital services (5%) or mental health care (2%) due to cost. Overall, three in ten adults 65 and older report delaying or going without certain medical care during the past year due to cost (32%).

Even among older adults who are eligible for Medicare, those with lower incomes report delaying or going without care at higher rates. More than four in ten older adults in households earning less than $40,000 annually report delaying or going without some form of medical care over the past year due to costs (compared to 24% of older adults with household incomes over $40,000). While Medicare helps older adults pay for routine doctor visits and hospital stays, substantial shares of lower income older adults report putting off or foregoing dental care (34%), vision care (20%), and hearing services including hearing aids (16%) that are not generally covered by Medicare.³ 

A large majority of the public (90%) favor expanding Medicare coverage to include dental, vision, and hearing coverage, including 97% of Democrats, 90% of independents, and 85% of Republicans. This proposal is also largely favored by adults 65 and older, including 96% of those in that age group who identify as Democrats or Democratic-leaning and 82% of their Republican counterparts. Proposals aimed at curbing the price individuals have to pay for their prescription drugs are favored by majorities of the public with at least eight in ten overall and at least three-fourths across partisans saying they favor each of the proposals asked about. Eighty-eight percent of adults favor limiting how much drug companies can increase the price for prescription drugs each year to not outpace the rate of inflation (including 93% of Democrats, 86% of independents, 89% of Republicans) and a similar share (85%) favor placing an annual limit on out-of-pocket prescription drug costs for people on Medicare (favored by 88% of Democrats, 85% of independents, 84% of Republicans). The proposed changes to Medicare drug negotiations as part of the reconciliation package poll findings were released earlier this week.

The Affordable Care Act

Views of the 2010 Affordable Care Act are still largely driven by party identification with nearly nine in ten Democrats saying they view the law favorably, while three-fourths of Republicans say they hold an unfavorable view. Independents are slightly more favorable than unfavorable with more than half saying they hold a positive opinion of the ACA. KFF has been polling on the ACA since its passage and since 2017 views have been more favorable than unfavorable but still sharply divided on party lines.

The COVID relief bill passed in early March 2021 providing additional financial help for people who buy their own health insurance coverage. Previous KFF polling found that a small minority of those likely eligible for additional financial help or coverage reporting going online to see if they qualify for a different or cheaper health insurance plan.

Among those under 65 years old, nine percent of those who are either uninsured or buy their own coverage reported going online in the in the two months before mid-May 2021 to see if they qualify for a different or cheaper health insurance plan or Medicaid as part of the COVID relief package. Four months later, the latest KFF polling finds that about one in four (23%) of those likely eligible for this assistance have gone online to see if they qualify, though majorities (75%) still have not.

In addition, changes to health insurance coverage provided under the Affordable Care Act continue to be seen through a partisan lens, with overwhelming majorities of Democrats and smaller majorities of Republicans expressing support. Overall, eight in ten adults favor making permanent the financial help to low- and moderate- income Americans who buy their own health insurance coverage (94% of Democrats, 79% of independents, 63% of Republicans). Three in four favor the federal government stepping in to provide insurance options for lower income people living in states that haven’t expanded their Medicaid programs (94% of Democrats, 76% of independents) but this is supported by a small majority (54%) of Republicans.

While the poll finds broad support for many of the Democratic proposed changes to the country’s health care system including the ACA, Medicaid, and Medicare, the poll did not ask about the potential costs and savings associated with each provision, or the size and scope of Democrats’ broader legislative plan, which includes many provisions unrelated to health care.

The KFF Health Tracking Poll was conducted in English and Spanish with a nationally representative sample of 1,146 U.S. adults aged 18 or older, including an oversample of 474 adults ages 65 and older. The survey was conducted online and via phone from September 23-October 4, 2021, combining sample from two online probability-based panels and telephone samples recruited from random digit dialing (RDD). Sampling, data collection, weighting and tabulation were managed by SSRS of Glen Mills, PA in close collaboration with Kaiser Family Foundation researchers. The KFF team developed the questionnaire, analyzed the data and contributed financing for the survey.

Panel surveys were conducted through two online panels: (1) The SSRS Opinion Panel, a representative probability-based panel of U.S. adults ages 18 and older, recruited using the SSRS Omnibus poll (a weekly dual-frame RDD telephone survey) and through address-based sampling (ABS) (n=939). (2) The IPSOS KnowledgePanel, a probability-based online panel of U.S. adults ages 18 and older recruited through ABS targeting panelist (n=85). In order to reach adults 65 and older, a group less likely to be reached through an online panel, as well as those who do not have access to the internet, 122 interviews were completed by telephone, (including 79 among those who had previously indicated they do not use the internet).

The combined online, cell phone, and landline sample was weighted to match the sample demographics to estimates for the national population. A multi-stage weighting process was used to adjust for the fact that not all survey respondents were selected with the same probabilities and to account for systematic non-response. In the first weighting stage, adjustments were made regarding the probabilities of selection to the two web panels, and for probability of selection and non-response to the telephone callback samples. Each of these surveys were probability samples of the U.S. adult population that were weighted to the Census Bureau’s March 2020 Current Population Survey (CPS), by gender, age, race/ethnicity, education, and Census region. The data were also weighted to match internet usage metrics based on the U.S. Census’s 2019 American Community Survey, civic engagement metrics based on the September 2019 CPS Volunteering and Civic Life Supplement, and to match party identification within age groups from previous KFF RDD samples.

All statistical tests of significance account for the effect of weighting.

The margin of sampling error including the design effect for the full sample is plus or minus 4 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available by request. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll. Kaiser Family Foundation public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.

1. A shortage of direct care workers predated and has been intensified by the COVID-19 pandemic, characterized by low wages and limited opportunities for career advancement. The direct care workforce is disproportionately female and Black.  Debate in Congress to increase funding for Medicaid HCBS is aimed at strengthening the direct care workforce. ↩︎
2. Freed, M., Ochieng, N., Sroczynski, N., Damico, A., Amin, K. July 28, 2021. “Medicare and Dental Coverage: A Closer Look” Available at https://modern.kff.org/medicare/issue-brief/medicare-and-dental-coverage-a-closer-look/. ↩︎
3. Most Medicare beneficiaries enrolled in Medicare Advantage plans are offered dental, vision and hearing benefits although the coverage varies widely. More at https://modern.kff.org/medicare/issue-brief/medicare-advantage-2021-spotlight-first-look/. ↩︎

Key Findings

• With much attention on the public’s view on Medicare drug price negotiations, the latest KFF Tracking Poll finds large majorities support allowing the federal government to negotiate and this support holds steady even after the public is provided the arguments being presented by parties on both sides of the legislative debate (83% total, 95% of Democrats, 82% of independents, and 71% of Republicans).
• Most adults – across partisans – don’t believe high drug prices are needed for drug companies to invest in new research instead agreeing that “even if U.S. prices were lower, drug companies would still make enough money to invest in the research needed to develop new drugs.” The results suggest that while hearing individual arguments may shift some views, the public still largely favors allowing Medicare drug negotiations when presented with the entirety of the public debate.
• As the debate over how to address prescription drugs continues, less than half of the public say they have confidence in President Biden or either party in Congress to recommend the right thing for the country on prescription drug prices, but Democratic lawmakers fare better than Republican ones. Among interest groups, AARP garners a slight majority of adults saying they are confident in the organization’s ability to recommend the right thing for the country on prescription drug pricing while fewer (14%) have the same level of confidence in pharmaceutical companies.
• While 85% of adults ages 65 and older report having some type of insurance that helps pay for prescription drugs, one in five older adults still report difficulty affording their prescription drugs, including 17% of older adults with some type of prescription drug coverage. The share who report difficulty affording prescription drugs increases to more than one in four among adults 65 and older who take four or more prescription drugs.

Public Favors Medicare Drug Negotiations

About eight in ten U.S. adults (83%) and adults 65 and older (78%) say they think the cost of prescription drugs is “unreasonable.” Lowering prescription drug prices in the U.S. has been a health care policy priority for decades and earlier this year, it topped the list of health care issues the public wanted Congress to tackle. One proposal aimed at lowering the cost of prescription drugs is to allow the federal government to negotiate the price of prescription drugs for people on Medicare and private insurance.

The Democrats’ budget reconciliation package includes a proposal to allow the federal government to negotiate prescription drug prices on behalf of Medicare beneficiaries and people enrolled in private plans. The proposal, which has been part of previous legislative proposals and previously estimated by The Congressional Budget Office (CBO) to result in about $450 billion in savings to Medicare¹ , has met strong opposition from the pharmaceutical industry, as well as some lawmakers. Yet, the proposal is largely popular among the public across partisans as well as among seniors, the group most directly impacted by such legislation. Eight in ten adults (83%) say they either “strongly favor” or “somewhat favor” allowing the federal government to negotiate with drug companies as do 84% of older adults (65 and older), including the vast majority (93%) of those ages 65 and older who identify as either a Democrat or lean Democratic, and three-fourths (76%) of older adults who are Republican or lean Republican.

Previous KFF polls have found that some attitudes are malleable on this issue as the public hears arguments from either side of the debate around Medicare drug price negotiations. The latest poll finds that when the public are presented with the main arguments being made by advocates on both sides of the debate, the shift in opinion is modest and support for negotiation remains high. After gauging initial support allowing the federal government to negotiate prices with drug companies, the poll presented respondents with arguments both for and against the proposal.

One-third of the public say the argument from those opposed to drug price negotiations is convincing compared to a large majority (84%) who say they found the argument from those in favor convincing.

Majorities of all adults as well as those 65 and older, across partisans, say they found the argument in favor of drug negotiations convincing while a smaller share said the same about the argument against the drug negotiations. Nearly half (45%) of all Republicans said the argument from those opposed, which highlights the increased role of the government and the drug companies’ stance that this will lead to fewer drugs coming to market, is also convincing. More than half (53%) of adults 65 and older who are Republican or Republican-leaning say they found the argument against drug negotiations convincing, compared to 18% of Democrat or Democratic-leaning older adults.

After hearing the arguments for and against the proposal to allow the federal government to negotiate prices with drug companies, attitudes remained relatively unchanged with a majority continuing to favor this proposal. While overall favorability stays the about same, there are some small shifts among groups especially in the share who “strongly favor” this proposal. For example, overall Republican support for drug negotiations decreases five percentage points but there is a large shift among those who say they “strongly favor” after hearing both arguments (44% to 28%). But even so, a majority of Republicans (71%) continue to support the proposal after hearing the arguments.

The pharmaceutical industry has argued that allowing the federal government to negotiate prescription drug prices will lead to less research and development of new prescription drugs. KFF polling finds few people (6%) saying they think “drug companies need to charge high prices in order to fund the innovative research necessary for developing new drugs” while a large majority (93%) say “that even if U.S. prices were lower, drug companies would still make enough money to invest in the research needed to develop new drugs” comes closer to their view. This view is consistent across partisanship and age groups.

Few Have Public’s Confidence To Recommend The Right Thing On Prescription Drug Pricing

Neither President Biden nor members of either party in Congress has gained the full confidence of the public to do what’s right for the country on prescription drug pricing. Slightly less than half of the public say they have “a great deal” or “a fair amount” of confidence in President Biden (46%) or Democrats in Congress (48%) to recommend the right thing for the country on prescription drug prices. One-third of the public (33%) say they have at least a fair amount of confidence in Republicans in Congress and few are confident that pharmaceutical companies will recommend the right thing (14%).

A slight majority of adults are confident in AARP’s ability to recommend the right thing for the country on prescription drug pricing. AARP is a non-partisan interest group focusing on the issues that impact adults over the age of 50 that has strongly advocated for Medicare drug negotiations.

AARP also has the confidence of older adults with about six in ten adults 65 and older saying they have at least “a fair amount” of confidence in AARP to recommend what is right for the country on prescription drugs.

One In Five Seniors Struggle Affording Prescription Drugs

The latest KFF Health Tracking Poll finds that 85% of adults ages 65 and older report having some type of insurance that helps pay for prescription drugs. Even still, one in five older adults report difficulty affording their prescription drugs, including 17% of older adults with some type of prescription drug coverage. The share who report difficulty affording prescription drugs increases to more than one in four among adults 65 and older who take four or more prescription drugs.

The KFF Health Tracking Poll was conducted in English and Spanish with a nationally representative sample of 1,146 U.S. adults aged 18 or older, including an oversample of 474 adults ages 65 and older. The survey was conducted online and via phone from September 23-October 4, 2021, combining sample from two online probability-based panels and telephone samples recruited from random digit dialing (RDD). Sampling, data collection, weighting and tabulation were managed by SSRS of Glen Mills, PA in close collaboration with Kaiser Family Foundation researchers. The KFF team developed the questionnaire, analyzed the data and contributed financing for the survey.

Panel surveys were conducted through two online panels: (1) The SSRS Opinion Panel, a representative probability-based panel of U.S. adults ages 18 and older, recruited using the SSRS Omnibus poll (a weekly dual-frame RDD telephone survey) and through address-based sampling (ABS) (n=939). (2) The IPSOS KnowledgePanel, a probability-based online panel of U.S. adults ages 18 and older recruited through ABS targeting panelist (n=85). In order to reach adults 65 and older, a group less likely to be reached through an online panel, as well as those who do not have access to the internet, 122 interviews were completed by telephone, (including 79 among those who had previously indicated they do not use the internet).

The combined online, cell phone, and landline sample was weighted to match the sample demographics to estimates for the national population. A multi-stage weighting process was used to adjust for the fact that not all survey respondents were selected with the same probabilities and to account for systematic non-response. In the first weighting stage, adjustments were made regarding the probabilities of selection to the two web panels, and for probability of selection and non-response to the telephone callback samples. Each of these surveys were probability samples of the U.S. adult population that were weighted to the Census Bureau’s March 2020 Current Population Survey (CPS), by gender, age, race/ethnicity, education, and Census region. The data were also weighted to match internet usage metrics based on the U.S. Census’s 2019 American Community Survey, civic engagement metrics based on the September 2019 CPS Volunteering and Civic Life Supplement, and to match party identification within age groups from previous KFF RDD samples.

All statistical tests of significance account for the effect of weighting.

The margin of sampling error including the design effect for the full sample is plus or minus 4 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available by request. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll. Kaiser Family Foundation public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.

1. Cubanski, J., Neuman, T., and Freed, M. July 23, 2021. “What’s the latest on Medicare drug price negotiations? Available at https://modern.kff.org/medicare/issue-brief/whats-the-latest-on-medicare-drug-price-negotiations/ ↩︎