The majority of enrollees who purchase health coverage through Affordable Care Act (ACA) exchanges receive premium tax credits to help them afford their monthly premiums. To a large extent, subsidized enrollees are shielded from premium increases because their subsidies rise along with premiums. On the other hand, middle-income people with incomes above 400% of the Federal Poverty Line (“FPL”, equal to $48,560 for an individual and $100,400 for a family of four in 2019) are not eligible for subsidies and may struggle to afford ACA-compliant plans.

Marketplace enrollment among subsidized enrollees rose from 8.7 million in 2015 to 9.2 million in 2018. However, premiums increased significantly, and the number of unsubsidized enrollees in ACA-compliant plans has fallen over this same period from 6.4 million to 3.9 million. Unlike subsidized enrollees, those with incomes over 400% of poverty have to bear the full cost of premium increases if they buy an ACA-compliant plan.¹ 

While premiums for ACA Marketplace plans are holding steady or falling slightly on average in 2019, whether ACA plan premiums are actually affordable for an individual depends on where they live, how old they are, and how much money they make. We analyzed 2019 premiums data to show how affordable the lowest-cost ACA Marketplace plan is in each county, by age and income, with a focus on middle-class people whose incomes are too high to qualify for subsidies.

This brief finds that affordability challenges are particularly acute for older adults with incomes just above the premium subsidy cutoff (400% of poverty), particularly in rural areas where premiums are highest.

Figure 1

Most unsubsidized enrollees who enroll in ACA-compliant plans do so outside of the Marketplace. This brief only includes premiums for plans that are available on the Marketplace, but bronze premiums for people who are not eligible for subsidies are generally similar whether an enrollee buys through the Marketplace or not. (In all but 14 counties, the lowest-cost plan available is a bronze plan.)

The interactive map shows a substantial decline in affordability between a $45,000 income (which would put an individual at 371% of the poverty level and make them eligible for subsidies) and $50,000 (412% of poverty and therefore not eligible for subsidies). This phenomenon is referred to as the “subsidy cliff” because subsidy eligibility ends sharply at 400% of poverty without a phase-out, even if premiums represent a substantial share of income for those above 400% of poverty.

In 21% of counties, a 40-year-old making $50,000 would have to pay more than 10% of their income for the lowest-cost plan in the Marketplace. However, because premiums are lower in urban areas than in rural areas, just 8% of Marketplace enrollees are in a county where that would be the case. In 25% of non-metropolitan counties (weighted by enrollment), a 40-year-old making $50,000 would spend more than 10% of their income on premiums for the cheapest plan available, compared with only 5% of people in metropolitan counties.² 

Rhode Island has the lowest average premiums for middle-class people ineligible for subsidies in 2019: a 40-year-old making $50,000 would pay about 5% of their income in premiums for the cheapest plan, on average. Wyoming has the highest average premiums for unsubsidized people: a 40-year-old making $50,000 would pay about 14% of their income in premiums for the cheapest plan, on average, with Nebraska and West Virginia in a close second and third place.

Figure 2 presents an interactive chart showing how much the national average premiums for a low-cost plan vary as a share of income at different income levels for people at various ages. (Figure 3 presents similar results as a static chart.) On average across the U.S., a 40-year-old making $45,000 would pay $227 a month (6% of their income) for a subsidized bronze exchange plan, whereas the same person making $50,000 would pay $340 a month (8% of their income) for the same plan without a subsidy. Because the ACA allows premiums for older adults to be three times those for younger enrollees, middle-class older people with unsubsidized coverage are the most likely to face affordability challenges. For example, a 27-year-old making $50,000 would pay 7% of their income in premiums for the average lowest-cost plan nationally, whereas a 60-year-old making the same income would pay 17% of their income in premiums. Even at an income of $70,000 (577% of the poverty level), a 60-year-old would have to pay 12% of income for a low-cost plan on average.

Figure 2: Average Lowest-Cost Plan Premium (by Income, Age, and Metal Level, 2019)

For older people living in very high-premium counties, the affordability gap is much more stark; in the 28 Nebraska counties with the highest premiums, a 60-year-old making $45,000 would pay nothing in monthly premiums and the same person making $50,000 would pay $1,314 (32% of income) for the lowest-cost plan.–

The premiums in this analysis are for the lowest-cost plan available in each county, but these low-cost bronze plans come with higher deductibles, copayments, or coinsurance than plans at higher metal tiers with higher monthly premiums. The average deductible for bronze plans in 2019 is $6,258, compared to $4,375 for silver plans (for people who do not receive cost-sharing subsidies because their incomes are above 250% FPL). While some services, including preventative care and often a few physician visits, are covered before enrollees reach their deductible, sicker enrollees may be better off choosing a silver or gold plan even if that means they spend a larger proportion of their income on premiums.

Discussion

After several years of rising ACA plan premiums, premiums are falling in many parts of the country for 2019. Despite this trend, premiums for even the cheapest exchange plans are still out of reach for many middle class people who are not eligible for ACA subsidies, particularly those who are older or live in high-premium areas. Several policy options have been proposed to address affordability for people buying their own coverage without a subsidy, such as expanding more loosely regulated short-term plans, creating state-based reinsurance programs, extending subsidies beyond 400% of poverty, and expanding eligibility for Medicaid or Medicare.

The Trump administration recently made changes to short-term, limited duration plans, with the goal of creating a more affordable option for people who are not eligible for subsidies. Short-term plans generally have significantly lower premiums than ACA-compliant coverage, in large part because these plans can exclude people with pre-existing conditions and may not cover certain services. Thus, while short-term plans come with lower premiums, these plans are generally not an option for people who have pre-existing conditions or expect to need high-cost services (e.g. for pregnancy, prescription drugs, or mental health care). Additionally, these plans will disproportionately attract healthy individuals away from ACA-compliant coverage, thus having an upward effect on premiums in the ACA-compliant individual market and possibly making unsubsidized coverage less affordable for people with pre-existing conditions.

The ACA established a temporary reinsurance program from 2014 to 2016 with the goal of making premiums more affordable during the early years of new market reforms. Reinsurance covers a portion of the health care expenses for high-cost patients, allowing insurers to reduce premiums.

Seven states (Alaska, Maine, Maryland, Minnesota, New Jersey, Oregon, and Wisconsin) have since created their own reinsurance programs, and initial evidence indicates that these programs have been successful in reducing individual market premiums, although the details of these plans vary widely between states. How much a reinsurance program can reduce premiums depends on the level of funding dedicated to it. Reinsurance reduces premiums somewhat for all enrollees ineligible for premium subsidies. However, this reduction in prices will not be enough to make plans affordable for all unsubsidized middle class people, particularly those facing the highest premiums as a share of income. For example, the cheapest plan in Natrona County, Wyoming costs $1,237 a month for an unsubsidized 60-year-old (25% of income for someone making $60,000). If the implementation of a reinsurance plan reduced all premiums by 10%, the cheapest plan would cost $1,113 (22% of income), which is still too expensive for many people to afford.

Expanding premium tax credits to enrollees over 400% of poverty would provide more significant assistance to those newly eligible for subsidies. For example, California Governor Newsom recently proposed expanding premium tax credits to incomes between 400 and 600% of poverty (incomes up to $72,840 for an individual).

Avoiding a subsidy cliff altogether would cost taxpayers more. One federal bill introduced in the House last year would extend premium subsidies to enrollees in all income brackets, and increase the amount of subsidies across the board. On average nationally, tax credits would need to extend to nearly 800% FPL to bring 2019 bronze premium payments down to 10% of income for a single 64-year-old, or just over 1,100% FPL to accomplish the same for silver premiums. In the 28 Nebraska counties with the most expensive 2019 premiums in the U.S., tax credits would need to extend beyond 1,400% FPL to bring bronze premium payments down to 10% of income for a single 64-year-old, or over 2,000% FPL to accomplish the same for silver premiums. In the case of an older couple living in a high-premium county, subsidies would need to extend beyond 3,000% FPL (a $500,000 income), for 2019 silver premiums to cost less than 10% of their income.

In late 2018, the Trump administration released new guidance and the Centers for Medicare and Medicaid Services (CMS) issued a discussion paper on Section 1332 waivers established by the ACA. This new guidance may prompt states to apply subsidies to ACA non-compliant plans or experiment with different subsidy structures, such as tax credits based on age and not income. One of the CMS waiver concepts describes extending subsidies to higher-income residents to address the “subsidy cliff.” Under a budget neutral waiver, however, increasing subsidy resources for one population group would necessitate reducing subsidy dollars available to other groups. Currently, ACA subsidies are structured so that lower-income enrollees pay a smaller percentage of their income (2% premium cap for those 100-133% of poverty) than higher-income enrollees (10% for those 300-400% of poverty), and they receive the bulk of subsidies. Additionally, as noted above, subsidies would need to extend well beyond 400% FPL to do away with the subsidy cliff altogether.

A number of recent congressional proposals would provide lower premium options to middle-class people buying their own coverage by expanding access to public programs like Medicare and Medicaid. For example, one bill would allow people age 50 and over to buy into Medicare, potentially lowering premiums through reduced prices paid to health care providers and curtailing administrative costs and profits. Another bill would allow states to set up programs that allow people to buy into the Medicaid program, capping premiums at 9.5% of income.

So far, while there seems to be a consensus that individual market premiums are out of reach for some middle-class people ineligible for ACA subsidies, there is little consensus around what to do about it.

We analyzed data from the 2019 Individual Market Medical files to determine premiums and the benchmark amounts to calculate premium tax credits for the scenarios presented. These files are available at data.healthcare.gov. Premiums for the 12 state-based Marketplaces are from KFF analysis of data received from Massachusetts Health Connector and KFF analysis of data published by HIX Compare from the Robert Wood Johnson Foundation. All premiums are displayed as the full price, rather than just the portion that covers essential health benefits.

The lowest-cost plan is a bronze plan in all but 14 counties where a silver plan is cheaper. In those 14 counties, the silver plan is used as the lowest-cost plan for this analysis. This analysis only includes on-exchange plans. Off-exchange plans generally have similar premiums to on-exchange plans with the exception of silver plans, which often include an additional premium load on-exchange only to account for cost-sharing reductions insurers must provide to some exchange enrollees.

All averages are weighted by county-level 2018 plan selections. 2018 plan selections come from the 2018 Marketplace Open Enrollment Period County-Level Public Use file provided by CMS, available here. In states running their own exchanges, we gathered county-level plan selection data where possible and otherwise estimated county plan selections based on the county population in the 2010 Census and total state plan selections in the 2018 OEP State-Level Public Use File provided by CMS, available here. Metro/Non-Metro county classifications are based on definitions from the Federal Office of Rural Health Policy.

1. While this analysis focuses on the unsubsidized population above 400% of poverty, the “coverage gap” in states that have not expanded Medicaid has also left a group of people with incomes below poverty unsubsidized and unable to afford care. The 2.2 million uninsured people in the coverage gap make too much to qualify for Medicaid or do not meet categorical requirements in those states, but are below the poverty line and thus are not eligible for ACA Marketplace subsidies. ↩︎
2. These averages are weighted by 2018 county-level plan selections. Alaska and Hawaii are excluded from this calculation because these states have different poverty guidelines, and thus different subsidy cutoffs, from the rest of the U.S. ↩︎

Key Findings:

• With increased attention among policymakers towards prescription drug costs, the February 2019 KFF Health Tracking Poll finds a majority of adults, including seniors, are in favor of many policy options aimed at curbing prescription drug costs. There is majority support – across party identification – for many current policy proposals, including recent Trump administration proposals like international reference pricing and transparency in drug advertisements. Both of these policy proposals are supported by large majorities of Democrats and independents, and a majority of Republicans.

  Majorities across the political divide support a range of policies aimed at lowering prescription drug costs, such as including list prices in ads and allowing the government to negotiate Medicare drug prices

• There is also bipartisan support for allowing the federal government to negotiate with drug companies to get a lower price for people with Medicare, which covers 60 million Americans. But attitudes towards this proposal shift after hearing potential arguments about how it might affect some people with Medicare.
• Among those currently taking prescription drugs, one-fourth of adults (24 percent) and seniors (23 percent) say it is difficult to afford their prescription drugs including about one in ten (overall and among seniors) saying it is “very difficult.” Certain groups are much more likely to report difficulty affording medication, including those who are spending $100 or more a month on their prescriptions (58 percent), those who report being in fair or poor health (49 percent), those who take four or more prescription drugs (35 percent), and those with incomes less than $40,000 annually (35 percent). In addition, three in ten of all adults (29 percent) report not taking their medicines as prescribed at some point in the past year because of the cost and one in ten (8 percent) say their condition got worse as a result of not taking their prescription as recommended.
• While the public sees profits made by pharmaceutical companies as a major factor contributing to the price of prescription drugs (80 percent), a majority (63 percent) also say profits made by pharmacy benefit managers (PBMs), companies that manage prescription drug benefits for health plans, are a “major factor” contributing to the price of prescription drugs.
• This month’s KFF Health Tracking Poll also tracks public opinion on the Affordable Care Act and the proposal to expand coverage through a national health plan, known commonly as Medicare-for-all and finds favorability towards both the ACA (50 percent) and Medicare-for-all (57 percent) statistically unchanged since last month.

Public Views Prescription Drug Costs As Unreasonable, Wants More Government Regulation

A majority of Americans (59 percent) believe prescription drugs developed over the past 20 years have generally made the lives of people in the U.S. better – with nearly four in ten saying they have made people’s lives “a lot better.” Yet, eight in ten (79 percent) say the cost of prescription drugs is “unreasonable.”

The public sees profits made by pharmaceutical companies as a major factor contributing to the price of prescription drugs. At least eight in ten – across party identification – say profits made by pharmaceutical companies are a “major factor” in the price of prescription drugs. This is followed by seven in ten (69 percent) who say the cost of research and development is a “major factor” contributing to the price.

The Trump administration proposed a new rule earlier this month affecting pharmacy benefit managers (PBMs), companies that manage prescription drug benefits for health plans. About six in ten (63 percent) of the public say profits made by these companies (PBMs) are a “major factor” contributing to the price of prescription drugs. About half (52 percent) say the cost of marketing and advertising is a major factor in prescription drug prices.

Public Does Not Trust Drug COmpanies To Price their products fairly

Majorities of the public trust pharmaceutical companies (either “a lot” or “somewhat”) to be good stewards in terms of developing new effective drugs (71 percent), and offering reliable information to consumers about drug safety and side effects (65 percent) as well as drug efficacy (61 percent). About half trust pharmaceutical companies to inform the public quickly when they learn of a safety concern with their drugs (47 percent) and even fewer trust pharmaceutical companies to price their products fairly (25 percent). This is a significant decrease from 41 percent who said they trusted pharmaceutical companies to price their products fairly back in 2008.

Bipartisan Support for Some Government Regulation on Prescription Drug Prices

Prescription drug costs have been a focus of lawmakers, with hearings held in both the House and Senate, and numerous proposals put forward by the Trump administration and members of Congress.  This is consistent with the public’s priorities as the January 2019 KFF Health Tracking Poll found lowering prescription drug costs remains a priority for the public with majorities of Democrats, independents, and Republicans saying this was important for Congress to work on.

The majority of the public is in favor of most current policy options aimed at helping keep the cost of prescription drugs down included in this month’s survey.

The vast majority of Americans favor requiring drug companies to include drug list prices in their advertisements (88 percent)¹ , making it easier for generic drugs to come to market (88 percent), and allowing the federal government to negotiate with drug companies to get a lower price on medications for people with Medicare (86 percent). All three of these policy proposals are supported by large majorities of Democrats, independents, and Republicans.

Most Americans are aware that people in this country often pay higher prices for prescription drugs than people in other countries such as Canada and Western Europe and a majority favor two proposals aimed at leveling international prices. Eight in ten favor allowing Americans to buy drugs imported from licensed Canadian pharmacies while two-thirds (65 percent) favor lowering what Medicare pays based on amounts paid in other countries where governments more closely control prices. Both of these proposals garner bipartisan support.

Majorities of the public favor placing an annual limit on out-of-pocket prescription drug spending for seniors with Medicare (76 percent). Fewer – but still a slight majority (53 percent) – favor allowing Medicare plans to put more restrictions on the use of certain drugs, like making patients try cheaper alternatives before taking a more expensive drug. Only a quarter favor allowing Medicare plans to exclude more drugs in order to keep prices down, a recent proposal from the Trump Administration.² 

Seniors’ views of Prescription Drug Policy Proposals

This month’s KFF Health Tracking Poll includes a deep dive into the experiences and attitudes of senior adults, 65 and older, who are more likely to report taking prescription medication and have typically had to shop for prescription drug coverage in addition to their Medicare coverage.

These results do not differ when looking specifically at the opinion of those who would be directly affected by changes to Medicare prescription drug coverage. A majority of seniors also favor allowing the federal government to negotiate with drug companies to get lower prices for people with Medicare (82 percent), placing an annual limit on out-of-pocket spending for people with Medicare (68 percent), and lowering what Medicare pays based on amounts paid by other countries where governments more closely control prices (60 percent). Fewer favor allowing Medicare plans to put more restrictions on the use of certain drugs (45 percent) or allowing Medicare plans to exclude more drugs (24 percent).

Public Opinion on Federal Government Negotiating on Medicare Drug Costs

Overall, about four in ten of all adults and seniors are aware the federal government does not currently negotiate with drug companies in order to get lower prices on prescription drugs for people with Medicare. A policy proposal that has been around for years, this idea has gained traction in recent months, with several members of Congress proposing various approaches to allow Medicare to negotiate drug prices. Overall, nearly nine in ten Americans (86 percent) favor allowing this type of negotiation, however, attitudes shift after hearing potential arguments that have been made both in favor and against the proposal. For example, support for Medicare negotiations increases to 91 percent after hearing the argument that this could save seniors money. On the other hand, opposition increases to two-thirds after hearing the opponents’ potential arguments that it could lead to less research. It is important to note that these arguments do not include specific details about different approaches to negotiation, including the extent to which they would protect access to needed medications, details which may influence the public’s attitudes.

Seniors’ opinions on allowing the federal government to negotiate with drug companies to get a lower price on medicines for people with Medicare can drop even lower than the public overall after hearing potential arguments.

People’s Experiences With Prescription Drug Costs and Plans

In addition to examining public support for proposed legislative changes affecting access and affordability of prescription drugs, this month’s poll also tracks people’s experiences with prescription drugs and their prescription drug plans.

The issue of prescription drug costs is personal to many Americans with six in ten (62 percent) saying they currently take prescription medicine, including one-fourth (24 percent) who currently take four or more prescription drugs. The share who say they currently take a prescription drug has increased slightly in KFF tracking polls over the past 5 years, which is consistent with other data showing a gradual increase in the share of Americans who take prescription drugs.³  Nine in ten seniors (89 percent) report currently taking prescription medicine, including more than half (54 percent) who report taking four or more.

Most people who take prescription drugs report that affording their prescriptions isn’t a burden, which could be due to the fact that for most people taking medications, insurance covers much of their costs.  Three-fourths report that it is either “very easy” (46 percent) or “somewhat easy” (29 percent) for them to pay the cost of their prescription medicine. In addition, nearly half say they spend less than $25 each month on all of their prescription drugs, including any co-pays or other out-of-pocket expenses.

Most seniors (75 percent) also say affording their prescription drugs is either “very easy” (42 percent) or “somewhat easy” (33 percent). Even a majority of seniors who are taking four or more prescription drugs say affording their prescriptions is easy. Overall, 16 percent of seniors say they are spending $100 or more a month on their prescriptions.

Who Struggles With Prescription Drug Costs?

Among those currently taking prescription drugs, about one-fourth (24 percent) and a similar share of seniors (23 percent) say it is difficult to afford their prescription drugs, including one in ten saying it is “very difficult.” Three in ten adults ages 50 to 64 report having difficulty affording their prescription medicines (30 percent) compared to about one-fourth of those ages 65 and over with Medicare (23 percent) and one-fifth of those under the age of 50 (21 percent), who take fewer drugs on a regular basis. This group, adults ages 50 to 64, is not yet eligible for Medicare but is more likely to be taking more prescription medicines than other non-Medicare eligible populations.

Who has the most difficulty affording prescription drugs? The most affected groups include people in fair or poor health, with low incomes, or taking at least 4 drugs monthly

Certain groups are much more likely to report difficulty affording medication, including those who are spending $100 or more a month on their prescriptions (58 percent), those who report being in fair or poor health (49 percent), those who take four or more prescription drugs (35 percent), and those earning less than $40,000 annually (35 percent).

About three in ten of all adults (29 percent) report not taking their medicines as prescribed at some point in the past year because of the cost. This includes about one in five who report that they haven’t filled a prescription (19 percent of total) or took an over-the counter drug instead (18 percent of total), and about one in ten who say they have cut pills in half or skipped a dose.

In addition, three in ten (29 percent) of those who report not taking their medicines as prescribed say their condition got worse as a result of not taking their prescription as recommended (eight percent of total).

Individuals who report difficulty affording their prescription drug costs are more likely than their counterparts to report not taking their medicines as prescribed due to cost (58 percent vs. 17 percent). Among this group, one-quarter (27 percent) say their condition got worse as a result of skimping on medications because of the cost.

Majorities say they usually talk to their doctor and a pharmacist about the safety and potential side effects of a newly prescribed drug (77 percent and 57 percent, respectively) compared to fewer who report usually talking to their doctor or pharmacist about cheaper alternatives (51 percent and 41 percent, respectively). Four in ten (42 percent) report usually talking to their doctor about the cost of a newly prescribed drug.

A smaller share of seniors report talking to their pharmacist or doctor about the safety, side effects, and cost of their prescription drugs as well as whether there are less expensive alternatives available.

Prescription Drug Plans

More commonly reported than problems affording prescription drugs are issues with prescription drug plans. Nearly half of those with health insurance that helps them pay for their prescription drugs say they experienced at least one of the following problems with their health insurance plan: they were told that their plan wouldn’t cover a drug prescribed to them (31 percent); required to try a less expensive drug first (29 percent); or had to wait more than two days to get their prescription filled (25 percent).

Nearly half (45 percent) of seniors with prescription drug coverage also say they have experienced a problem with their plan with three in ten reporting they have had their plan not cover one of their prescriptions (28 percent). Slightly fewer report having to try a less expensive alternative first (23 percent) or having to wait more than two days to get their prescription filled (21 percent).

When choosing a prescription drug plan, a larger share of seniors report that it is more important to them to have a lower co-pay at the pharmacy when they get their prescriptions filled (51 percent) than paying a lower premium each month (35 percent). This may be due to the fact that nearly six in ten seniors (55 percent) report taking four or more prescription drugs.  Half of seniors (47 percent) report either comparing co-pays (36 percent), premiums (36 percent), or drugs that are covered (28 percent) when choosing their prescription drug plans.

This KFF Health Tracking Poll was designed and analyzed by public opinion researchers at the Kaiser Family Foundation (KFF). The survey was conducted February 14th–24th 2019, among a nationally representative random digit dial telephone sample of 1,440 adults ages 18 and older, living in the United States, including Alaska and Hawaii (note: persons without a telephone could not be included in the random selection process). The sample included 290 respondents reached by calling back respondents that had previously completed an interview on the KFF Tracking poll more than nine months ago. This month’s poll also includes an analysis of older Americans age 65 or older (n=606). To obtain a large enough sample, the sampling frame included an oversample of older adults using cell phones (n=26) and landlines (n=75) as well as callbacks to adults who fit the age criterion using the SSRS Omnibus poll (n=136). To efficiently obtain a sample of lower-income and non-White respondents, the sample also included an oversample of prepaid (pay-as-you-go) telephone numbers (25% of the cell phone sample consisted of prepaid numbers) as well as a subsample of respondents who had previously completed Spanish language interviews on the SSRS Omnibus poll (n=11). Both the random digit dial landline and cell phone samples were provided by Marketing Systems Group (MSG).

Computer-assisted telephone interviews conducted by landline (464) and cell phone (976, including 662 who had no landline telephone) were carried out in English and Spanish by SSRS of Glen Mills, PA. For the landline sample, respondents were selected by asking for the youngest adult male or female currently at home based on a random rotation. If no one of that gender was available, interviewers asked to speak with the youngest adult of the opposite gender. For the cell phone sample, interviews were conducted with the adult who answered the phone. KFF paid for all costs associated with the survey with additional funding for the over-sample provided by the John Hopkins’ Bloomberg School of Public Health.

The combined landline and cell phone sample was weighted to balance the sample demographics to match estimates for the national population using data from the Census Bureau’s 2017 American Community Survey (ACS) on sex, age, education, race, Hispanic origin, and region along with data from the 2010 Census on population density. The sample was also weighted to match current patterns of telephone use using data from the January-June 2018 National Health Interview Survey. The weight takes into account the fact that respondents with both a landline and cell phone have a higher probability of selection in the combined sample and also adjusts for the household size for the landline sample, and design modifications, namely, the oversampling of prepaid cell phones and likelihood of non-response for the re-contacted sample. To ensure accurate representation of the older population, the data were weighted separately for those younger than 65 and those 65 or older. 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 3 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. In 2018 President Trump announced his prescription drug plan titled “American Patients First,” which included the proposal to require drug manufacturers to publish list prices for their prescription drugs in television advertisements. KFF Health Tracking Polls consistently find a majority of the public – including a majority of Democrats, independents, and Republicans, have supported this policy proposal. ↩︎
2. The Trump Administration’s FY2019 budget proposal included this proposal and it was referenced in the Administration’s May 2018 blueprint on drug costs. ↩︎
3. Kantor, E.D., Rehm, C.D., Haas, J.S. et al. (2015). Trends in Prescription Drug Use Among Adults in the United States from 1999-2012. JAMA, 314(17), 1818-1830. Available at https://jamanetwork.com/journals/jama/fullarticle/2467552 ↩︎