This fact sheet profiles the health status of Haiti prior to the devastating earthquake that hit the island nation on January 12, 2010. It reviews the major U.S. government global health and development programs operating in Haiti and examines the U.S. response to the quake and the future health challenges as the nation rebuilds.

Fact Sheet (.pdf)

This report finds that 44 states and the District of Columbia are experiencing higher than expected program enrollment and spending for fiscal year 2010. At least 29 states say they are considering additional mid-year cuts in provider rates and program benefits.

The recession and the scheduled end on Dec. 31, 2010 of enhanced federal matching money for Medicaid that was provided through the American Recovery and Reinvestment Act of 2009 will have a significant impact on state fiscal year 2011 budgets, Medicaid directors reported.

The report augments the most recent annual Medicaid budget survey report, released in September 2009, and is based on discussions with leading Medicaid directors and a brief survey of Medicaid directors in all 50 states and the District of Columbia late in 2009.

NOTE: Updated report on fiscal years 2010 and 2011 now available.

Report (.pdf)

Medicare Health and Prescription Drug Plans Monthly Tracking Reports

These briefs present monthly data on Medicare Advantage participation, enrollment and penetration. They also summarize recent activities by the Centers for Medicare and Medicaid Services (CMS), participating health plans, and the research community pertaining to the Medicare Advantage program and prescription drug plans that began serving the Medicare population in January 2006. The reports were prepared by researchers at Mathematica Policy Research Inc.

April 2010 Report (.pdf)

March 2010 Report (.pdf)

February 2010 Report (.pdf)

January 2010 Report (.pdf)

December 2009 Report (.pdf)

November 2009 Report (.pdf)

October 2009 Report (.pdf)

September 2009 Report (.pdf)

August 2009 Report (.pdf)

July 2009 Report (.pdf)

June 2009 Report (.pdf)

May 2009 Report (.pdf)

April 2009 Report (.pdf)

March 2009 Report (.pdf)

February 2009 Report (.pdf)

January 2009 Report (.pdf)

December 2008 Report (.pdf)

November 2008 Report (.pdf)

October 2008 Report (.pdf)

September 2008 Report (.pdf)

August 2008 Report (.pdf)

July 2008 Report (.pdf)

June 2008 Report (.pdf)

May 2008 Report (.pdf)

April 2008 Report (.pdf)

March 2008 Report (.pdf)

February 2008 Report (.pdf)

January 2008 Report (.pdf)

December 2007 Report (.pdf)

November 2007 Report (.pdf)

October 2007 Report (.pdf)

September 2007 Report (.pdf)

August 2007 Report (.pdf)

July 2007 Report (.pdf)

June 2007 Report (.pdf)

May 2007 Report (.pdf)

April 2007 Report (.pdf)

March 2007 Report (.pdf)

Februrary 2007 Report (.pdf)

January 2007 Report (.pdf)

December 2006 Report (.pdf)

November 2006 Report (.pdf)

October 2006 Report (.pdf)

September 2006 Report (.pdf)

August 2006 Report (.pdf)

July 2006 Report (.pdf)

June 2006 Report (.pdf)

April 2006 Report (.pdf) April 2006 Report Addendum (.pdf)

March 2006 Report (.pdf)

February 2006 Report (.pdf)

January 2006 Report (.pdf)

December 2005 Report (.pdf)

November 2005 Report (.pdf)

October 2005 Report (.pdf)

September 2005 Report (.pdf)

August 2005 Report (.pdf)

July 2005 Report (.pdf)

June 2005 Report (.pdf)

May 2005 Report (.pdf)

April 2005 Report (.pdf)

March 2005 Report (.pdf)

February 2005 Report (.pdf)

January 2005 Report (.pdf)

December 2004 Report (.pdf)

November 2004 Report (.pdf)

October 2004 Report (.pdf)

September 2004 Report (.pdf)

August 2004 Report (.pdf)

July 2004 Report (.pdf)

This data spotlight examines trends in benefits and cost-sharing for Medicare Advantage plans in 2010, including the wide variations found across plans and the rapid increase in cost sharing requirements for some benefits, including stays in skilled nursing facilities. It also examines the annual limits on out-of-pocket spending set by most Medicare Advantage plans and the availability of coverage for drugs in the Medicare drug benefit’s coverage gap, or “doughnut hole.”

This data spotlight is one in a series looking at the 2010 Medicare Advantage plan options and trends around the Medicare Advantage plan. These spotlights were prepared by a team of researchers at Mathematica Policy Research Inc. and the Kaiser Family Foundation.

Data Spotlight (.pdf)

Now Available: 2011 Medicare Advantage Spotlight: Plan Availability and Premiums

The Kaiser Family Foundation has issued a series of data spotlight looking at the 2010 Medicare Advantage plan options and trends around the Medicare Advantage plan. These spotlights were prepared by a team of researchers at Mathematica Policy Research Inc. and the Kaiser Family Foundation.

Plan Enrollment Patterns and Trends

Benefits and Cost Sharing

Plan Availability and Premiums

The Massachusetts special election has roiled the political world and profoundly affected the prospects for health reform just when it looked like passage was a lock.  Efforts are underway to put health reform legislation back together again on Capitol Hill, but not since powerful Ways and Means Chair Wilbur Mills fell into the Tidal Basin with Fanne Foxe in 1974, halting momentum on a deal on health reform that seemed ready to happen, has something this unexpected so affected the prospects for health reform at the eleventh hour.

Since the Massachusetts vote many have claimed it was a referendum on national health reform. To test that assumption with actual data we conducted a post-election poll of Massachusetts special election voters with the Washington Post and colleagues at Harvard University. The findings suggest that the story of health care and the special election is far more nuanced than some have made it out to be.

First, while health care policy did top the list of voting issues, the economy and general discontent with Washington also were significant factors for Brown voters. Second, and perhaps more importantly, Brown voters’ top complaint about health reform was not about the substance of the legislation itself or its perceived impact on them or their families, but about a policymaking process that they seemed to think had gone badly wrong.

For Brown voters health reform became a reflection of, and in some ways a proxy for, deeper concerns about how Washington works today. We saw health care play this kind of larger symbolic role once before in another special election that marked an historic moment in health reform: the 1991 Pennsylvania Senate race in which Democrat Harris Wofford pulled a surprise victory over Republican Dick Thornburgh.  Our polls showed that health care was the number one issue in that race too.  But in 1991 in Pennsylvania, health was largely a proxy for the deeper voter worries about the economy. That race marked the occasion of the first Kaiser poll and spurred our decision to get into the business of doing independent polling and survey research on health policy.

Our more recent post-election poll of special election voters found health care was the top issue in Massachusetts, both among those who supported now-Senator Scott Brown and among those who voted for Democrat Martha Coakley, named by about one in three voters as the primary factor in their vote.  Overall, nine in ten voters said health care was a factor at some level in their voting decision.

When we asked those health care voters who went for Brown what they meant when they said reform efforts were a factor in their vote, the top response – offered by thirty percent of this group – revolved around their anger with some aspect of the political process. What about the process was making Massachusetts voters so “wicked mad”, as we famously say in Boston?  Here is a flavor of what our poll respondents said in response to an open-ended question that enabled them to tell us what was on their minds:

“I don’t like the way that the healthcare plan is being handled. They have bought senators’ votes. They have paid off senators in Louisiana and Nebraska and they made a special deal with labor unions regarding the Cadillac healthcare plan. They fixed it.”

“I don’t like the way they vote on everything behind closed doors. Obama does just what he wants to do because he is president and no one really seems to know what’s going on.”

“There hasn’t been any meaningful discussions. They are behind closed doors. [They] need to back up and take this more slowly. We have universal health care in Massachusetts.  Not perfect, but a model.”

“No one has told us anything that is going on in health reform. We have been given no specifics. I am recovering from leukemia and I have no idea of what coverage will be available and also the costs I will face.”

“[I am] offended they are pushing the health care bills down our throats. They are rushing the greater good by getting it done, instead of getting it done right.”

“I feel they are not looking out for the individual, they are looking out more for the political party. They are not listening to the people who elected them, just to the political party.”“The health care bill [is being] rammed through, and it’s important to have this.  With Coakley there would be less of a chance to have a better bill.”

This is not to say that opposition was solely about the process, or that all Brown supporters would back a public option and a boost in the subsidy levels if only these were first discussed in lengthy, open-door meetings covered by C-SPAN. Many Brown voters expressed opposition to the proposed legislation (22 percent) or concern about the personal impact of reform (13 percent). Still, it’s worth emphasizing that substantive objections to policy did not top the list. One reason is that people don’t understand the details of the legislation.  Another is that Brown’s campaign focused less on the substance of the legislation – much of which is similar to the plan adopted in Massachusetts with his support – and more on his campaign argument that Bay State residents, who already have health reform, would have to pay higher taxes if national health reform passes, and on the special deals made in Washington to win support from key Democratic senators.

So what now? What do Massachusetts voters want their newly elected Republican senator to do on health reform when he goes to Washington? According to the poll, seven in ten voters, including nearly half of Brown supporters (48 percent), want Senator Brown to work with the Democrats on health care reform. The same opinions held for independents: nearly two thirds of independents (64 percent) say they want to see Brown work in a bipartisan way on the health care proposals put forward by President Obama and the Democrats in Congress.  (And ultimately Senator Brown will need to run for reelection in Massachusetts, a state that elects Republicans but moderate to liberal ones).

Yes, health reform was a factor in my home state. But the message from Massachusetts seems to have been more about dissatisfaction with Washington and the political process than about the substance of health reform itself. Meanwhile, this same dynamic appears to be playing out in national views of health reform legislation. The proposed reforms have taken a beating in public debate and in the polls, including our own surveys which show the public split down the middle when you ask them for a general up or down opinion on the proposed legislation. But as our latest tracking poll shows, when we ask the public about the actual specifics of the legislation they tend to be much more supportive. Here too the public may be reacting more to the exaggerations of the debate, the inherent combativeness of the process and the general failure to communicate the ways in which the proposed legislation would benefit ordinary Americans than to the substance of the legislation itself.

Angry voters are angry voters, and it’s not necessarily good news for our political system, or for incumbents, if the voters are rejecting the process more than the substance. But it’s better news for health reform than the post- Massachusetts conventional wisdom would have us believe. It suggests both an opportunity missed and an opportunity still ahead to communicate more effectively with the public about what health reform will do for them.

Health reform bills passed in the House and Senate would create a national high-risk pool insurance program to offer health coverage to otherwise uninsurable individuals during the interim period between the enactment of legislation and the implementation of broader health care reform. This issue brief discusses the structure, operation, benefits and challenges of state high-risk pool programs and describes how temporary national high-risk pool would be created as part of health reform.

Issue Brief (.pdf)

The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) provides states new options to reach and enroll the estimated 5 million eligible but uninsured low-income children into Medicaid and CHIP. One key tool provided to states by the law is Express Lane Eligibility (ELE), which allows state Medicaid and CHIP agencies to borrow and rely on eligibility findings from other need-based programs, such as Head Start and the National School Lunch Program, to determine and/or renew Medicaid or CHIP eligibility for children.

Under the ELE initiative, Congress gives states significant flexibility to design and build enrollment and retention initiatives that meet their unique needs. Thus, in designing an ELE initiative, there are a number of key decision points a state will face. This brief, the third in a new series called Putting Children on the Express Lane to Health Insurance, provides an overview of those key decisions that a state will need to address.

Issue Brief (.pdf)

MENLO PARK, Calif. – A new Kaiser Family Foundation poll finds that Americans are divided over congressional health reform proposals, but also that large shares of people, including skeptics, become more supportive after being told about many of the major provisions in the bills.

The January Kaiser Health Tracking Poll, conducted before the Massachusetts Senate vote, finds opinion is divided when it comes to the hotly debated legislation, with 42 percent supporting the proposals in the Congress, 41 percent opposing them and 16 percent withholding judgment.  However, a different and more positive picture emerged when we examined the public’s awareness of, and reactions to, major provisions included in the bills.  Majorities reported feeling more favorable toward the proposed legislation after learning about many of the key elements, with the notable exceptions of the individual mandate and the overall price tag.

For example, after hearing that tax credits would be available to small businesses that want to offer coverage to their employees, 73 percent said it made them more supportive of the legislation. Sixty-seven percent said they were more supportive when they heard that the legislation included health insurance exchanges, and 63 percent felt that way after being told that people could no longer be denied coverage because of pre-existing conditions. Sixty percent were more supportive after hearing that the legislation would help close the Medicare “doughnut hole” so that seniors would no longer face a period of having to pay the full cost of their medicines.  Of the 27 elements of the legislation tested in the poll, 17 moved a majority to feel more positively about the bills and two moved a majority to be more negative.

In some cases elements of the legislation were popular enough to prompt a majority of skeptics to soften their opposition, including the tax credits for small businesses (62% of current opponents said it made them more supportive), the fact that most people’s existing insurance arrangements would not change (59%), and the stipulation that no federal money would go to abortion (55%).

A smaller number of provisions cut the other way. When told that nearly all Americans would be required to have health coverage, for instance, 62 percent of people said it made them less likely to support the legislation and 51 percent said they were less likely to support the reform package after learning it will cost at least $871 billion over 10 years.

“It’s one thing to talk about the public’s perception of health care reform legislation, which right now is in some ways negative, but it’s another to tell people what’s actually in the bill and when you do that people are more positive,” said Kaiser President and CEO Drew Altman.

The poll finds that even after a year of substantial media coverage of the health reform debate, many Americans remain unfamiliar with key elements of the major bills passed by the House and Senate. About half are aware that tax credits would be available to small businesses, one of the most popular provisions. And 44 percent recognize that the legislation would help close the Medicare “doughnut hole.”

Awareness can matter. Among the least known elements of the bills, those with the biggest potential to change minds include the fact that the Congressional Budget Office has said health reform would reduce the deficit (only 15% expect the legislation to reduce the deficit, but 56% said hearing that makes them more supportive) and that the legislation would stop insurers from charging women more than men (37% are aware that the legislation would do this, but 50% said this provision makes them more supportive).  There were no lesser known provisions that would push a majority of supporters away from the bill.

Independents Occupy The Middle Ground In the Debate

Americans’ views of health reform generally track with their politics: Most Democrats (64%) support the proposals on Capitol Hill, while an even larger majority of Republicans (76%) oppose them. The middle ground is left to independents, with 41 percent in favor and 43 percent opposed– even as a narrow majority (52%) backs the general idea that it is more important than ever to take on health reform now.

As with the public overall, independents say the elements most likely to push them in the direction of supporting the legislation include the tax credits for small businesses (74%); the insurance exchanges (69%); and the stability in coverage for most people with employer-sponsored plans (66%). Similarly, they are turned off by the individual mandate (67% say this makes them less supportive) and the overall cost of health reform (57%).

Independents do differ in some ways from those with declared partisan leanings. They are much more likely than Republicans to say that they feel more supportive of the legislation because it would provide coverage for the uninsured (61% of independents compared to 22% of GOP members). And they are more concerned than Democrats about the bills’ multi-billion dollar price tag; 57 percent of independents say the cost makes them feel less supportive, compared to 34 percent of Democrats.

Many Seniors Are Unaware of Effort To Close The Medicare “Doughnut Hole”

The new survey finds that America’s seniors, a politically important group, lean against the proposed legislation, with 48 percent opposed, 37 percent in favor and 15 percent offering no opinion. However the survey finds that, somewhat surprisingly, seniors were less likely than younger Americans to be aware that the legislation includes provisions to close the “doughnut hole.” Thirty-seven percent of seniors were aware of such provisions, compared to 53 percent of those under age 40. Six in 10 seniors say that if the legislation did work to close the doughnut hole they would feel more supportive of it, a level of support identical to that found among younger Americans.

There is a generational split, however, on proposals that would limit future increases in some Medicare provider payments. Younger Americans favor such measures by almost a 2-to-1 margin while the opposite is true of seniors.

The full question wording, results, charts and a brief on the poll can be viewed online.

The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible information and analysis on health issues.

Embargoed for release until:January 22, 2010

For further information contact:Rakesh Singh, (650) 854-9400, RSingh@kff.orgChrisLee (202) 347-5270, CLee@kff.org

Americans AreDivided About Health Reform Proposals Overall, But the Public, IncludingCritics, Becomes More Supportive When Told About Key Provisions

MENLO PARK, CA –A new Kaiser Family Foundation poll finds thatAmericans are divided over congressional health reform proposals, but also thatlarge shares of people, including skeptics, become more supportive after beingtold about many of the major provisions in the bills.

The January Kaiser HealthTracking Poll, conducted before the Massachusetts Senate vote, finds opinion isdivided when it comes to the hotly debated legislation, with 42 percentsupporting the proposals in the Congress, 41 percent opposing them and 16percent withholding judgment. However, a different and more positivepicture emerged when we examined the public’s awareness of, and reactions to,major provisions included in the bills. Majorities reported feeling morefavorable toward the proposed legislation after learning about many of the keyelements, with the notable exceptions of the individual mandate and the overallprice tag.

For example, after hearingthat tax credits would be available to small businesses that want to offercoverage to their employees, 73 percent said it made them more supportive ofthe legislation. Sixty-seven percent said they were more supportive when theyheard that the legislation included health insurance exchanges, and 63 percent feltthat way after being told that people could no longer be denied coveragebecause of pre-existing conditions. Sixty percent were more supportive afterhearing that the legislation would help close the Medicare “doughnut hole” sothat seniors would no longer face a period of having to pay the full cost oftheir medicines. Of the 27 elements of the legislation tested in thepoll, 17 moved a majority to feel more positively about the bills and two moveda majority to be more negative.

In some cases elements of thelegislation were popular enough to prompt a majority of skeptics to softentheir opposition, including the tax credits for small businesses (62% ofcurrent opponents said it made them more supportive), the fact that mostpeople’s existing insurance arrangements would not change (59%), and thestipulation that no federal money would go to abortion (55%).

A smaller number ofprovisions cut the other way. When told that nearly all Americans would berequired to have health coverage, for instance, 62 percent of people said itmade them less likely to support the legislation and 51 percent said they wereless likely to support the reform package after learning it will cost at least$871 billion over 10 years.

“It’s one thing totalk about the public’s perception of health care reform legislation, whichright now is in some ways negative, but it’s another to tell people what’s actuallyin the bill and when you do that people are more positive,” said Kaiser President and CEO Drew Altman.

The poll finds that evenafter a year of substantial media coverage of the health reform debate, manyAmericans remain unfamiliar with key elements of the major bills passed by theHouse and Senate. About half are aware that tax credits would be available tosmall businesses, one of the most popular provisions. And 44 percent recognizethat the legislation would help close the Medicare “doughnut hole.”

Awareness can matter. Amongthe least known elements of the bills, those with the biggest potential tochange minds include the fact that the Congressional Budget Office has saidhealth reform would reduce the deficit (only 15% expect the legislation toreduce the deficit, but 56% said hearing that makes them more supportive) andthat the legislation would stop insurers from charging women more than men (37%are aware that the legislation would do this, but 50% said this provision makesthem more supportive). There were no lesser known provisions that would pusha majority of supporters away from the bill.

Independents Occupy TheMiddle Ground In the Debate

Americans’ views of healthreform generally track with their politics: Most Democrats (64%) support theproposals on Capitol Hill, while an even larger majority of Republicans (76%)oppose them. The middle ground is left to independents, with 41 percent infavor and 43 percent opposed– even as a narrow majority (52%) backs the generalidea that it is more important than ever to take on health reform now.

As with the public overall,independents say the elements most likely to push them in the direction ofsupporting the legislation include the tax credits for small businesses (74%); theinsurance exchanges (69%); and the stability in coverage for most people withemployer-sponsored plans (66%). Similarly, they are turned off by theindividual mandate (67% say this makes them less supportive) and the overallcost of health reform (57%).

Independents do differ insome ways from those with declared partisan leanings. They are much more likelythan Republicans to say that they feel more supportive of the legislationbecause it would provide coverage for the uninsured (61% of independentscompared to 22% of GOP members). And they are more concerned than Democratsabout the bills’ multi-billion dollar price tag; 57 percent of independents saythe cost makes them feel less supportive, compared to 34 percent of Democrats.

Many Seniors Are Unawareof Effort To Close The Medicare “Doughnut Hole”

The new survey finds that America’sseniors, a politically important group, lean against the proposed legislation,with 48 percent opposed, 37 percent in favor and 15 percent offering noopinion. However the survey finds that, somewhat surprisingly, seniors wereless likely than younger Americans to be aware that the legislation includesprovisions to close the “doughnut hole.” Thirty-seven percent of seniors wereaware of such provisions, compared to 53 percent of those under age 40. Six in10 seniors say that if the legislation did work to close the doughnut hole theywould feel more supportive of it, a level of support identical to that foundamong younger Americans.

There is a generationalsplit, however, on proposals that would limit future increases in some Medicareprovider payments. Younger Americans favor such measures by almost a 2-to-1margin while the opposite is true of seniors.

Methodology

The survey was designed andanalyzed by public opinion researchers at the Kaiser Family Foundation and wasconducted January 7 through January 12, 2010, among a nationally representativerandom sample of 2,002 adults ages 18 and older. Telephone interviewsconducted by landline (1,350) and cell phone (652, including 255 who hadno landline telephone) were carried out in English and Spanish. Themargin of sampling error for the total sample is plus or minus 3 percentagepoints. The questions about specific elements of health reform legislationwere asked of random quarter-samples of respondents, and for these questionsthe margin of sampling error is plus or minus 5 percentage points. For resultsbased on subgroups, the margin of sampling error is higher.

The full question wording,results, charts and a brief on the poll can be viewed online.

The Kaiser Family Foundation is a non-profit privateoperating foundation, based in Menlo Park, California,dedicated to producing and communicating the best possible information andanalysis on health issues.