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This video explores the powerful force that media can be in the lives of teens and tweens. The three young people who are profiled explain what types of media they use—such as smart phones, computers, TV, video games—how much time they spend with media and what impact it has on their lives.
The Washington Post/Kaiser Family Foundation/Harvard University Survey of Detroit Area Residents reveals a population that is facing some of the worst effects of the current economic recession. Home of the nation’s domestic auto industry, Detroit’s residents have been at the forefront of the country’s economic woes. The survey illuminates the experiences and needs of those living in the midst of this economic catastrophe, including questions about job loss and job security, views about the future of the Detroit area, the U.S. auto industry, and the future for American workers more generally. It looks at the stark differences in experiences and attitudes of those living in the city of Detroit compared with the surrounding suburbs. It also explores how Detroiters feel about their local, state, and federal governments, particularly in light of recent federal government action such as the economic stimulus and the aid provided to General Motors.
The survey is the 18th in a series of surveys that have been conducted as part of a three-way partnership between The Washington Post, the Kaiser Family Foundation and Harvard University.
Almost a year into an often acrimonious health reform debate, we stand poised for near certain passage of historic health reform legislation. Yet, somewhat perplexingly, there’s now talk about whether a law that has not even been enacted might actually be repealed and reporters have been calling asking what the chances of repeal may be.
I have a very hard time imagining any scenario for repeal unfolding. Calls for repeal have much to do with maneuvering for advantage in the upcoming midterm election and little to do with how the American people will ultimately feel about the law. And the role of health reform in the midterms should not itself be over played. While the issue may be used to get the attention of voters in some districts who tend to turn out to vote in mid-term elections, health has not generally been a powerful voting issue in elections, and other issues such as jobs and the economy (as well as now potentially terrorism) are likely to be much bigger factors.
To be sure, once health reform passes there may be an “expectations gap,” with the public expecting help with their health insurance to arrive much faster than it actually will. One of our recent tracking polls found that about half of Americans believe that people will begin getting help buying coverage and insurance companies will be required to accept all comers this year or next. The actual timeline in the bills is slated to be quite a bit slower, and in the meantime it’s likely that costs will rise and the number of uninsured will increase as they would have if no health reform bill had passed.
But by 2013-2014, the only available remedy to people’s continuing struggles with health insurance will be the law itself—passed by the Congress, signed into law by the President and ready to provide tangible assistance to the public. Rather than support calls for repeal, the public’s reaction is much more likely to cut the other way—people will put pressure on their elected representatives to accelerate implementation of the insurance reforms and subsidies they can get under the law. Critics may be able to rally their base with attacks on health reform legislation, but it will deliver too much to too many to win general public support for repeal.
Implementation is not self-executing. It will take sustained and well-planned effort to make sure the public understands what the legislation does and how it will benefit them. Many groups have a role to play in making this happen as does the government. But once the legislation is out there, elected officials will have every incentive to make it work and keep it popular and perhaps even to improve on the help it provides to people struggling with their health care bills.
It’s an old maxim in political science that benefits once conferred are difficult, if not impossible to take away, and there are a variety of groups that will benefit under health reform: about 15 million additional people will be covered by Medicaid; 18-20 million people will receive new government subsidies for health insurance each year; many will benefit over time from guaranteed access to insurance regardless of pre-existing conditions; older people buying insurance on their own will see their premiums fall; and 3 million Medicare beneficiaries who fall into the donut hole each year could get better drug coverage. Virtually everybody gets added peace of mind from the insurance reforms that will protect them or a family member from being barred from insurance if they have a pre-existing condition or from being dropped or charged more if they get sick.
Experience with the Medicare prescription drug law may be instructive. In July of 2004, seven months after the law was passed, we asked people on Medicare what lawmakers should do about the law. 10 percent said it should be repealed. Four months later 12 percent of seniors said the same thing. Two years later in November of 2006, about a year after enrollment in drug plans began, we asked the public as a whole what message they would send to policymakers about the law. Still just 8 percent favored repeal while most favored improvements of different kinds.
Some have argued that the fact that the process of paying for the law begins before the benefits kick in will add to frustration with the law. But the financing structure of the law, a complex array of savings and revenue measures that affect many different groups, could actually become a strength that protects it from broad-based public resentment after passage. That’s because there is no single broad-based tax to rally the American people against. Health providers and industries take hits, but for the most part (with the exception of insurers), they have largely acquiesced to the savings and fees. Very high-income people will probably face higher taxes, though relatively few people would be affected. Young and healthy people may pay higher premiums as insurance market reforms are implemented, though many of them will be buying coverage for the first time so may not notice the difference. And, the so-called “Cadillac plan” tax (if it is included in a final deal) could end up affecting a large number of employers and workers over time since the thresholds for the tax grow much more slowly than the expected increase in premiums, but the effects will be indirect and not necessarily obvious to people. According to the Joint Committee on Taxation estimates, in most cases the tax wouldn’t be paid because insurers and employers would instead trim coverage or introduce efficiencies to avoid it. The fact that the burden of paying for health reform is spread across so many different interests and groups has made the law vulnerable to traditional behind the scenes lobbying on Capitol Hill, but its combination of widespread benefits and targeted pain will provide political insulation with the public at-large after passage.
Still, health reform legislation will undoubtedly be controversial up until the (expected) passage and beyond, and debate about repeal may play a role in the mid-term elections later this year. It will be especially important for the news media to keep any discussion of repeal in the context of the mid-term elections in which it will be raised so as not to add momentum to an idea that is mostly a reflection of the rough and tumble of election campaigns. Once the law is passed, there is little chance that the public will do anything but seek its more rapid implementation, and policymakers will work to build on and improve it over time.
The January Kaiser Health Tracking 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 poll, conducted before the Massachusetts Senate vote, finds opinion about the legislation is split, with 42 percent supporting the proposals, 41 percent opposing them and 16 percent withholding judgment. But majorities reported feeling more favorable toward the legislation after learning about key elements such as the availability of tax credits for small businesses, the creation of health insurance exchanges, the inability of insurers to deny people coverage because of pre-existing conditions and the move to close the Medicare drug benefit’s “doughnut hole.” The notable exceptions were the individual mandate and the overall price tag, both of which tended to make people less supportive of reform efforts.
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. It also finds that 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.
Findings (.pdf)
Chartpack (.pdf)
Toplines (.pdf)
The Foundation, as part of The Washington Post/Kaiser Family Foundation/Harvard University partnership series, conducted a poll to better understand how health care played into the mix of issues and frustrations that brought voters to the polls in the Massachusetts special election for U.S. Senate. The poll was conducted among a random sample of 880 voters in the Massachusetts special election on January 19, 2010 and also interviewed were 242 Massachusetts adults who did not participate in the election. This is the 19th in a series of surveys dating back to 1995 that have been conducted as part of this partnership project.
Toplines (.pdf)
Read The Washington Post article on the survey
The Message from Massachusetts, The Latest “Pulling It Together, From Drew Altman”
Generation M2: Media in the Lives of 8- to 18-Year-Olds is the third in a series of large-scale, nationally representative surveys by the Foundation about young people’s media use. The report is based on a survey conducted between October 2008 and May 2009 among a nationally representative sample of 2,002 3rd-12th grade students ages 8-18, including a self-selected subsample of 702 respondents who completed seven-day media use diaries, which were used to calculate multitasking proportions.
Full Report (.pdf)
Toplines:
2009 (.pdf)
2004 (.pdf)
1999 (.pdf)
One of the first provisions that would be implemented under federal health reform bills in the House and the Senate would establish a national high-risk pool program to offer coverage to otherwise uninsurable individuals during the interim period between enactment and implementation of broader health care reforms.
High-risk pools provide a safety net for people who are denied coverage by private insurers due to their health. Most states that permit insurers to decline applicants for health reasons have high-risk pools today. The House and Senate bills would extend risk pool protection nationally, reduce the costs of risk pool coverage for many participants, and provide $5 billion dollars to subsidize the costs of coverage. The House and Senate provisions are similar, but not identical, and their provisions would need to be reconciled in any final health reform legislation.
This brief examines the role of high-risk pools as a coverage safety net today and reviews key issues involved in implementing a national high-risk pool. It was authored by Karen Pollitz of the Georgetown University Health Policy Institute.
Brief (.pdf)
The Washington Post/Kaiser Family Foundation/Harvard University Survey of Detroit Area Residents reveals a population that is facing some of the worst effects of the current economic recession. Home of the nation’s domestic auto industry, Detroit’s residents have been at the forefront of the country’s economic woes. The survey illuminates the experiences and needs of those living in the midst of this economic catastrophe, including questions about job loss and job security, views about the future of the Detroit area, the U.S. auto industry, and the future for American workers more generally. It looks at the stark differences in experiences and attitudes of those living in the city of Detroit compared with the surrounding suburbs. It also explores how Detroiters feel about their local, state, and federal governments, particularly in light of recent federal government action such as the economic stimulus and the aid provided to General Motors.
The survey is part of an ongoing three-way partnership between The Washington Post, the Kaiser Family Foundation and Harvard University. The partners worked together to pick the survey topics, design the survey instruments, and analyze the results. The Washington Post featured a collection of articles built upon the findings from the survey.
Survey Report (.pdf)
This fact sheet provides an overview of the Medicare drug benefit and the additional subsidies available to certain eligible low-income beneficiaries.
Fact Sheet – December 2009 (.pdf)
New 50-State Survey Illustrates Key Role of CHIP Reauthorization and the Federal Stimulus Law in Safeguarding Coverage
WASHINGTON – Despite the deep recession, most states have managed to safeguard and, in some cases, expand health coverage for children and parents in their Medicaid and Children’s Health Insurance Programs in 2009, according to a new survey from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured. But the gains, which could serve as a base for covering millions more people under health reform, are threatened by the impending end of key federal assistance at the end of 2010 and before health reform coverage would begin.
The annual 50-state survey of eligibility rules, enrollment and renewal procedures and cost-sharing practices in Medicaid and CHIP for children and parents found that, overall, most states in 2009 continued to expand and simplify their Medicaid and CHIP programs, the main vehicles for providing coverage to low-income children and families, even as they faced the bleakest economic picture in years and severe budget pressures. However, budget shortfalls did result in cutbacks in some states.
“The renewal of CHIP and the fiscal relief and eligibility and enrollment protections for Medicaid in the American Recovery and Reinvestment Act (ARRA) proved critical to enable states to continue their commitment to providing coverage to millions of low-income families,” said Diane Rowland, Executive Vice President of the Foundation and Executive Director of the KCMU. “However, even with signs of economic recovery, state revenues are still mired in a severe slump and, faced with the end of enhanced federal money after 2010, fiscal shortfalls are likely to cause states to consider significant cuts to Medicaid and CHIP.”
Despite National Gains, Prominent Disparities Remain
While the survey reveals significant overall progress nationally in expanding public coverage or making it easier to access, wide variations in coverage persist. Among the survey findings:
Gains Could Be Eroded By The Recession, Weakening the Coverage Base for Health Reform
States’ commitment to providing Medicaid and CHIP coverage to low-income children and families will continue to be tested in 2010 as dismal state budget circumstances persist. Recent forecasts indicate states will face even bigger shortfalls in the upcoming fiscal year. At the same time, the federal assistance that states have relied on under ARRA is scheduled to expire at the end of the 2010 calendar year, and along with it the requirement that states maintain eligibility levels and refrain from imposing enrollment barriers. That raises the prospect of substantial state cuts in Medicaid and CHIP that could reverse recent expansions and undermine the base of coverage for low-income families upon which broader health reform efforts seek to build.
The leading reform bills in Congress build on Medicaid to expand health coverage to millions of people, but differ in the scope of the expansion they envision, the level of federal support they would provide to states, and in how they treat coverage for children. These survey findings provide a baseline against which future progress can be measured. Further, as policymakers attempt to craft final legislation, they can draw on what states have learned about the importance of simplifying enrollment and renewal procedures, covering parents, and limiting cost sharing. The simple and coordinated procedures that have helped assure that eligible children and parents secure and retain coverage, and that have enabled families to transition smoothly between programs when family circumstances change, will be essential in a new health insurance system.
Today’s report, A Foundation for Health Reform: Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and CHIP for Children and Parents During 2009, and related materials, including a new issue paper on key issues to consider in health reform regarding coverage of low-income children, are available online here. In addition, an audio press briefing on the release will be available after 6 p.m. ET today.
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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.
The Kaiser Commission on Medicaid and the Uninsured provides information and analysis on health care coverage and access for the low-income population, with a special focus on Medicaid’s role and coverage of the uninsured. Begun in 1991 and based in the Kaiser Family Foundation’s Washington, D.C. office, the Commission is the largest operating program of the Foundation. The Commission’s work is conducted by Foundation staff under the guidance of a bipartisan group of national leaders and experts in health care and public policy.