The December Kaiser Health Tracking Poll finds a dip on several measures of public opinion on health care reform. The number of Americans who say they personally will be better off if reform passes fell to 35 percent in December, down from 42 percent last month. Meanwhile, 27 percent say they will be worse off, and 32 percent said they don’t expect to see much of a difference. Similarly, 45 percent say the country would be better off if health care reform passes down from 54 percent in November. This compares to 31 percent who say the country will be worse off and 17 percent who see no impact. Public opinion in December looks more like it did in August, the last time this debate became so contentious.

Despite the dip on these measures, 54 percent of the public says that it is more important than ever to pursue health reform now, while 41 percent say the country cannot afford it. Those proportions have remained fairly steady throughout the fall, though the gap between the majority who want reform now and those who don’t tightened this month.

The December poll, the ninth in a series designed and analyzed by the Foundation’s public opinion survey research team, examines voters’ specific health care issue interests and experiences and perceptions about health care reform.

Key Findings

Chartpack

Toplines

Medicare Part D helps cover the cost of outpatient prescription drugs for 27 million beneficiaries enrolled in private stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug (MA-PD) plans. The majority of Part D enrollees pay a monthly premium for Medicare drug coverage. This data spotlight examines premiums for enrolling in Medicare’s PDPs in 2010 and trends since 2006. 

The spotlight is one in a series analyzing key aspects of the Medicare Part D drug plans that will be available to beneficiaries in 2010. The analysis was conducted jointed by Jack Hoadley and Laura Summer of Georgetown University, Elizabeth Hargrave of NORC at the University of Chicago, and Juliette Cubanski and Tricia Neuman of the Kaiser Family Foundation.

Data Spotlight (.pdf)

This Part D Data Spotlight examines key differences between basic and enhanced Medicare stand-alone prescription drug plans (PDPs), including monthly premiums, cost sharing, and gap coverage. It also examines plan names to assess whether they convey meaningful differences between basic and enhanced PDPs.

Companies that sponsor Medicare Part D prescription drug plans are required to offer a basic benefit, either the standard Part D benefit defined by law or an actuarially equivalent benefit design. Plan sponsors can also offer plans with enhanced drug benefits. Enhanced plans are required to have a greater actuarial value than basic plans, but plans vary in the ways in which they improve coverage.

The spotlight is one in a series analyzing key aspects of the Medicare Part D drug plans that will be available to beneficiaries in 2010. The analysis was conducted jointed by Jack Hoadley and Laura Summer of Georgetown University, Elizabeth Hargrave of NORC at the University of Chicago, and Juliette Cubanski and Tricia Neuman of the Kaiser Family Foundation.

Data Spotlight (.pdf)

A key element of health reform will be meeting the needs of low-income children. Overall, a major goal of proposals is to expand coverage by building on Medicaid, providing subsidies to low- and moderate-income individuals to buy coverage through new health insurance exchanges, and requiring individuals to obtain coverage. Current proposals also could significantly change coverage for some children already eligible for Medicaid and CHIP.

This issue brief examines several key issues to consider about low-income children’s coverage under health reform. Medicaid and CHIP are proven programs that have successfully covered millions of low-income children with diverse health needs. As reform efforts continue, it will be important to consider how to build upon the accomplishments of Medicaid and CHIP, develop effective relationships and transitions between public and private coverage, and assure that low-income children receive coverage that meets the full range of their health needs and offers meaningful financial protections for their families. Further, adequately planning and funding for the transition to reform will be key to preventing any disruptions in children’s coverage or care as reform is implemented.

This issue brief was released as part of a package of related materials in conjunction with a media briefing on the findings of an annual 50-state survey of Medicaid and CHIP eligibility and enrollment policies.

Issue Brief (.pdf)

Although Medicare is not the main focus of current health reform legislation, the bill recently passed by the House—H.R. 3962, America’s Affordable Health Choices Act of 2009—and the bill before the Senate—H.R. 3590, Patient Protection and Affordable Care Act—include a number of provisions that would affect Medicare program expenditures.

This policy brief considers the proposed 10-year Medicare savings and increased spending in the two proposals in the context of other laws enacted during the last 15 years that have resulted in significant changes to the Medicare program. The analysis calculates net changes in 10-year projected Medicare expenditures estimated at the time each law was enacted as a share of the contemporaneous projected Medicare baseline spending. The results help to illustrate the relative magnitude of each law’s effect on Medicare expenditures as projected at the time of enactment.

Policy Brief (.pdf)

Previous Version:

Analysis of HR 3200 and Senate Finance Committee Chairman’s Mark – October 2009 (.pdf)

The beginning of the recession, from December 2007 through December 2008, led to an increase in the overall number of uninsured. Despite a 1.5 million increase in the number of uninsured adults, however, the number of uninsured children declined by 800,000 during this time period. States have played a key role in this progress for children by maintaining and expanding children’s coverage. This issue brief highlights seven states (Alabama, Maryland, New Jersey, New York, Oklahoma, Texas and Vermont) that were selected because they use a range of approaches to protect children’s coverage. In these seven states alone, 500,000 children gained coverage in 2008, representing nearly two-thirds of the national decline in uninsured children.

Issue Brief (.pdf)

In April 2010, the Foundation issued a policy brief examining key issues affecting the U.S. Global Health Initiative (GHI). This policy brief and chartpack provide a detailed breakdown of the U.S. budget for the global health programs in President Obama’s GHI, announced in May 2009. In addition, the regularly updated Budget Tracker provides the current status of key global health accounts throughout the budget and appropriations process.

The GHI, proposed as a six-year effort, would for the first time develop a comprehensive, U.S. government-wide strategy for global health focused on the health challenges and needs of those in low- and middle-income countries. The initiative builds on the Bush Administration’s efforts to address HIV, TB, and malaria through the President’s Emergency Plan for AIDS Relief (PEPFAR) and President’s Malaria Initiative (PMI) but also broadens and augments the focus on other global health challenges, particularly maternal and child health, family planning and reproductive health, and neglected tropical diseases. The effort currently encompasses most, but not all, of the federal government’s investment in global health.

The brief provides an overview of the projected budget for the GHI, including the $8.6 billion proposed by the Administration in its pending fiscal year 2010 request and the $8.4 billion approved in fiscal year 2009. It examines the different U.S. programs that would fall under the GHI over time, tracking data back to fiscal year 2001. The supplemental chartpack includes additional breakouts and budget trends over time.

Policy Brief (.pdf)

Chartpack (.pdf)

NEW: Foundation brief looks at implications of 2011 quality ratings for Medicare Advantage plans.

The Centers for Medicare and Medicaid Services (CMS) rates the relative quality of the private plans that are offered to Medicare beneficiaries through the Medicare Advantage program as a way of aiding beneficiaries who are considering enrolling in such a private plan. CMS rates Medicare Advantage plans on a one to five-star scale, with five stars representing the highest quality.

This analysis by Kaiser Family Foundation researchers finds that quality ratings vary by plan characteristics. For example:

• Private Fee-For-Service plans and regional Preferred Provider Organizations (PPOs) have below average ratings — significantly lower than HMOs and local PPOs.
• Non-profit plans have significantly higher average ratings than for-profit plans.
• More experienced plans (with contracts beginning before 2004) have higher ratings than newer ones.
• Average quality ratings also vary widely among the largest organizations offering Medicare Advantage plans.

Overall, nearly one in four Medicare Advantage enrollees is in plans with four or more stars. However, the share of enrollees in highly rated plans varies greatly by state — from less than 2 percent in 25 states and Washington D.C. to more than half in Massachusetts, Oregon and Hawaii.

The analysis is based on the ratings posted by CMS on the Medicare Compare Web site, with additional information from the CMS Plan Directory and enrollment files. The analysis examines the summary scores for the plans, which are an overall measure of the quality of care, access to care, responsiveness, and beneficiary satisfaction provided by the plans. It does not attempt to assess the validity of the quality ratings.

The Foundation also has issued a new analysis examining changes in the 2010 health reform law that will reward bonuses to private Medicare Advantage plans based on quality rating. The analysis is available online.

Issue Brief (.pdf)

In 2009, despite the bleakest economic picture in years, states managed to safeguard and in some cases expand health coverage for children and parents in their Medicaid and Children’s Health Insurance Programs, according to the Kaiser Family Foundation’s annual 50-state survey of Medicaid and CHIP eligibility rules, enrollment and renewal procedures and cost-sharing Practices. That was in large part due to the substantial help that states received through the congressional reauthorization of CHIP and the enactment of the American Recovery and Reinvestment Act (ARRA).

However, those 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 for Medicaid programs at the end of 2010, the survey found. That in turn raises the prospect that new fiscal shortfalls could cause states to consider significant cuts to Medicaid and CHIP even before health reform coverage would begin.

The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured released its annual 50-state survey and a package of related reports that examine trends and key issues in the coverage of low-income children and adults during a media briefing at the Foundation’s Washington, D.C., office.

News Release

A Foundation for Health Reform: Findings of An Annual 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures and Cost-Sharing Practices in Medicaid and CHIP for Children and Parents During 2009

Materials from the Dec. 8, 2009, Media Briefing

Agenda (.pdf)

Participant Bios (.pdf)

Presentation Slides (.pdf)

Podcast of the Media Briefing

Related Reports Released Dec. 8:

Coverage of Low-Income Children: Key Issues to Consider in Health Reform

Protecting Children During the Recession: Spotlight on State Health Coverage Efforts

Where Are States Today? Medicaid and State-Funded Coverage Eligibility Levels for Low-Income Adults

Monthly Medicaid Enrollment by State through December 2008

In 2009, despite the bleakest economic picture in years, states managed to safeguard and in some cases expand health coverage for children and parents in their Medicaid and Children’s Health Insurance Programs, according to the Kaiser Family Foundation’s annual 50-state survey of Medicaid and CHIP eligibility rules, enrollment and renewal procedures and cost-sharing Practices. That was in large part due to the substantial help that states received through the congressional reauthorization of CHIP and the enactment of the American Recovery and Reinvestment Act (ARRA).

However, those 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 for Medicaid programs at the end of 2010, the survey found. That in turn raises the prospect that new fiscal shortfalls could cause states to consider significant cuts to Medicaid and CHIP even before health reform coverage would begin.

The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured released its annual 50-state survey and a package of related reports that examine trends and key issues in the coverage of low-income children and adults during a media briefing at the Foundation’s Washington, D.C. office.

Executive Summary (.pdf)

Full Report (.pdf)

Data Tables (.pdf)