This annual 50-state survey finds that number of people on Medicaid and state spending on the program are climbing sharply as a result of the recession, straining state budgets and pressuring officials to curb costs despite increased financial help from the federal government through the American Recovery and Reinvestment Act (ARRA).

The survey finds that these trends are expected to continue well into the 2010 fiscal year, with the slumping economy contributing to the loss of jobs, private health coverage and state tax revenue at a time when more people are seeking help from public programs.

Across the country, states estimate Medicaid enrollment grew by an average of 5.4 percent in state fiscal 2009, the highest rate in six years, surpassing the projected 3.6 percent increase at the start of the year. Similarly, total Medicaid spending growth averaged 7.9 percent in FY 2009, the highest rate in five years, well above the 5.8 percent projected growth. For FY 2010, states estimate Medicaid enrollment will grow by 6.6 percent over FY 2009 levels.

The survey finds that, based on initial legislative appropriations, Medicaid spending across states is expected to grow by an average of at least 6.3 percent in fiscal 2010. But officials in three-fourths of the states are concerned that those appropriations will not be enough, leading to more budget shortfalls and more pressures to trim services and spending.

Executive Summary (.pdf)

Full Report (.pdf)

Event Page

This document contains the key findings from the September Health Tracking Poll. The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted September 11 through September 18, 2009, among a nationally representative random sample of 1,203 adults ages 18 and older. Telephone interviews conducted by landline (801) and cell phone (402, including 147 who had no landline telephone) were carried out in English and Spanish. The margin of sampling error for the total sample is plus or minus 3 percentage points. For results based on subgroups, the margin of sampling error is higher.

Key Findings (.pdf)

The September Kaiser Health Tracking Poll finds that public support for health reform ended its summer slide, reversed course and moved modestly upwards in September. The survey also finds initial majority support for taxing expensive health plans and imposing fees on insurers to pay for reform.

Fifty-seven percent of Americans now believe that tackling health care reform is more important than ever—up from 53 percent in August. The proportion of Americans who think their families would be better off if health reform passes is up six percentage points (42% versus 36% in August), and the percentage who think that the country would be better off is up eight points (to 53% from 45% in August).

Substantial majorities of Americans continue to say they back individual reform components designed to expand coverage, including an individual mandate (68%), an employer mandate (67%) and an expansion of state programs such as Medicaid and the Children’s Health Insurance Program (82%).

When it comes to paying for reform, two ideas now under discussion among policymakers garner initial majority support. Fifty-seven percent of the public say they would support “having health insurance companies pay a fee based on how much business they have” and 59 percent would support “having health insurance companies pay a tax for offering very expensive policies.” In both cases, Republicans are evenly divided while Democrats and political independents tilt in favor.

The September poll, the sixth 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

Summary of Recent Results of Public Opinion on Medicare Expansion (.pdf)

Toplines

This document contains the chartpack from the September Health Tracking Poll. The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted August 4 through August 11, 2009, among a nationally representative random sample of 1,203 adults ages 18 and older. Telephone interviews conducted by landline (801) and cell phone (402, including 123 who had no landline telephone) were carried out in English and Spanish. The margin of sampling error for the total sample is plus or minus 3 percentage points. For results based on subgroups, the margin of sampling error is higher.

Chartpack (.pdf)

This document contains the toplines from the September Health Tracking Poll. The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted September 11 through September 18, 2009, among a nationally representative random sample of 1,203 adults ages 18 and older. Telephone interviews conducted by landline (801) and cell phone (402, including 147 who had no landline telephone) were carried out in English and Spanish. The margin of sampling error for the total sample is plus or minus 3 percentage points. For results based on subgroups, the margin of sampling error is higher.

Toplines (.pdf)

A Profile of American Indians and Alaska Natives and Their Health Coverage

This brief examines the health coverage, access to care and health status of American Indians and Alaska Natives across the country. Although the U.S. government has an established responsibility through tribal agreements to provide health care services to members of federally recognized Indian tribes, many American Indians and Alaska Natives lack access to health care.

The brief gives an overview of the some of the demographic factors that influence the health and insurance coverage of American Indians and Alaska Natives. It examines the relatively high rates of chronic conditions experienced by American Indians and Alaska Natives compared to other racial and ethnic groups.

The brief also provides information about the Indian Health Service and health coverage and access to care for this population.

Issue Brief (.pdf)

This data note explores who is more or less likely to say that they are satisfied with their health insurance plan, examines how people’s opinions of their plan vary with health status and what people’s health care experiences and concerns can tell us about their health coverage.

Overall, the Foundation’s August 2009 tracking poll found that most Americans with insurance give their plan a favorable rating, and most are satisfied with various aspects of their coverage and care. However, on closer examination, the data finds that younger Americans, those with lower incomes and those who report being in poor personal health are significantly less likely to say they are satisfied with their insurance than their counterparts. And though most Americans say their insurance is “excellent” or “good,” these positive ratings do not necessarily paint a complete picture, as significant portions of those who rate their insurance positively still say they face problems paying their medical bills or are dissatisfied with certain aspects of their coverage. Additionally, recent Foundation polls indicate that substantial portions of insured people are concerned about the cost of their health care and insurance, the adequacy of their insurance to meet potential health care needs, and the stability of their insurance coverage.

Data Note (.pdf)

This brief highlights key strategies to address financing, program administration and community workforce challenges that key experts, federal and state officials and advocates believe must be overcome to expand access to home and community-based services (HCBS).

Among the key ideas drawn from a working group discussion at the Foundation are the benefits of:

• providing additional federal financing to states to provide Medicaid HCBS and to administer these benefits;

• simplifying the process for states to provide HCBS;

• increasing Medicaid income-eligibility and resource limits for HCBS and expediting program eligibility determinations; and

• devoting greater attention to increasing capacity in the community and long-term care workforce development, including wages, training and benefits.

Brief (.pdf)

This brief presents analysis of the latest available Medicaid spending and enrollment data to examine recent trends in program enrollment, total spending, spending by service, and spending per enrollee. The focus is on spending changes between 2006 and 2007, with historical context also provided.

After Medicaid spending declined in 2006 for the first time in the program’s history, spending climbed by 5.3 percent in 2007. In raw dollars, spending increased to $330.8 billion in 2007, up from $314.2 billion the year before. Main contributors to this growth included increases in spending on hospital inpatient care, Medicaid managed care and hospital outpatient care, with particularly large increases in a small number of states driving the overall trend.

Medicaid spending grew between 2006 and 2007 despite enrollment declines of 0.6 percent, defying historical patterns in which growth in Medicaid spending had been driven primarily by enrollment growth. In 2007, spending growth was related not to enrollment growth but rather to increases in the growth rate of spending per enrollee, particularly for acute care services. The current economic recession, however, suggests that Medicaid spending is likely to revert to historical patterns and grow along with enrollment increases.

Over the entire 2000 to 2007 period, annual growth in Medicaid spending per enrollee was considerably slower (4.8%) than growth in per capita national health expenditures (6.5%).

Issue Brief (.pdf)

This brief summarizes lessons in offering more home and community-based services from states at the forefront of the effort. It describes current options for state Medicaid programs and draws on interviews with state officials to provide details about specific policies and procedures in states.

Brief (.pdf)