KFF designs, conducts and analyzes original public opinion and survey research on Americans’ attitudes, knowledge, and experiences with the health care system to help amplify the public’s voice in major national debates.
Health care remains among the top three election issues voters want to hear the presidential candidates discuss. Kaiser’s new series of election briefs frame the challenges the heath care system faces, provide basic facts, and offer questions to assess the presidential candidates’ plans on key health policy issues. Check back for more issue briefs.
Women consistently cite health care as one of the top issues they want the Presidential candidates to address, reflecting their experiences with the health care system as patients, mothers, and caregivers for frail and disabled family members. Women’s priorities for health care reform cut across many critical topics, including health insurance coverage and affordability, the cornerstones of the candidates’ health proposals, as well as long-term care, delivery system issues, and reproductive health. This brief discusses each of these issue areas from a women’s perspective and summarizes the presidential candidates’ stated positions on these topics.
How do health care costs and coverage affect women’s access to care?
Affordability. The impact of health costs can be particularly acute for women, who are more likely to use health care services throughout their lives, yet have lower incomes and fewer resources than men. Women are more likely than men to report that cost is barrier to care (Figure 1) Even among privately insured women, 17% report delaying or going without needed health care because they could not afford associated costs such as co-payments or non-covered services.1The effects of costs are particularly acute for low-income women.2
Figure 1
Problems Accessing Health Care Due to Cost
Sources:Kaiser Health Tracking Poll: Election 2008 (conducted April 3-13, 2008).
Coverage. Almost 17 million women are uninsured, (18% of women) most of whom are in low-income working families. Many of these women lack access to employer-based coverage because they work part-time/year or in firms or industries that don’t offer insurance. Many women cannot purchase insurance on their own because they have pre-existing health conditions or cannot afford the monthly premiums. Nationally, 63% of women get insurance through their own (38%) or their spouses employer (25%), 10% are assisted by Medicaid, and 6 purchase coverage through the individual market.3
Scope of benefits. Maternity care, prescription drugs, contraceptives and mental health care are important benefits for women. Many of these benefits, especially mental health and contraceptives are limited in many job-based insurance plans and are typically excluded in the individual insurance market, particularly maternity care.4
The Candidates’ Positions:Senator McCain proposes providing tax credits to help individuals purchase insurance in the individual insurance market and reforming the tax code to include the value of employer sponsored health insurance plans as part of workers’ taxable income. The McCain proposal would create a federally-supported “Guaranteed Access Plan” to assist people who are denied coverage due to pre-existing conditions.5
The campaign has no stated official position on the benefits that are often limited in the individual market, including maternity care, mental health, and contraceptives.
Senator Obama would expand public program coverage of low-income families, particularly Medicaid and SCHIP, and broaden access to employer-sponsored coverage. For uninsured women who still would not qualify for Medicaid, Senator Obama’s proposal would provide subsidies for families to purchase coverage and provide a choice of plans through a health insurance exchange with a structure and benefits that would be similar to that offered to federal employees.6
What are the special long-term care concerns facing older women and their families?
Long-term care. Women have a longer life expectancy than men and comprise the vast majority of the oldest and frailest group of seniors. Half (49%) of women (compared to 28% of men) over 65 live on less than $20,000 a year, 17% have physical disabilities, one-fourth (23%) have cognitive limitations and 39% live alone. As a result, more than 75% of nursing home residents and two-thirds of home health users are women.7
Medicare offers very limited long-term care benefits (only after a hospitalization) and Medicaid pays for long-term care only for very poor women or those who have become impoverished from high health expenses. In the private sector, individually purchased long-term insurance policies can be unaffordable to most middle income families unless purchased well before there is need for assistance.
Caregiving. In the U.S., 12% of women are caregivers to frail or ill relatives, including children, parents, or other family members. While many women have taken advantage of the job protection provided by the Family and Medical Leave Act (FMLA), which allows workers to take up to 12 weeks of leave from their job to care for a new child, sick family member or for their own medical care, this law does not provide for paid leave. In addition, many women do not have paid sick leave and do not get paid when they need to stay home or care for a sick family member.
The Candidates’ Positions:Senator McCain has stated his support for a variety of state-based programs for delivering care to people in a home setting, and stated that he will take steps to provide individuals monthly stipends to hire care providers and purchase care-related services and goods.8 He would not expand the FMLA and argues that sick days should be negotiated between management and labor and opposes employer mandates.9
Senator Obama supports the creation of a national insurance program to provide people with functional needs the financial assistance to pay for the supports and services that will enable them to live independently in their communities. He also supports improving the quality of elder care, including training more nurses and health care workers in geriatrics.10 He would support a requirement that employers provide seven paid sick days per year and expand the FMLA to cover businesses with 25 or more employees (currently 50 or more) and broaden the eligibility for the leave benefit to include an expanded list of purposes including for parents to participate in school activities, elder care, and to address domestic violence and sexual assault.11
How is women’s health affected by the health care delivery system?
Provider Shortages. Experts predict that the current health care workforce will be insufficient to meet future health needs. This is particularly a concern for services that are important to women such as primary care, mammography, obstetrics/gynecology, abortion and mental health. Fewer medical graduates are choosing primary care specialties and in 2004, nearly 50% of U.S. counties had no obstetrician/gynecologist providing direct patient care, and 87% of counties (representing 35% of U.S. women) had no abortion provider. In some parts of the country, women wait more than 40 days for their first-time mammograms.12
Prevention and Chronic Disease. Rising rates of chronic illness and other preventable conditions indicate critical gaps in health promotion and delivery. The cost of managing chronic conditions, which has been estimated to account for over 75% of health spending,13 has emerged as a major health reform issue. Women are disproportionately affected by many chronic conditions such as asthma, obesity, arthritis, autoimmune diseases, and certain cancers. 14 For women, wellness and prevention initiatives are most successful when they are tailored to their biological needs and societal roles.
Information Technology. Enhanced use of information technology could benefit women by improving communication and coordination of care between providers. Women are more likely than men to rely on different providers, and women with multiple chronic conditions may visit as many as 16 different specialists in a year, often leading to duplicative diagnostic testing and confusion over care plans.15 Electronic records can also facilitate the transfer of sex- and gender-specific knowledge between researchers and clinicians, and enable tracking of individual patient outcomes. For women who make the overwhelming majority of family health decisions, access to a comprehensive medical record may enhance record-keeping and clarify choices.
Research. Sex- and gender-based clinical research continues to find major differences in how men and women experience many aspects of disease, including risk factors, symptoms, detection, and treatment. In addition to improving diagnosis and treatment, the identification of these differences can help shape effective policies on issues such as health care workforce development, prevention and chronic care initiatives, and the use of technology that better meet the health care needs of women.
The Candidates’ Positions: Senator McCain would promote public health initiatives that would include changing behavior, incentives to encourage screenings, and payment mechanisms that would reward outcomes and patient compliance. He also supports more federal research on chronic disease. He supports the rapid deployment of information systems and technology that will allow doctors to practice across state lines and argues that the market will respond to system demands and provide the health information technology infrastructure. 16
Senator Obama would expand funding to improve the primary care provider and public health practitioner workforce and would also establish community outreach programs to improve health care access in underserved areas. He supports legislation to encourage research examining gender and health disparities.17 He maintains that the broad adoption of standards-based electronic health information systems will generate large savings in the health care system which will help fund his coverage expansion proposals. 18
How do federal policies affect women’s access to reproductive health services?
Abortion. Federal and state laws have been used to restrict access to abortion services by banning intact D&E abortions (so-called “partial birth” abortions), imposing parental consent and waiting laws, exempting health care providers from performing abortions, restricting the use of public funds, and limiting services provided by U.S. funded non-governmental organizations. It is likely that the next President will be faced with the selection of at least one new Supreme Court justice as well as several lower court federal judges, with these appointments possibly tipping access to abortion in either direction.
Contraception. Contraception is one of the most widely used preventive care services for women. Insurance coverage of contraceptives increases access for women. Today, 27 states require private health plans to cover contraceptives, but a change in federal law would be needed to require that all employer-sponsored provide coverage. For low-income women, public financing of family planning services through Title X, the federal family planning program, and Medicaid provides both access to contraception and primary care. However, the level of Title X funding has not kept pace with medical inflation, straining the ability of providers to serve low-income women and teens.
Education and information. There have also been longstanding debates about the scope of information in teen sex education programs. Federal funding for abstinence-only sex education which prohibits information about contraception and condoms has more than tripled since 2001. In the wake of the recent rise in teenage births 19 and with increasing evidence that sexually transmitted infections are a significant health concern for many teens, new attention is being directed to these issues.
HIV. As women account for a growing share of the HIV epidemic, there is greater emphasis on HIV testing and knowing one’s status. The American College of Obstetricians and Gynecologists now recommends that all adult women be screened routinely for HIV. Given the epidemic’s disproportionate impact on minorities and the effectiveness of treatments in slowing the progress of AIDS, there is also greater emphasis on encouraging women of color to be screened.
The Candidates’ Positions: Senator McCain supports overturning the Roe v. Wade decision and allowing states to decide on abortion legality. He maintains that government should empower and strengthen pro-life organizations and efforts and supports the ban on the use of federal funds for abortion. 20 He also supports a complete federal ban on certain abortions (so-called “partial birth” abortions). 21
Senator Obama supports upholding Roe v.Wade and opposed the ban on use of federal funds for abortion.22 He contends that state-level bans on certain abortions (so-called “partial birth” bans) should include exceptions for the pregnant woman’s health. He supports requiring insurance companies to cover prescription contraceptives and would increase funding for the federal Title X program. He also supports comprehensive sex education that teaches about abstinence as well as contraception. 23
Included below are a series of questions to help further evaluate the candidates’ proposals.
What strategies will the candidate employ to improve the affordability of health insurance for families?
Will plans be required to cover services such as maternity care, mental health, and contraceptives?
How would the candidate’s health reform program affect Medicaid and SCHIP coverage for low-income women and kids?
How would the availability and affordability of long-term care services be improved?
What efforts would the candidate undertake to address existing and future health care workforce shortages especially in the areas of primary care, mental health, obstetrics and gynecology, and radiology for mammography?
How would the candidate encourage further research on gender and health disparities?
How would the candidate address the impact of the AIDS epidemic on women, particularly women of color of in the U.S.?
Prepared by the Kaiser Family Foundation and the Connors Center for Women’s Health and Gender Biology at the Brigham and Women’s Hospital.
This analysis, published in the November 6, 2008, New England Journal of Medicine (NEJM), finds that seven in ten registered voters say major changes are needed in the U.S. health care system. The article is the second in a series of reports published in NEJM examining how the election can provide insights about future health policy. The article examines the public’s perceptions of the state of the American health care system, the role of health care as a 2008 election issue, and the contrasting health policy views of registered voters who intend to vote for Senator McCain and Senator Obama. The findings are based on a Kaiser/Harvard survey of registered voters in September, as well as other surveys this year and historical Election Day exit polls.
The article, “,” was written by Harvard School of Public Health Professor of Health Policy Robert J. Blendon, Sc.D.; Kaiser Family Foundation President and CEO Drew E. Altman, Ph.D.; Harvard Opinion Research Program Managing Director John M. Benson, M.A.; Kaiser Vice President and Director of Public Opinion and Survey Research Mollyann Brodie, Ph.D.; Harvard Opinion Research Program Assistant Director Tami Buhr, A.M.; Kaiser Associate Director of Public Opinion and Survey Research Claudia Deane, M.A.; and Kaiser Public Opinion and Survey Research staff Sasha Buscho.
This document contains the detailed toplines from the “Pre-election Poll: Voters, Health Care and the 2008 Election” designed and analyzed by researchers at the Kaiser Family Foundation and Harvard School of Public Health. The study’s findings are featured in an article published in The New England Journal of Medicine. The survey was conducted September 10 through September 21, 2008, among a nationally representative random sample of 1,622 registered voters age 18 and older. Of these registered voters, 680 self-identified as “McCain voters” by saying if the election were held today, they would vote or lean toward voting for McCain-Palin. A total of 765 self-identified as “Obama voters” by saying if the election were held today, they would vote or lean toward voting for Obama-Biden.
Based on data from Kaiser’s Second Post-Katrina Survey, this Survey Brief profiles low-income adults in New Orleans in 2008, examining their demographics, personal recovery from the aftermath of Hurricane Katrina, worries and concerns, and financial and health care challenges. It finds that low-income adults in New Orleans are more likely than other adults in the city to still be dealing with recovery from the aftermath of Hurricane Katrina and facing financial and health care challenges.
The Kaiser Second Post-Katrina Survey was fielded house-to-house and by telephone from March 5 to April 28, 2008 among 1,294 randomly selected adults ages 18 and older residing in Orleans Parish.
Medicare is a valuable source of health insurance for nearly 45 million Americans – mainly seniors ages 65 and older, but also 7 million younger adults with permanent disabilities. Before Medicare was signed into law in 1965, about half of all seniors lacked hospital insurance. Today, virtually all people ages 65 and over are covered by Medicare. Medicare is a popular program, but faces a number of issues and challenges in the years to come. A critical challenge is how to finance care for future generations without unduly burdening beneficiaries, taxpayers, or the general economy. Another pressing issue relates to the role of private plans in Medicare, in light of rapid enrollment growth in recent years, and concerns about the current payment system for private plans. A third issue is the relatively new Medicare prescription drug benefit and how to address concerns about its current structure and further limit the burden of prescription drug spending. Lastly, there is the challenge of how to make health and long-term care more affordable for beneficiaries in light of rising health costs.
Medicare plays a central role in broader discussions about the future of entitlement programs. Together, Medicare, Medicaid and Social Security account for more than 40 percent of the federal budget. Given ongoing concerns about the state of the economy, the candidates’ positions on these popular but fiscally challenged programs are of profound importance to the retirement security of current and future retirees.
Background
What is Medicare? Medicare plays a central role in the U.S. health care system, providing health coverage to one in seven Americans. Like Social Security, Medicare is a social insurance program that provides health coverage to individuals, without regard to their income or health status. People pay into Medicare throughout their working lives, so they and their spouses will have Medicare when they turn 65. Medicare funding comes primarily from three sources: payroll tax revenues, general revenues, and premiums paid by beneficiaries.
Who is covered by Medicare? Medicare covers a population with diverse needs and circumstances. 1
Characteristics of Medicare’s 45 Million Beneficiaries
SOURCE: Current Population Survey; CMS Medicare Current Beneficiary Survey, 2006.
While many beneficiaries enjoy good health, a quarter or more have serious health problems and live with multiple chronic conditions, including cognitive impairments and functional limitations. Although the majority of the Medicare population is over age 65, 16 percent are under age 65 and permanently disabled, and while most beneficiaries live at home, 5 percent live in a long-term care setting. Many Medicare beneficiaries live on modest incomes and most depend on Social Security as their primary source of income.
What benefits does Medicare cover? Medicare provides coverage of basic health services including care in hospitals and other settings, physician services, diagnostic tests, preventive services and, as of 2006, also includes an outpatient prescription drug benefit offered through private plans. However, gaps in coverage and potentially high out-of-pocket costs are a growing concern. Medicare generally does not pay for costs associated with long-term care, which can be prohibitively expensive, nor for dental care, vision, or hearing. The traditional fee-for-service Medicare program does not have an annual cap on out-of-pocket spending and the drug benefit has a significant gap in coverage before catastrophic coverage begins.
How are Medicare benefits provided? Medicare beneficiaries have the option to get their benefits through the traditional fee-for-service (FFS) program – sometimes called Original Medicare – or through private health plans, such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) – currently called Medicare Advantage. Under traditional FFS Medicare, beneficiaries can choose to be treated by virtually any hospital or doctor, while enrolling in a Medicare Advantage plan typically requires treatment from providers in a network, or paying a higher fee to receive care from an out-of-network provider. Medicare Advantage plans generally provide all benefits covered under traditional Medicare, but many plans offer additional benefits. Today, most Medicare beneficiaries are covered under FFS Medicare, although the number of enrollees in private Medicare Advantage plans has risen dramatically in recent years, now totaling more than 10 million of Medicare’s 45 million beneficiaries. In addition, as of 2006, Medicare beneficiaries have access to subsidized prescription drug coverage offered through private plans, either stand-alone prescription drug plans, or Medicare Advantage plans.
Policy Challenges Facing Medicare
Quick Facts on Medicare Financing Challenges
Medicare is 14% of the federal budget
Between 2010 and 2030, the number of people on Medicare is projected to rise from 46 million to 78 million
The Medicare Part A Hospital Insurance Fund will have insufficient funds to pay for full benefits beginning in 2019
Financing Care for Future Generations Financing care for future generations is perhaps the greatest challenge facing Medicare, due to sustained increases in health care costs, the aging of the U.S. population, and the declining ratio of workers to beneficiaries. Annual increases in health care costs are placing upward pressure on Medicare spending, as for other payers. Government experts warn that by 2019, there will be insufficient funds in the Medicare Part A (Hospital Insurance) Trust Fund to pay for benefits, 2 and most experts agree that current benefit levels cannot be sustained without additional revenue coming in to the program. Annual growth in Medicare spending is largely influenced by the same factors that affect health spending in general: increasing prices of health care services, increasing volume and utilization of services, and new technologies. In the past, provider payment reforms, such as the hospital prospective payment system, have helped to limit the growth in Medicare spending. Moving forward, system-wide efforts to curtail overall health care costs would help to improve Medicare’s financial outlook. There is general agreement among policymakers and experts that changes are needed to ensure the long-term viability of the Medicare program, but little consensus on how best to do so.
Assessing the Role of Private Plans and Providing Adequate Payments
Quick Facts on Medicare Advantage
10.1 million beneficiaries are now enrolled in a Medicare Advantage plan, up from 5.3 million in 2003
Between The government pays 113% more for beneficiaries enrolled in Medicare Advantage than for beneficiaries in traditional Medicare in 2008
Since the 1970s, many Medicare beneficiaries have had the option to receive their Medicare benefits through private health plans, mainly Medicare HMOs, as an alternative to original fee-for-service Medicare. Over the past decade, Congress has made several policy changes to encourage private plan participation in Medicare and enrollment growth. A relatively generous payment system for Medicare Advantage has encouraged greater plan participation in recent years, significantly expanding the number of private plans offered throughout the country and making extra benefits available to more beneficiaries. Currently, all beneficiaries have access to at least one Medicare Advantage plan, mainly due to the emergence of new types of private plans in rural areas. 3 While some have supported the expanded role of Medicare Advantage plans as a means to improve benefits and lower costs under Medicare, the role of private plans in Medicare has been called into question in part due to the fact that the government actually pays these plans more per enrollee than if they were in traditional FFS Medicare, according to analysis by government entities.4 This payment system increases Medicare expenditures, reduces the solvency of the Part A trust fund, and increases Part B premiums paid by all beneficiaries, according to Medicare actuaries. 5
In light of Medicare’s overall fiscal challenges, many policymakers have expressed concern about the current payment system. Another concern relates to the fairness of using Medicare Advantage to provide extra benefits to enrollees, in that the majority of beneficiaries are not enrolled in Medicare Advantage plans and therefore do not receive extra benefits these plans might offer. Achieving a reasonable balance among multiple goals for the Medicare program—including keeping Medicare fiscally strong, setting adequate payments to private plans, and meeting beneficiaries’ health care needs—will be critical issues for policymakers in the near future.
Improving the Medicare Prescription Drug Benefit
After years of discussion and debate, in 2003 Congress authorized a new outpatient prescription drug benefit (Medicare Part D) that took effect in 2006. Beneficiaries can get Medicare drug coverage by enrolling in either a private plan that offers the Medicare drug benefit only or a Medicare Advantage plan that offers prescription drug coverage along with Medicare’s other benefits. The law explicitly prohibits the federal government from negotiating drug prices directly with manufacturers, pharmacies, or plans; instead, the program relies on market-based competition between private insurance plans to drive down drug costs. Since 2006, annual costs for the program have been lower than initially projected and the development of the private drug plan market has been robust, with dozens of plans available in each state. Currently nearly 26 million people on Medicare are enrolled in a Part D drug plan. 6
Quick Facts on Medicare Part D
90% of all Medicare beneficiaries have prescription drug coverage in 2008, but 4.6 million still have no drug coverage
3.4 million beneficiaries enrolled in a Part D plan had drug spending high enough to reach the coverage gap or “doughnut hole” in their plan in 2007
The experiences of Medicare beneficiaries with Part D have not been free of challenges or confusion as they confront decisions about whether to enroll in a plan and which plan to choose and learn how the benefit works. A unique feature of the benefit that is of particular concern is known as the coverage gap, or “doughnut hole”, where beneficiaries whose total drug spending exceeds a certain amount each year pay 100 percent of the costs of their drugs until they reach the level that qualifies for catastrophic coverage. The coverage gap could be a major concern for beneficiaries with multiple health conditions who may not be able to afford their medications once they reach the gap.7
In response to ongoing concerns about certain features of the Part D program, many policymakers have called for reforms that would improve coverage or access to medications. Some would reduce or eliminate the coverage gap or “doughnut hole”, although doing so would likely result in an increase in Medicare spending which may be controversial given the fiscal challenges facing the program. Some favor changing the law to allow the federal government to use its buying power to negotiate with drug companies to try to get lower prices for prescription drugs for people on Medicare. However, proponents of the status quo are concerned that government negotiations will result in price controls that would ultimately drive U.S. drug companies to do less research and development. Another more significant change would involve the government creating its own Medicare drug plan option in which beneficiaries could choose to enroll in lieu of enrolling in a private plan.
Another issue related to Part D that continues to draw attention relates to whether people in the United States should be permitted to import lower-cost prescription drugs from other countries. Both Senator John McCain and Senator Barack Obama would allow importation of prescription drugs from other developed countries, provided the drugs are safe.
Keeping Medicare Benefits Adequate and Affordable
Quick Facts on Medicare Benefits and Affordability
Medicare covers less than half of beneficiaries’ total medical and long-term care expenses
Out-of-pocket spending on health care as a share of income for Medicare beneficiaries increased from 11.9% in 1997 to 15.5% in 2003 9
Despite significant protections offered by Medicare, the program is less generous than a typical large-employer plan. 8 Medicare has a relatively high deductible for inpatient care ($1,024 in 2008) and does not have a cap on out-of-pocket spending, potentially exposing people with serious medical problems to extremely high expenses. Medicare offers prescription drug coverage, but the standard benefit has a coverage gap which grows larger each year. Also Medicare does not cover long-term care expenses, which can be prohibitively expensive, nor does it pay for eyeglasses or hearing aids. As costs have risen over time, beneficiaries are spending a larger share of income on health care and premiums. 9
To help fill in Medicare’s benefit gaps and make care more affordable, many people on Medicare have some form of supplemental coverage. 10
Employer-sponsored retiree health plans are the primary source of supplemental coverage for people on Medicare, although these benefits have been eroding over time as employers grapple with rising health costs. Beneficiaries with very low incomes rely on Medicaid to supplement Medicare and Medicaid has become a critically important source of coverage for nursing home care, but beneficiaries typically have to spend down virtually all of their life savings in order to qualify for Medicaid assistance.
In the current fiscally constrained environment, there is little discussion about expanding Medicare to cover long-term care or in substantially reducing cost sharing for people covered by the program. In fact, some lawmakers have proposed changes that would reduce the growth in program spending by shifting additional costs onto beneficiaries. Examples of such policies include proposals to “means-test” benefits (that is, limit benefits only to those with low incomes), raise the age of eligibility, and increase premiums, deductibles, and cost sharing. Congress took a small step in this direction by charging higher Part B premiums for Medicare beneficiaries with higher incomes (over $82,000/single; $164,000/couple in 2008). A similar proposal would subject more beneficiaries to higher premiums for their Medicare Part D coverage.
Assessing Candidate Positions
Medicare has not emerged as a central issue in 2008 and neither of the presidential campaigns or major political parties has released a detailed set of Medicare policy proposals or specific measures to achieve long-term fiscal balance. Discussion of Medicare policy to date has focused generally on the role of private plans in Medicare, ways to lower the cost of prescription drugs, and system-wide changes to reduce health care costs overall, such as adopting electronic medical records, increasing preventive care, and improving chronic care delivery. However, the direction and pace of reform will be significantly affected by the election outcome. The future direction of the program appears to be governed by differences in ideology, particularly the role of government versus the role of the private sector. The broad visions of how Medicare should be designed in the future and how Medicare benefits should be provided will inform the policy choices made by Congress and the administration over the next four years. Therefore it is important to carefully consider the policy recommendations of the candidates to understand their vision for the future of Medicare.
The following questions are intended to help discern the candidates’ approaches to Medicare reform.
QUESTIONS FOR THE CANDIDATES
What specific strategies would you recommend to keep Medicare financially secure for future generations?
Would you support means-testing Medicare, limiting benefits only to those with low incomes?
Do you think higher-income people on Medicare should be asked to pay more than others for their Medicare benefits? How would you define “higher income?”
Would you support charging higher premiums to those with higher incomes for the Medicare drug benefit, as for Part B (physician services)?
What is the appropriate role of private health plans in Medicare? Do you support the current payment system for Medicare Advantage plans?
How would you propose to improve the Medicare drug benefit? Do you support eliminating the coverage gap, allowing the government to negotiate drug prices, or allowing beneficiaries to import drugs from abroad? How would you pay to eliminate the coverage gap?
How would you propose to help people on Medicare and their families with the rising cost of medical care and the high cost of long-term care?
1Data for this section come from Kaiser Family Foundation analysis of the Centers for Medicare and Medicaid Services Medicare Current Beneficiary Survey.
22008 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.
4Medicare Payment Advisory Commission analysis of plan bid data from CMS, November 2007.
52008 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.
6Centers for Medicare and Medicaid Services, Medicare Advantage, Cost, PACE, Demo, and Prescription Drug Plan Contract Report – Monthly Summary Report, September 2008.
7J. Hoadley, E. Hargrave, J. Cubanski, and T. Neuman, “The Medicare Part D Coverage Gap: Costs and Consequences in 2007,” Kaiser Family Foundation, August 2008; available athttp://www.kff.org/medicare/7811.cfm.
8D. Yamamoto, T. Neuman and M. Strollo, “How Does the Benefit Value of Medicare Compare to the Benefit Value of Typical Large Employer Plans?” Kaiser Family Foundation, September 2008; available at http://www.kff.org/medicare/7768.cfm.
9P. Neuman, J. Cubanski, K. Desmond, T. Rice, “How Much ‘Skin In The Game’ Do Medicare Beneficiaries Have? The Increasing Financial Burden of Health Care Spending, 1997-2003” Health Affairs, November/December 2007; available at http://www.kff.org/medicare/med110107oth.cfm; K. Desmond, T. Rice, J. Cubanski, P. Neuman, “The Burden of Out-of-Pocket Health Spending Among Older Versus Younger Adults: Analysis from the Consumer Expenditure Survey, 1998-2003”, Kaiser Family Foundation, September 2007; available at http://www.kff.org/medicare/7686.cfm.
10Kaiser Family Foundation, “Examining Sources of Coverage Among Medicare Beneficiaries: Supplemental Insurance, Medicare Advantage, and Prescription Drug Coverage — Findings from the Medicare Current Beneficiary Survey,” August 2008; available at http://www.kff.org/medicare/7801.cfm.
This policy brief examines the underlying shifts in health insurance coverage in 2007, which resulted in a 1.5 million decrease in the number of uninsured people under age 65, due to increased public coverage. This includes about 300,000 in Massachusetts, which implemented its comprehensive health reform that year. The brief also projects that the current economic downturn and rising unemployment rate likely will cause the number of uninsured to grow by at least 2 million in 2008.
Health Affairs Article: Florida’s Medicaid Reform: Informed Consumer Choice?
Florida’s Medicaid reform program aims to encourage consumer choice and market competition by giving health plans new authority to vary benefits and having enrollees choose among the different plans. However, about three in 10 enrollees were not aware that they needed to make this health plan choice and over half of those who were aware reported difficulty making a plan choice, according to a Health Affairs article based on the Kaiser Family Foundation’s 2006-2007 Survey of Florida Medicaid Beneficiaries conducted during the first year of the state’s reform effort.
The study found that three-quarters of the enrollees who were unaware of their need to choose a plan said that they had not been told so by the state, suggesting that they either did not receive, did not read or did not understand the state’s letter and other communications about their transition.
The study, Florida’s Medicaid Reform: Informed Consumer Choice?, was written by Teresa Coughlin, Sharon K. Long and Timothy Triplett of the Urban Institute; Samantha Artiga and Barbara Lyons of the Kaiser Family Foundation; and Paul Duncan and Allyson Hall of the University of Florida.
The Foundation, in collaboration with the Urban Institute and the University of Florida, is conducting a follow-up survey in Florida to continue to track the experiences of beneficiaries in the reform program.
In addition, the Foundation released a separate policy brief that provides an overview of the Florida Medicaid reform and a summary of available research findings to date from various evaluators of the program.
Trends in Access to Care Among Working-Age Adults, 1997-2006
This policy brief finds about 39 million working-age adults nationally reported cost as a barrier to receiving needed health care in 2006, a number that grew by an average of 1 million people annually over the decade studied. Uninsured working-aged adults experienced the most consistent erosion over the 10 years, resulting in a widening gap in access to care between insured and uninsured adults.
2008 Update on Consumers’ Views of Patient Safety and Quality Information
An updated examination of consumers’ views on health care quality information reveals major challenges remain in providing the public with comparative quality information and encouraging its use.
The 2008 Update on Consumers’ Views of Patient Safety and Quality Information finds that three in 10 (30%) Americans say they have seen health care quality comparisons of health insurance plans, hospitals, or doctors in the past year. Not all people make health care choices or decisions in a given year that would call for the use of quality information, but this is a downward trend from surveys in 2006 (36%) and 2004 (35%) and roughly equivalent to the level in 2000 (27%). Further, just one in seven (14%) Americans report that they “saw” and “used” comparative health quality information for health insurance plans, hospitals, or doctors in the past year, again down from roughly one in five in both 2006 (20%) and 2004 (19%).
The report of consumer views on quality information was conducted in August as part of the Kaiser Health Tracking Poll: Election 2008 series. The report draws on data from a set of questions related to consumer quality information that the Kaiser Family Foundation has asked since 1996, at times in conjunction with partners. The report also examines public opinion on the coordination of health care among different health care providers and steps the public has taken to better organize their own care.
The survey was conducted by telephone from July 29 to August 6, 2008, among a randomly selected nationally representative sample of 1,517 respondents 18 years of age and older. The margin of sampling error for the overall survey is plus or minus three percentage points. For results based on subsets of respondents the margin of error is higher.
