Medicare and the President’s Fiscal Year 2009 Budget Proposal

This fact sheet summarizes key Medicare-related provisions in the Bush Administration’s fiscal year 2009 budget proposal, as well as additional legislation that responds to the Medicare Trustees’ “Medicare Funding Warning.”

Fact Sheet (.pdf)

In the past year the Bush Administration has moved forward with significant changes to the Medicaid program via rule-making. Taken together, six new regulations could result in an estimated $12 billion reduction in federal Medicaid spending over the next five years according to the regulatory impact statements prepared by Centers for Medicare and Medicaid Services. This brief focuses on the six new regulations that have been the source of considerable controversy and explains current policy, the proposed regulatory changes as well as the impact and issues with these changes.

Issue Brief (.pdf)

With some federal and state policy makers considering ways to encourage more people to purchase non-group, or individual, health care coverage, this new analysis by Kaiser Family Foundation researchers examines how often people at different income levels buy such coverage when they do not have access to employer coverage or do not obtain public coverage.

The analysis finds that relatively few people at lower incomes purchase non-group coverage, with one in 20 purchasing it among those with incomes at the federal poverty level ($18,660 for a family of four in 2003 dollars). As income increases, the coverage rate increases, though even at four times the poverty level, only about a quarter of individuals purchased coverage. And among those with incomes at least 10 times the poverty level, only about half purchased coverage in the non-group market. The analysis does not assess the reasons why people do not purchase non-group insurance, which could include a perceived lack of affordability or value associated with the coverage, a willingness to remain uninsured for a period of time, or restrictions imposed by insurers based on health status.

The findings suggest some of the challenges policy makers may face in considering ways to encourage more people to purchase non-group coverage.

Report (.pdf)

This policy brief provides an overview of health centers, with a special focus on the relationship between health centers and private health insurance. The analysis of 10 years of national data reveals that health centers do not receive adequate reimbursement from private insurers to cover the costs of treating commercially insured patients. The cumulative shortfalls jeopardize the ability of health centers to fulfill their mission of providing access to care for low-income patients.

Issue Brief (.pdf)

This document includes detailed results from a November 2007 Kaiser/Harvard survey of likely primary voters in 35 states (and the District of Columbia) with January or February 2008 primaries or caucuses. Data from the survey was published in the Jan. 24 New England Journal of Medicine as part of an analysis by Harvard and Kaiser researchers.

The survey was conducted by telephone November 1-11, 2007 before any primary elections had occurred, in order to reflect voters’ initial views on the issues. The survey included 674 self-reported registered voters who said they were likely to vote in their state’s Democratic primary or caucus, and 508 voters who reported they were likely to vote in the Republican primary or caucus. The margin of error for likely Democratic primary/caucus voters is plus or minus four percentage points, and plus or minus five percentage points for likely Republican primary/caucus voters.

 Toplines (.pdf)

Embargoed for release until:Wednesday, January 23, 2008

For further information contact: Kate Schoen, Kaiser, (650) 854-9400, kschoen@kff.orgTodd Datz, HSPH, (617) 432-3952, tdatz@hsph.harvard.edu

Presidential Candidates’ Platforms Reflect Sharp Differences in Perspectives of Democratic and Republican Primary Voters on Health Care Problems

Analysis Draws On Data From New Kaiser/Harvard Survey of Likely Voters in Early Primary States, As Well As 10 Recent National Polls

With the next wave of presidential primary elections quickly approaching, researchers from Harvard School of Public Health and the Kaiser Family Foundation, writing in the Jan. 24, 2008 New England Journal of Medicine, find that the sharply contrasting health care platforms of the leading Democratic and Republican presidential candidates reflect dramatic differences in the perspectives of their primary voters.

Written by Robert J. Blendon, Sc.D., Professor of Health Policy and Political Analysis at the Harvard School of Public Health, Drew E. Altman, Ph.D., President of the Kaiser Family Foundation and four co-authors, the article analyzes a newly released Kaiser/Harvard survey of likely primary voters in 35 states (and the District of Columbia) with January or February primaries or caucuses, as well as data from 10 other recent surveys by national media polling organizations.

“Although Americans agree that health care is an important problem in this country, there are huge differences between Republicans and Democrats on what should be done to improve health care,” Dr. Blendon said.

“In the primaries, we’re seeing the presidential candidates adopt health plans that to some extent mirror the concerns of their party’s core voters – with leading Democrats aiming for universal coverage by building on the employer-based system and Republicans offering tax-based incentives to encourage more people to buy coverage on their own,” Dr. Altman said. “Finding a way to bridge these differences will be important to winning independents in the general election and to fashioning a legislative compromise in the new Congress in 2009.”

The researchers conclude that Democratic and Republican voters in the early primary states are looking for different things when it comes to health reforms. For example, the Kaiser/Harvard poll conducted for the article finds that about two-thirds (65%) of likely Democratic primary voters say they would like presidential candidates to propose plans for universal (or nearly universal) coverage even if it involves a substantial increase in government spending. In contrast, only about one in four likely Republican primary voters say they want to hear about this kind of major effort (23%), with about the same proportion saying they would prefer no action on this front (27%). The plurality of likely Republican primary voters (42%) says that they would prefer a more limited, less costly expansion.

Early primary voters also differ on the specific health care issues they say would be most important in choosing a candidate. Democratic voters are divided between a focus on expanding insurance coverage and controlling costs, while cost issues dominate among Republican voters, with substantially fewer citing improving the quality of medical care or expanding health insurance coverage, the Kaiser/Harvard poll of likely primary voters finds.

The researchers conclude that the candidates’ approaches to health reform are rooted in the different experiences and views of Democrats and Republicans. For example, substantially more Democrats than Republicans say there is so much wrong that the health care system needs to be completely rebuilt. Republicans are also considerably more satisfied than Democrats with the cost and quality of their own care and are less likely to be worried about losing their coverage.

“These marked differences in satisfaction – both national and personal – coexist with real differences in terms of where Republicans and Democrats turn to look for solutions to the problems of high costs and the uninsured,” the authors write in the article. “Although a plurality of Democrats say that government should have primary responsibility for making sure that Americans have health care, and the majority say they are willing to pay higher taxes for increased coverage, the plurality of Republicans say health care coverage should be an individual responsibility.”

The article, Health Care in the 2008 Presidential Primaries, was written by Harvard School of Public Health Professor of Health Policy Robert J. Blendon, Sc.D.; Kaiser Family Foundation President Drew E. Altman, Ph.D.; Kaiser Associate Director of Public Opinion and Media Research Claudia Deane, M.A.; Harvard Opinion Research Program Managing Director John M. Benson, M.A.; Kaiser Director of Public Opinion and Media Research Mollyann Brodie, Ph.D.; and Harvard Opinion Research Program Assistant Director Tami Buhr, A.M. A link to the article is available online here, along with full results from the new Kaiser/Harvard survey.

Methodology

Data for the NEJM article were drawn from a public opinion survey of likely primary voters in the early primary states, designed and analyzed by researchers at the Henry J. Kaiser Family Foundation and Harvard School of Public Health. The survey, which included voters in the 35 states (and the District of Columbia) with primaries or caucuses scheduled for January or February 2008, was conducted by telephone November 1-11, 2007, before any primary elections had occurred, in order to reflect voters’ initial views on the issues. The survey included 674 self-reported registered voters who said they were likely to vote in their state’s Democratic primary or caucus, and 508 voters who reported they were likely to vote in the Republican primary or caucus. The margin of error for likely Democratic primary/caucus voters is plus or minus four percentage points, and plus or minus five percentage points for likely Republican primary/caucus voters. This main survey was supplemented with data from 10 additional telephone surveys conducted by national media polling organizations between November 2006 and September 2007.

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The Kaiser Family Foundation is a non-profit, private operating foundation dedicated to providing information and analysis on health care issues to policymakers, the media, the health care community, and the general public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.

Harvard School of Public Health is dedicated to advancing the public’s health through learning, discovery, and communication. More than 300 faculty members are engaged in teaching and training the 900-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit http://www.hsph.harvard.edu.

This analysis find that the sharply contrasting health care platforms of the leading Democratic and Republican presidential candidates reflect dramatic differences in the perspectives of their primary voters. The article analyzes a newly released Kaiser/Harvard survey of likely primary voters in 35 states (and the District of Columbia) with January or February primaries or caucuses, as well as data from 10 other recent surveys by national media polling organizations.

The article, “Health Care in the 2008 Presidential Primaries,” was written by Harvard School of Public Health Professor of Health Policy Robert J. Blendon, Sc.D.; Kaiser Family Foundation President Drew E. Altman, Ph.D.; Kaiser Associate Director of Public Opinion and Media Research Claudia Deane, M.A.; Harvard Opinion Research Program Managing Director John M. Benson, M.A.; Kaiser Director of Public Opinion and Media Research Mollyann Brodie, Ph.D.; and Harvard Opinion Research Program Assistant Director Tami Buhr, A.M. It was published in the Jan. 24 New England Journal of Medicine.

 News Release

New England Journal of Medicine article (free access)

 Survey Toplines

Aliyah Baruchin, freelance health contributor, The New York Times and other news outlets, New York, NY Racial and ethnic disparities in health care

Steve Bogira, freelance journalist and author, Chicago, IL The impact of poverty and race on health, and the disparity in health care, reflected in two adjacent city neighborhoods

Greg Branch, freelance journalist, former Managing Editor, BET News, New York, NY Recruitment of medical personnel from Africa and Asia and its impact on the developing world and on U.S. medical policies

Karen Brown, health reporter/producer, WFCR-FM Radio, Western New England An in-depth look at Massachusetts health reform in action – what’s working, what’s not, and what other states can learn

Karen Houppert, freelance reporter and author; special correspondent, The Washington Post Magazine, Baltimore, MD The state of drug treatment in the U.S., and the human and financial costs of drug treatment policies

Naseem Sowti Miller, health reporter, The Ocala Star-Banner, FL The quality of medical care in jail and prisons, and the broader impact on public health and health care

Jeremy Olson, medical reporter, St. Paul Pioneer-Press, MN An exploration of the long-term care crisis andthe social, financial and political solutions

Renata Simone, independent documentary film producer and reporter, Boson, MA The rise of medical tourism, access and affordability of health insurance, and the globalization of health care

Robert Winn, independent documentary film producer, New York, NY The unintended impact of anti-immigrant policies on other disadvantaged communities

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This Medicare Part D data spotlight examines three common techniques used by Medicare stand-alone prescription drug plans in 2008 to manage enrollees’ use of formulary drugs, such as quantity limits, prior authorization, and step therapy rules. This is one in a series analyzing key aspects of the 2008 Medicare Part D prescription drug plan choices.

It analyzes data from the 47 stand-alone prescription drug plans available nationwide using a sample of 169 commonly-used and high-cost prescription drugs. It finds that utilization management restrictions are more common in 2008 than in 2006, with 30% of sample drugs subject to some use restriction in 2008, up from 20% in 2006.

The analysis was conducted jointed by Jack Hoadley of Georgetown University, Elizabeth Hargrave and Katie Merrell of NORC at the University of Chicago, and Juliette Cubanski and Tricia Neuman of the Kaiser Family Foundation.

Data Spotlight (.pdf)

This Medicare Part D data spotlight examines the formularies (list of covered drugs) of Medicare stand-alone prescription drug plans in 2008, changes since 2006, and differences in how plans cover brand-name and generic drugs. This is one in a series analyzing key aspects of the 2008 Medicare Part D prescription drug plan choices.

It analyzes data from the 47 stand-alone prescription drug plans available nationwide using a sample of commonly-used and high-cost prescription drugs. The analysis finds that there has been relative stability in the coverage of sample drugs since 2006. It also finds that most drug plans (91 percent) cover more than 90 percent of the generic sample drugs, while only 28 percent of plans cover more than 90 percent of brand-name sample drugs.

The analysis was conducted jointed by Jack Hoadley of Georgetown University, Elizabeth Hargrave and Katie Merrell of NORC at the University of Chicago, and Juliette Cubanski and Tricia Neuman of the Kaiser Family Foundation.

Data Spotlight (.pdf)