This report examines the structure and impact of Medicaid’s role in long-term care. Based on a roundtable discussion of policy makers and experts and drawn from a body of health services research, the report highlights policy challenges facing the Medicaid program today and identifies issues in providing long-term care going forward. By gathering evidence to address key policy issues, such as integrating services, benefit design, quality monitoring and financing, the report can serve as a foundation for the current and ongoing policy debate regarding Medicaid’s future role as a provider of long-term care services and supports for low-income elderly and disabled Americans.

Report (.pdf)

Benefit Improvements for Low-Income Medicare Beneficiaries

The Kaiser Family Foundation has prepared a summary showing how the House-passed Children’s Health and Medicare Protection (CHAMP) Act legislation would change current law regarding assistance for low-income Medicare beneficiaries.

The summary describes proposed changes to current programs that provide assistance to low-income Medicare beneficiaries, including the Medicare Savings Program and the Medicare Part D Low-Income Subsidy (LIS) Program.

The summary reviews how the CHAMP Act would modify each of these programs in terms of eligibility requirements, verification of income and resources, re-enrollment procedures, coordination with other programs, application requirements, and estate recovery.

Summary (.pdf)

Women’s Health Policy: Are the Times Really A-Changing? – Editorial

This editorial describes the current state of key women’s health policy issues, including reproductive health, long-term care, and Medicaid, and assesses how policymakers might address these issues in the future. The piece was written by Kaiser Vice President and Director of Women’s Health Policy, Alina Salganicoff, and was published in the journal Women’s Health Issues.

Editorial (.pdf)

A new, detailed analysis of the latest US Census Bureau data on health insurance coverage looks behind the 2.2 million increase in the number of uninsured, examining changes by age and income. Reversing years of steady declines, the number of uninsured children has grown by one million over the last two years. And, as debate continues on reauthorization of SCHIP, the analysis shows that 48 percent of the increase in uninsured children from 2005 to 2006 was among families with incomes between 200% and 399% of the federal poverty level (roughly $40,000 to $80,000 for a family of four in 2006). Among kids, the share with employer-sponsored insurance declined by 1.2 percentage points, but there was no change in the share with Medicaid or SCHIP coverage to offset the employer decline since most children in this income group are not eligible for public coverage under current rules.

Issue Brief (.pdf)

UPDATED: An updated version of this analysis is now available online.

Recent policy debate has focused on the issue of rising health care costs and whether it might be possible to control costs by requiring consumers to pay a larger share of their health care costs out of pocket. While most of the policy discussion has focused on people of working age, rising health care costs and the burden of out-of-pocket spending also affects seniors, who generally have higher medical expenses and lower incomes than younger adults.

This analysis examines the relative burdens of out-of-pocket spending on seniors and younger adults. Using data from the Consumer Expenditures Survey from 1998 to 2003, it finds that seniors consistently spent a larger share of their income out of pocket on health care than younger people. Given the persistent differences between young and old, it suggests that even with Medicare’s prescription drug benefit, significantly narrowing the wide gap between seniors and younger adults in their out-of-pocket spending burdens is unlikely.

The paper presents analysis by Katherine A. Desmond, M.S., and Thomas Rice, Ph.D., of the University of California, Los Angeles; and Juliette Cubanski, Ph.D. and Patricia Neuman, Sc.D., of the Kaiser Family Foundation.

Issue Brief (.pdf)

This document contains the detailed toplines from the Kaiser Health Tracking Poll: Election 2008 – August 2007

 Toplines (.pdf)

This document presents key findings from the August 2007 Kaiser Health Tracking Poll: Election 2008, which tracks changes in the saliency of health as a political and policy priority, what the public’s priorities are for a health reform plan and whether any candidates are breaking through with the public with their health reform plans.

 Key Findings (.pdf)

This August 2007 tracking poll finds that health care remains the top domestic issue that the public wants presidential candidates to address in the campaign, trailing only Iraq on the public’s overall priority list.

Both Republicans and Independents rank health care second to Iraq, while Democrats for the first time rank the two issues as equally important for the candidates to discuss.

The poll also examines the public’s perceptions of the presidential candidates’ positions and commitment to health care as an issue. Consistent with the previous two tracking polls, nearly six in 10 people don’t know or can’t name a candidate who best represents their own views on health.

The Kaiser Health Tracking Poll: Election 2008 is part of a broader effort by the Kaiser Family Foundation to provide a central hub for resources and information about health policy issues in the 2008 election. The August poll was designed and analyzed by Foundation researchers and involved a nationally representative random sample of 1,500 adults, who were interviewed by telephone between August 2 and August 8. The margin of sampling error for the survey is plus or minus 3 percentage points; for results based on subgroups, the sampling error is higher.

Key Findings

Topline/Survey

For further information contact:Larry Levitt, (650) 854-9400, llevitt@kff.orgCraig Palosky, (202) 347-5270, cpalosky@kff.orgKate Schoen, (650) 854-9400, kschoen@kff.org

Few Have Seen the Movie But Nearly Half of the Public is Familiar With It

“Sicko” Gets Many Talking About Health Care Issues, Reinforcing Views of Some and Encouraging Others (Even Some Conservatives) To Re-Think the Need for Reform

Menlo Park, CA — If the potential impact of Michael Moore’s documentary “Sicko” were dependent solely on those who have actually seen the film, the result might be a passionate but narrow conversation among the 4% of adults who said they watched it in a new Kaiser Family Foundation poll.

But, with a big free media bounce reaching beyond the movie reviews to the news and talk shows, the new poll finds that almost half (46%) had seen the movie or heard or read something about it a little over a month after its national release. This is not much less than the share of adults (61%) who were aware of “An Inconvenient Truth,” the documentary on climate change featuring former Vice President Al Gore released in May 2006.

Among those familiar with “Sicko,” 45% said they had a discussion with friends, co-workers, or family about the U.S. health system as a result of the movie; 43% said they were more likely to think there is a need to reform the health system; 37% were more likely to think other countries have a better approach to health care; and 27% said they were paying more attention to the positions of presidential candidates on health care. About equal numbers of those aware of the movie thought it accurately represents problems in the U.S. health system (36%) versus overstating them (33%), and positive impressions of “Sicko” outweighed negative ones 48% to 33%.

“Our poll shows how the combination of good timing, a controversial director, and lots of free media attention can generate real impact for a film that very few people have actually seen,” said Kaiser President and CEO Drew E. Altman, Ph.D. “Sicko is not a commercial juggernaut like Transformers or Harry Potter, and we’re not likely to find Michael Moore action figures at fast food restaurants any time soon. But we are starting to see how films about social issues that capitalize on free media rather than traditional marketing can become social phenomena too.”

The movie has been much more likely to resonate with those already inclined to support its point of view. For example, 43% of self-identified liberals who are familiar with the film had a very positive impression of it, compared to 9% of conservatives.

But its impact is not entirely predictable — while 56% of liberals familiar with the documentary report that they are more likely to believe there is a need for reform of the U.S. health care system as a result, a smaller but still substantial share of conservatives aware of “Sicko” (29%) also said so, as did 23% of Republicans. And, 37% of conservatives said they had a discussion with friends, co-workers, or family about the health system following the movie, while 18% said they were paying more attention to what the presidential candidates are saying about health care. Results were similar by party identification.

Still, “Sicko” has not altered what have long been the fundamental factors shaping the public’s views on health care. When asked what has had the biggest impact on their opinions about the issue of health care recently, just 2% of the group aware of “Sicko” cited the film; 62% pointed to their personal health care experiences, and 9% said it’s what they’ve heard or read about proposals from presidential candidates.

The film’s main targets — health insurers and HMOs — were viewed unfavorably by about half the public overall (51% and 46%, respectively), which is similar to perceptions of drug companies (52% unfavorable) and a larger share than viewed defense contractors unfavorably (41%). By contrast, hospitals and doctors were viewed largely favorably by the public.

METHODOLOGY

The Kaiser Family Foundation poll about the movie “Sicko” was conducted as a part of the Kaiser Health Tracking Survey: Election 2008 from August 2 to August 8 among a nationally representative telephone sample of 1,500 adults, including 748 adults who reported having seen the movie or heard or read anything about it. The margin of sampling error for the full survey is plus or minus three percentage points, and for results based on respondents familiar with the movie “Sicko”, the margin of sampling error is plus or minus four percentage points. For results based on subgroups, the margin of sampling error is higher. Full results, including question wording, are available online here.

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.

With the 2008 presidential race well underway, some analysts believe that political independents will play a key role in the final vote. In July 2007, The Washington Post, the Kaiser Family Foundation, and Harvard University released a Survey of Political Independents exploring the views and priorities of these voters on a variety of issues. This Survey Brief takes an in-depth look at independents’ views on health care, including the saliency of the issue, which party best represents their own views, whether candidates should focus on lowering costs or expanding coverage, and willingness to pay to cover the uninsured.

Looking at self-identified independents as a whole, health care is a moderately salient issue, ranking third among most important problems for the government to address (well behind Iraq and just behind immigration, an issue that was receiving intense news coverage at the time of the poll), and second among issues that are extremely important to independents personally (behind Iraq). Yet because independents are not a uniform group, the brief also looks at how five different subgroups of independents think about health care.

The Survey of Political Independents, the 16th in this partnership series, was conducted by telephone from May 3 to June 3, 2007 among 2,140 randomly selected adults nationwide, including 1,014 self-identified independents.

 Survey Brief (.pdf)

 The Washington Post/Kaiser Family Foundation/Harvard University Survey of Political Independents