This brief analyzes the composition and medical costs of the uninsured in Louisiana after Hurricane Katrina. The estimates in the brief are the first available that are based on a detailed analysis of who the uninsured are in Louisiana, their current medical spending, and what their spending might be under Medicaid. The findings show that expanding Medicaid coverage to Louisiana’s uninsured would cost an estimated $2.3 billion in 2006 dollars. It also suggests that many of those who left Louisiana after Hurricane Katrina had coverage, so the number of uninsured in the state remained about the same, but their share of the total population increased.

Issue Brief (.pdf)

Black Americans account for more HIV and AIDS cases, people estimated to be living with AIDS, and HIV-related deaths than any other racial/ethnic group in the U.S. Today, Black Americans make up about 12 percent of the U.S. population, but account for half of all new AIDS cases. And, despite medical advances which have sharply reduced HIV-related mortality rates for all racial/ethnic groups, HIV death rates are still significantly higher for Black Americans than other groups.

The following chartpacks provide a detailed look at HIV/AIDS in Black America:

Chartpack: July 2007 (.pdf)

Chartpack: August 2006 (.pdf) – Presentation for the Black AIDS Institute Special Symposium titled “Moving Forward: The State of AIDS in Black America” on August 13, 2006, at the XVI International AIDS Conference in Toronto, Canada. Speakers included Rev. Jesse Jackson, president and founder, Rainbow Push Foundation; Julian Bond, chairman NAACP; Rev. Al Sharpton, president and founder, National Action Network; Phil Wilson, executive director, Black AIDS Institute; and Rep. Maxine Waters (D-Calif.)

This survey by The Washington Post, the Kaiser Family Foundation, and Harvard University–the 16th in an ongoing partnership–provides a detailed look at self-identified independents: who they are, what issues matter to them, how they approach politics and elections, and their views on key issues including health care, Iraq, and immigration.

It assesses the views and attitudes of independents, their past voting behavior, their political and ideological leanings, their demographic makeup, and provides an early look at their likelihood to vote and their preferences in the 2008 election. The survey also compares the views of independents to those of Democrats and Republicans. The telephone poll was conducted from May 3 to June 3, 2007, among 2,140 randomly selected adults nationwide, including 1,014 who self-identified as political independents.

The survey’s findings were featured in the July 1, 2007, Washington Post. Additional articles drawing on the survey findings are expected to run in the Post over the next few weeks.

A related statewide survey in Virginia by the three partners examines similar issues for indendents in Virginia. These findings were featured in the July 8, 2007, Washington Post.

Survey Brief: Political Independents and Health Care

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Virginia Toplines

Washington Post Articles

This document contains the full survey results for the national Post/Kaiser/Harvard survey on the views and leaning of political independents.

Toplines (.pdf)

The proportion of elderly adults over age 65 in nursing homes has declined over the past two decades, most noticeably in recent years. Reasons suggested for this trend include reductions in disability rates among elderly people, improvements in mechanisms for coping with disability, and changes in the residential and long-term care options available to elderly people with disabilities. This report focuses on the characteristics, needs, and payment sources for the care of elderly nursing home residents, as well as changes in these trends as the size of the resident population has declined between 1999 and 2004.

Some of the reports findings include:

• The number of elderly long-stay nursing home residents (90 days or longer) declined from 1.21 million to 1.06 million between 1999 and 2004, while the demographic profile of these residents changed little during the time period;
• Disease prevalence was higher and multiple conditions were more common among elderly nursing home residents in 2004 compared to 1999 indicating an increasingly sicker population; and
• Medicaid is the main payer for elderly long-stay residents, accounting for 68% of these residents in 2004.

Report (.pdf)

This document contains the full survey results for statewide Post/Kaiser/Harvard survey on the views and leaning of political independents in Virginia.

Survey (.pdf)

Wednesday, June 27, 2007

For further information contact:Craig Palosky, KFF, (202) 347-5270Robin Herman, HSPH, (617) 432-4752Chris Murphy, BCBSMA, (617) 246-4851

POLL FINDS MOST MASS. RESIDENTS SUPPORT NEW HEALTH REFORM LAW, INCLUDING INDIVIDUAL MANDATE, AS INITIAL DEADLINE NEARS

The Main Reason: They Believe It is “the Right Thing to Do”

Many Residents Are Skeptical About the Affordability of Health Coverage for Families Required to Buy Insurance Without State Subsidies

As a key July 1 implementation milestone approaches, most Massachusetts residents support a new state law to provide health coverage to almost all residents, including the individual mandate that requires residents to obtain coverage or pay a penalty, according to a new June poll of 1,003 Massachusetts residents.

The poll, conducted by the Kaiser Family Foundation, the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation, finds support for the new health insurance law has increased. In this recent poll, two-thirds (67%) of state residents who have heard of the new health insurance law support it, compared with 16% who oppose it. In a poll conducted last September, six in 10 residents (61%) who had heard of the law said they supported it.

In addition, more than half (57%, compared to 52% in September) say they support the law’s individual mandate requirements, compared with 36% who oppose it.

“Given reports of sticker shock and ongoing debate about the law, we might have expected overall support to fall, but in fact, support is widespread and has gone up,” said Kaiser President and CEO Drew E. Altman, Ph.D. “If Massachusetts succeeds, it will have a big impact on the momentum for national health reform.”

Residents who support the law mainly say it is because they believe “it is the right thing to do” (90% of those who support say this is a major reason) and because they believe broader coverage will keep costs down by providing more incentives for preventive care (79%). Among the small group of residents who oppose the law, most say people shouldn’t be required to buy insurance if they can’t afford it (72%) or if they don’t want it (61%).

The random-sample telephone poll was conducted between May 29 and June 10 and has a margin of error of plus or minus 4 percentage points for results based on the full sample. The margin of error is higher for results based on subgroups.

Perceptions of who benefits and who gets hurt

The public sees the law as benefiting many key groups in the state, with large majorities saying it will help people who are uninsured (72%), poor people (66%) and young people (60%). Small businesses stand out as the one group that the public perceives will be hurt by the law (52%, compared with 25% who say small businesses will benefit).

In terms of personal impact in a state with a modest uninsured population, about one in four residents (24%) say the law will benefit them personally, about twice as many as who say the law will hurt them personally (12%). About six in ten (62%) say they do not expect the law to have much impact on them personally.

Although the new law does not include any proposed tax increases, a strong majority (66%) still believe the law will cause their taxes to go up in the future.

“After years of anti-tax sentiment, it is surprising that the law remains popular among a majority of people who believe it could cause their taxes to increase,” said Robert J. Blendon, Sc.D., professor of health policy and political analysis at the Harvard School of Public Health and the Kennedy School of Government.

Views of Connector Health Plans

The Massachusetts law requires state residents to obtain health coverage and created the Commonwealth Health Insurance Connector to offer affordable insurance plans. Uninsured residents with incomes less than three times the federal poverty level may receive subsidized coverage. Those with higher incomes who are ineligible for state subsidies must obtain coverage at their own expense or pay a penalty on their taxes equal to half the cost of coverage, unless insurance premiums exceed affordability thresholds established by the Connector.

When offered examples of health insurance plans that would be available to individuals and families of different incomes, strong majorities of residents say the subsidized plans available to moderate-income individuals and families are reasonably priced and would leave enrollees well-protected from high medical bills. More than half also say it would be fair to require people to sign up and pay for such plans.

However, the poll finds residents are more skeptical about the affordability of the unsubsidized plans, which would be available to higher-income residents without health insurance. When asked about two such plans, roughly six in 10 say that they are not reasonably priced, that they would leave enrollees vulnerable to high medical bills, and that it would be unfair to require people to buy them.

“I am pleased that the poll results demonstrate increased support for the new health care law. This support combined with growing awareness of the law means this legislation is right for Massachusetts,” said Jarrett Barrios, incoming president of the Blue Cross Blue Shield of Massachusetts Foundation.

Knowledge of the new law

The survey finds that the vast majority of Massachusetts residents say they have heard at least a little about the new health insurance law, with only 13% saying that they have not heard anything about the law. However, the very groups that are most likely to be impacted by the changes are more likely to report not knowing anything about the law – young people (21%), poor residents (26%), and those uninsured at some point over the year (22%).

More than seven in 10 (72%) also say they do not know the deadline to obtain health coverage in order to avoid paying a penalty on their taxes – and those who think they know the deadline are not always correct. Overall 16% cite the upcoming July 1 deadline (the date the individual mandate goes into effect and health insurance coverage is required) and another 2% cite December 31 (the date an individual must prove he or she had health insurance coverage to avoid paying a penalty).

METHODOLOGY

The Kaiser Family Foundation/Harvard School of Public Health/Blue Cross Blue Shield of Massachusetts Foundation Massachusetts Health Reform Tracking Survey was conducted through a three-way partnership between the Kaiser Family Foundation (KFF), Harvard School of Public Health (HSPH), and Blue Cross Blue Shield of Massachusetts Foundation (BCBSMA Foundation). The survey was designed and analyzed by researchers at KFF and HSPH, with input and review from BCBSMA Foundation. This is the first in a series of surveys the partnership will conduct over the coming year to measure Massachusetts residents’ attitudes toward and experiences with the new health reform law.

A state-wide representative random sample of 1,003 Massachusetts residents ages 18 and older was interviewed by telephone from May 29 through June 10, 2007. Interviews were conducted in English and Spanish by International Communications Research of Media, Pennsylvania. The margin of sampling error for the survey is plus or minus 4 percentage points; for results based on subgroups, the margin of sampling error is higher. Sampling error is only one of many potential sources of error in this or any other public opinion poll.

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: www.hsph.harvard.edu

The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to expand access to health care. Through grants and policy initiatives, the Foundation works with public and private organizations to broaden health coverage and reduce barriers to care. The Foundation focuses on developing measurable and sustainable solutions that benefit uninsured, vulnerable and low-income individuals and families in the Commonwealth.

International Assistance for Global Health and HIV/AIDS in the Developing World

The Foundation produces two separate annual reports that help to track funding from the G8, European Commission and other donor governments who collectively provide the bulk of international assistance for global health priorities, including HIV/AIDS, through bilateral programs and contributions to multilateral organizations, including the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Donor Funding for Health in Low- & Middle- Income Countries: This report tracks the most recently available data on official development assistance for health from the U.S., European Community and other donor nations.

Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from the G8, European Commission and Other Donor Governments: This Kaiser/UNAIDS report tracks funding levels of the donor governments that collectively provide the bulk of international assistance for AIDS through bilateral programs and contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Introduction

Financing a sufficient and sustained response to the HIV/AIDS epidemic in low- and middle- income countries has emerged as one of the world’s greatest challenges, and one that will be with us for the foreseeable future. International assistance from donor governments, through bilateral aid and contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria as well as other financing channels, is a critical part of this response. Other international financing sources include multilateral institutions and the private sector. Domestic spending by many affected-country governments to combat their epidemics, as well as spending by households and individuals within these countries, are also major parts of the response. Funding from all these sources has risen over the past decade. Despite these increases, however, the difference between UNAIDS’ estimates of resource needs compared to resources available in 2006 was US$6 billion, a difference that could even grow larger over the next few years. Most of this difference will need to be filled by the international community.

This analysis provides the latest available data on international assistance for AIDS in low- and middle- income countries provided by donor governments, including the Group of Eight (G8), the European Commission (EC), Ireland, the Netherlands, Sweden, Switzerland, and other donor governments who provide international development assistance. The data were collected and analyzed through a collaborative effort between UNAIDS and the Kaiser Family Foundation. The Center for Strategic and International Studies also conducted research for this project.

Key Highlights

In 2006, international AIDS assistance from the G8, EC, and other donor governments reached its highest level ever: ƒ

• Commitments totalled US$5.6 billion, of which US$4.5 billion was provided through bilateral channels (including earmarked multilateral commitments) and US$.943 billion to the Global Fund (adjusted to represent an AIDS share).
• The equivalent of seven in ten commitment dollars was disbursed in 2006 (including current and past commitments), totalling US$3.9 billion in resources made available for AIDS in low- and middle-income countries.

Funding from donor governments has risen significantly over the past several years:

• Between 2002 and 2006, commitments and disbursements each increased more than three-fold, although commitments rose at a faster rate than disbursements.
• Between 2005 and 2006, commitments rose by 28% and disbursements by 11%.

Increases in international AIDS assistance from donor governments have been driven by a subset of G8 Members and, notably, a few non-G8 Members:

• In 2006, the United States was the largest donor in the world, accounting for close to half (47%) of funding commitments by governments and 41% of disbursements. Among resources available for the fight against AIDS in low-and middle- income countries from all sources (domestic and international) in 2006, the U.S. accounted for 18%, the largest share.
• The Netherlands accounted for the second largest share of commitments from all donor governments and third largest share of disbursements in 2006. The United Kingdom accounted for the second largest share of disbursements. Sweden and Ireland each accounted for larger shares than some G8 Members.

Most funding provided by donor governments is channelled bilaterally or earmarked through multilateral instruments, accounting for 76% of disbursements in 2006; the remainder is provided through the Global Fund. Funding channel patterns vary significantly by donor.

UNAIDS estimates that US$14.9 billion was needed to address the epidemic in low- and middle- income countries in 2006:

• Of this, an estimated US$8.9 billion was available from all sources (public and private), with donor governments accounting for 44% (US$3.9 billion in disbursements).
• The U.S., U.K., and the Netherlands accounted for the largest shares of assistance funding.
• Still, there was a gap of US$6.0 billion between resources available from all sources and resources needed in 2006.

Assessing “fair share” in the context of international assistance is a challenging task and there is no single, agreed upon methodology for doing so. Two different methodologies used in this analysis indicate that, in 2006:

• While the U.S. government provided the bulk of international assistance for AIDS, it provided a smaller share of all resources available for AIDS (from donor governments, multilaterals, the private sector, and domestic sources) than the U.S. share of the world’s economy (as measured by gross domestic product or GDP). This was also the case for Canada, France, Germany, Italy, and Japan. The U.K., the Netherlands, Sweden, and Ireland each provided greater shares of all resources for AIDS than their shares of GDP.
• When standardized by GDP per US$1 million, to account for differences in the sizes of government economies, the Netherlands provided the highest amount in 2006, followed by Sweden and Ireland. The U.K. was fourth and the U.S., fifth.

This survey finds that, with a July 1 implementation milestone approaching, most Massachusetts residents support a new state law to provide health coverage to almost all residents, including the individual mandate that requires residents to obtain coverage or pay a penalty.

The poll, conducted by the Kaiser Family Foundation, the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation, finds support for the new health insurance law has increased. In this recent poll, two-thirds (67%) of state residents who have heard of the new health insurance law support it, compared with 16% who oppose it. In a poll conducted September 2006, six in 10 residents (61%) who had heard of the law said they supported it.

In addition, more than half (57%, compared to 52% in September) say they support the law’s individual mandate requirements, compared with 36% who oppose it.

Residents who support the law mainly say it is because they believe “it is the right thing to do” (90% of those who support say this is a major reason) and because they believe broader coverage will keep costs down by providing more incentives for preventive care (79%). Among the small group of residents who oppose the law, most say people shouldn’t be required to buy insurance if they can’t afford it (72%) or if they don’t want it (61%).

The random-sample telephone poll of 1,003 residents was conducted between May 29 and June 10 and has a margin of error of plus or minus 4 percentage points for results based on the full sample. The margin of error is higher for results based on subgroups.

News Release

Chartpack

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