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.
A Political History of Medicare and Prescription Drug Coverage
Thomas R. Oliver, Philip R. Lee, and Helene L. Lipton
This article examines the history of efforts to add prescription drug coverage to the Medicare program. It identifies several important patterns in policymaking over four decades. First, prescription drug coverage has usually been tied to the fate of broader proposals for Medicare reform. Second, action has been hampered by divided government, federal budget deficits, and ideological conflict between those seeking to expand the traditional Medicare program and those preferring a greater role for private health care companies. Third, the provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 reflect earlier missed opportunities. Policymakers concluded from past episodes that participation in the new program should be voluntary, with Medicare beneficiaries and taxpayers sharing the costs. They ignored lessons from past episodes, however, about the need to match expanded benefits with adequate mechanisms for cost containment. Based on several new circumstances in 2003, the article demonstrates why there was a historic opportunity to add a Medicare prescription drug benefit and identifies challenges to implementing an effective policy.
The following exhibits can be found in the above PDF.HMOs and HospitalsExhibit 7.1aPercent of the Population in HMOs in California and the United States, July 2002Exhibit 7.1bHMO Penetration Rates for California Counties, March 2003Exhibit 7.1cStates with Highest and Lowest Shares of the Population in HMOs, July 2002Exhibit 7.1dEnrollment in the Five Largest HMOs in California, July 2002Exhibit 7.2aCommunity Hospital Beds Per 100,000 Population, California and the United States, 1985-2001Exhibit 7.2bDistribution of Community Hospitals by Ownership Type, California and the United States, 1989 and 2001Exhibit 7.2cCommunity Hospital Admissions and Emergency Room Visits Per 1,000 Population, California and the United States, 2001Exhibit 7.2dCommunity Hospital Adjusted Expenses Per Inpatient Day, California and the United States, 1999-2001Nursing Homes, Providers, and Prescription Drugs Exhibit 7.3aNumber of Residents, Facilities, Beds, and Occupancy Rates in Certified Nursing Facilities, California, 1995-2002Exhibit 7.3bNursing Facilities by Ownership Type and Payer Source, California and the United States, 2002Exhibit 7.4aNon-Federal Physicians Per 100,000 Civilian Population, California and the United States, 1975-2002Exhibit 7.4bMean Physician Net Income, California and the United States, 1994 and 2000Exhibit 7.4cMean Physician Net Income for Primary Care and Specialist Physicians, California and the United States, 1997 and 2000Exhibit 7.4dSources of Physician Practice Revenue, California and United States, 1999Exhibit 7.5Registered Nurses Per 10,000 Population, California and the United States, 1999-2001Exhibit 7.6Health Care Personnel, California and the United StatesExhibit 7.7Prescription Drug Use, Sales, and Prices, California and the United States, 2002
The following exhibits can be found in the above PDF.
Distribution of Coverage
Exhibit 3.1Distribution of the Total Population by Health Insurance Status, California and the United States, 2002Exhibit 3.2aDistribution of the Non-Elderly (Ages 0-64) by Health Insurance Status, California and the United States, 2002Exhibit 3.2bDistribution of Non-Elderly Adults (Ages 19-64) by Health Insurance Status, California and the United States, 2002Exhibit 3.2cDistribution of Children (Ages 18 and Under) by Health Insurance Status, California and the United States, 2002Exhibit 3.3Health Insurance Coverage of the Non-Elderly (Ages 0-64) by Selected Characteristics, California and the United States, 2002Exhibit 3.4aDistribution of the Low-Income Non-Elderly by Health Insurance Status, California and the United States, 2002Exhibit 3.4bHealth Insurance Coverage of Low-Income Children and Non-Elderly Adults, California and the United States, 2002Characteristics of the Uninsured Exhibit 3.5Non-Elderly Uninsured, California and the United States, 1994-2002Exhibit 3.6aNon-Elderly Uninsured Rates by Age and Gender, California and the United States, 2002Exhibit 3.6bNon-Elderly Uninsured Rates by Federal Poverty Threshold, California and the United States, 2002Exhibit 3.6cNon-Elderly Uninsured Rates by Race/Ethnicity, California and the United States, 2002Exhibit 3.6dNon-Elderly Uninsured Rates by Citizenship Status, California and the United States, 2002Exhibit 3.6eCharacteristics of the Non-Elderly Uninsured, California and the United States, 2002Exhibit 3.7Uninsured Non-Elderly Adults by Parental Status and Income, California, 2002Exhibit 3.8aRate of Non-Elderly Uninsured by Family Work Status, California and the United States, 2002Exhibit 3.8bRates of Uninsured Workers by Industry, California, 2001
The article “Ending an Era of Denial,” published in the March/April 2004 edition of Foundation News & Commentary explores the role of foundations in responding to HIV/AIDS in the U.S. and globally. The article, co-authored by Jennifer Kates, Director of HIV Policy at the Kaiser Family Foundation and Drew Altman, PhD., President and CEO of the Foundation provides an overview of Kaiser’s work related to HIV/AIDS to illustrate the many ways that foundations can help to make a difference in the battle against the epidemic.
The following exhibits can be found in the above PDF.Health StatusExhibit 2.1aSelf-Reported Health Status Among Adults, California and the United States, 1995 and 2002Exhibit 2.1bFair or Poor Self-Reported Health Status Among Adults, by Race/Ethnicity, California and the United States, 2002Exhibit 2.2aAge-Adjusted Mortality Rate, California and the United States, 1979-1999Exhibit 2.2bInfant Mortality Rate, California and the United States, 1990-2001Exhibit 2.3The Top Ten Leading Causes of Death, California and the United States, 2000Exhibit 2.4Percentage of Adults Ever Diagnosed with High Blood Pressure, by Race/Ethnicity, California and the United States, 2001Exhibit 2.5Estimated Distribution of New Cancer Cases by Site, California and the United States, 2003Exhibit 2.6Percentage of Adults Who Have Been Diagnosed with Diabetes, California and the United States, 1990-2002Exhibit 2.7aNew AIDS Cases per 100,000 Population, California and the United States, 1994-2001Exhibit 2.7bNew AIDS Cases per 100,000 Population, by Gender and Race/Ethnicity, California and the United States, 2001/2000Exhibit 2.8aPercentage of Adults Who Are Current Smokers, California and the United States, 1992 and 2002Exhibit 2.8bPercentage of Males and Females Who Are Current Smokers, California and the United States, 2002Exhibit 2.9aPercentage of Adults Who Are Overweight or Obese, California and the United States, 1992 and 2002Exhibit 2.9bPercentage of Adults Lacking Regular and Sustained Physical Activity, by Race/Ethnicity, California and the United States, 2000Preventive Care, Access to Care, and Use of ServicesExhibit 2.10aPercent of Live Births Where Mothers Received Early Prenatal Care, California and the United States, 1990-2001Exhibit 2.10bBirths of Low Birthweight Babies, California and the United States, 1990-2001Exhibit 2.10cPercent of Children, Ages 19-35 Months, Who Have Up-to-Date Immunizations, California and the United States, 1995 and 2002Exhibit 2.11aPercentage of Women 40 and Older Who Have Not Had a Mammogram in the Last Two Years, California and the United States, 1990 and 2002Exhibit 2.11bPercentage of Adult Women Who Have Not Had a Pap Smear Within the Last Three Years, California and the United States, 1992-2002Exhibit 2.12aPercentage of Adults Who Have Not Had Their Cholesterol Checked in the Past Five Years, California and the United States, 1993 and 2001Exhibit 2.12bPercentage of Adults Ages 50 and Older Who Have Had a Sigmoidoscopy or Colonoscopy Exam in the Past 10 Years, California and the United States, 2001Exhibit 2.13aUsual Source of Care by Insurance Type, Ages 18-64, California, 2001Exhibit 2.13bUsual Source of Care by Insurance Type, Ages 0-17, California, 2001Exhibit 2.13cPercentage of Adults Who Did Not Visit a Doctor at Least Once in the Past Year Because of the Cost, California and the United States, 1995 and 2000
The following exhibits can be found in the above PDF.
Per Capita SpendingExhibit 6.1aTrends in Personal Health Care Expenditures Per Capita, California and the United States, 1991-1998Exhibit 6.1bAnnual Change in Personal Health Care Expenditures Per Capita and the CPI, California and the United States, 1992-1998Exhibit 6.1cPersonal Health Care Expenditures Per Capita, by Source of Payment, California and the United States, 1998Exhibit 6.1dTrends in Medicare Personal Health Care Expenditures Per Enrollee, California and the United States, 1991-1998Exhibit 6.1eTrends in Medicaid Personal Health Care Expenditures Per Enrollee, California and the United States, 1991-1998Exhibit 6.1fPer Capita Health Care Spending by Type of Service in 1998, and Average Annual Percent Growth, 1991-1998, California and the United StatesExhibit 6.1gPer Enrollee Medicare Health Care Spending by Type of Service in 1998, and Average Annual Percent Growth, 1991-1998, California and the United StatesExhibit 6.1hPer Enrollee Medicaid Health Care Spending by Type of Service in 1998, and Average Annual Percent Growth, 1991-1998, California and the United StatesSpending by Service, and as a Percent of State and National Spending and RevenueExhibit 6.2aDistribution of Total Personal Health Care Expenditures by Payer and Type of Service, California and the United States, 1998Exhibit 6.2bTrends in Rates of Increase in Personal Health Care Expenditures by Type of Service, California, 1992-1998Exhibit 6.3Personal Health Care Expenditures as a Percent of GSP/GDP, California and the United States, 1980-1997Exhibit 6.4State Health Care Expenditures as a Percent of Total State Expenditures, California and the United States, Fiscal Year 2001
This chartbook provides California and U.S. data and trend analysis on a broad range of health system and financing indicators, including demographics and health status data, insurance coverage and the uninsured, employer health insurance premiums and offer rates, Medicaid and Medicare enrollment and spending, and health care industry trends.
The following exhibits can be found in the above PDF.Exhibit 1.1California’s Share of the United States Population, 2002Exhibit 1.2Cumulative and Projected Population Growth Since 1980, California and the United States, 1980-2025Exhibit 1.3aTrends in Birth Rates, California and the United States, 1990-2001Exhibit 1.3bTrends in Birth Rates by Race/Ethnicity, California, 1995-2000Exhibit 1.3cTrends in Teenage Birth Rates, California and the United States, 1990-2001Exhibit 1.4Population by Race/Ethnicity, California and the United States, 2002Exhibit 1.5Educational Attainment, California and the United States, 2002Exhibit 1.6Citizenship Status, California and the United States, 2002Exhibit 1.7Trends in Median Family Income, California and the United States, 1990-2001Exhibit 1.8Trends in the Percentage of the Population Below Poverty, California and the United States, 1981-2001Exhibit 1.9Family Work Status, California and the United States, 2001
The following exhibits can be found in the above PDF.
Medicaid
Exhibit 5.1aMedicaid Enrollees by Enrollment Group, California and the United States, FY2000Exhibit 5.1bMonthly Medicaid Enrollment: Percent Change from Previous Year and Number of Enrollees, California and the United States, June 1997 – June 2002Exhibit 5.1cCalifornia’s Medi-Cal Enrollment by County, January 2003Exhibit 5.2Percent of Medicaid Enrollees in Managed Care Plans, California and the United States, 1988-2002Exhibit 5.3Annual Growth and Amount of Total Medicaid Expenditures (Federal and State), California and the United States, FY1991-FY2002Exhibit 5.4aFederal Medicaid Funds as a Percent of Total Federal Funds to States, California and the United States, FY2001Exhibit 5.4bState Medicaid General Fund Spending as a Percent of Total General Fund Expenditures, California and the United States, FY2001Exhibit 5.4cMedicaid Spending by Type of Service, California and the United States, FY 2002Coverage for Low-Income Children Exhibit 5.5aEligibility Levels for Children in Medi-Cal and Healthy Families, 2003Exhibit 5.5bChildren Enrolled in Medi-Cal and Healthy Families, California and the United States, December 2002Exhibit 5.5cHealthy Families and Medi-Cal Enrollment for Children Ages 0-17, by County, 2003Exhibit 5.5dUninsured Children, by Eligibility for Medi-Cal and Healthy Families, California 2001Exhibit 5.5eHealthy Families Expenditures, FY2002Medicare Exhibit 5.6aMedicare Enrollment by Eligibility Category, California and the United States, July 2002Exhibit 5.6bCalifornia’s Medicare Enrollment by County, July 2002Exhibit 5.7Profile of Medicare Beneficiaries, California and the United StatesExhibit 5.8Percentage of Medicare Beneficiaries Enrolled in Medicare+Choice Managed Care Plans, California and the United States, 1989-2004Exhibit 5.9Total Medicare Spending, California and the United States, 2001Exhibit 5.10Dual Enrollee Enrollment and Spending, California and the United States, 2002Exhibit 5.11Sources of Prescription Drug Coverage, California Seniors and U.S. Medicare Beneficiaries
These survey findings of Americans’ views on global HIV/AIDS are part of Kaiser’s national “Survey of Americans on HIV/AIDS,” conducted in spring 2004. Other portions of the national survey will be released this summer. This portion of the survey explores such issues as foreign aid, general knowledge about the global epidemic and the role of the United States, as well as which individuals are associated with the fight against global HIV/AIDS and where Americans get information about the issue (June 2004).
