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Medicaid Managed Care: An Analysis of the Health Care Financing Administration’s Notice of Proposed Rulemaking
A fact sheet summarizing data from a survey conducted between January and March of 1998 with 1,583 firms with 200 or more workers. The survey, which is conducted annually, focuses on the characteristics of the health benefit plans sponsored by employers.The supplemental questions discussed in this brief were developed jointly by staff from the Kaiser Family Foundation and KPMG and funded by the Foundation.
National Survey Suggests Need for Broad Public Debate About Medicare Reform:Americans Know Medicare Faces Problems, But Not Ready To Make Hard Choices
Future Options Not Well UnderstoodFew Know About Medicare+Choice
Embargoed For Release Until: Noon, Tuesday, October 20, 1998
For further information contact: Matt James or Tina Hoff (650) 854-9400 or Sara Knoll (202) 347-5270
Washington, DC – A new survey by the Kaiser Family Foundation and Harvard School of Public Health highlights the challenges for policymakers as they consider ways to shore up the Medicare Trust Fund and finance care for the growing number of seniors. While most Americans know Medicare faces fiscal problems, they are not ready to support changes that would produce major savings, according to the new survey. In addition, generational differences and low levels of public knowledge about the proposed options for reform will present more hurdles for policymakers when the debate over Medicare’s future comes before the Congress. The National Bipartisan Commission on the Future of Medicare is scheduled to make recommendations on reform to Congress in March 1999.
“This process could end in a train wreck when the debate turns to specific proposals and their consequences if the public is not more informed about the problems facing Medicare and the options for reform,” said Drew Altman, PhD, President of the Kaiser Family Foundation.
Public Opinion on Policy Options
Most Americans do not believe Medicare is headed for a “crisis,” though they do think the program has financial problems (40% “major” and 26% “minor”). Cutting across generations and political affiliation, the large majority (77%) say it is “very important” to them personally that the program is preserved for future retirees.
“Overall, the public trusts Democrats — 43 percent — more than Republicans — 27 percent — to deal with the problems facing Medicare,” said Robert J. Blendon, Sc.D., Professor of Health Policy and Political Analysis at Harvard University. “As a result, if the Republicans remain the majority party in Congress, they will need bipartisan support in order to make any major reforms in the Medicare program.”
Even though almost seven in ten Americans (68%) think fraud and abuse in Medicare is a “major reason” the program is likely to face financial difficulty, only two in ten (20%) think that better management alone is enough to save the program. While they recognize that there are no painless answers, when presented with the arguments for and against specific options to reform Medicare, there is only one proposal that is currently favored by a majority of the country: having higher-income seniors pay more (65% support and 32% oppose).
Experts say this option alone will not produce sufficient savings to assure the solvency of the Medicare Trust Fund in the future, but the public rejects most other options when the arguments for and against each are weighed:
Not only are most Americans unprepared to accept painful measures to reduce future spending, but across age and party lines most want expansions of the program to address gaps in coverage even when told their taxes or premiums would go up: 68 percent favor expanding Medicare to cover prescription drugs, and 69 percent favor covering long-term care. Almost as many Americans (60%) also favor the proposal to expand Medicare by letting people nearing the age of eligibility, 62 to 64 years old, buy into the program early.
Medicare Managed Care
Moving Medicare beneficiaries from the traditional program to managed care plans is a goal of many reformers. If more seniors were in HMOs and other managed care plans, half of Americans (50%) think it would be “harder” for Medicare patients who are sick to see medical specialists, as compared with just nine percent who think it would be “easier” (34% say “it would not make much difference”). More think the quality of care for Medicare patients who are sick would suffer (31%) than improve (14%) under managed care, but almost half (47%) think there would be no change as compared to the quality of care under the traditional program.
Medicare and the Budget Surplus
While keeping taxes down is important to the public as an election year issue (67% say “very important” to their vote), just 18 percent would use the government surplus to cut taxes. A larger share of the public would like the surplus to be used to protect Social Security and Medicare (42%). When forced to choose between the two programs: 24 percent of Americans pick Social Security and 15 percent Medicare. Almost two-thirds (65%) of those 65 and older say the extra funds should be used to protect Social Security and Medicare. If the money were to be used for only one program preserving Social Security remains the higher priority for seniors: 30 percent say Social Security and 25 percent Medicare.
The Need for Public Education on New Medicare+Choice, and Reform Options
Seniors, in general, are more knowledgeable than those under 65 about the basics of Medicare: 63 percent know the program does not pay for prescription drugs (vs. 22% of those under 65), and 44 percent know it does not pay for long-term nursing home care (vs. 34%). But, as the Federal government gets ready to launch a campaign to educate the public about Medicare+Choice, a new federal program designed to expand the range of health plan options available to Medicare beneficiaries, only one in five (20%) Americans, including 24 percent of seniors, say they have seen, heard, or read anything about this program. Furthermore, only 9 percent of seniors correctly say that the new program gives beneficiaries a choice of health plans.
Most Americans also say they know little to nothing about the options being considered to change Medicare (50% say “only a little” and 25% say they know “nothing” at all). Even among seniors, relatively few consider themselves well informed about the options under consideration (43% “only a little” and 20% know “nothing”). Two in five Americans (39%) know the Medicare Commission exists, and only 13 percent say they are following news stories about its work even “fairly closely.” Seniors are no more aware of the Commission or its activities than younger Americans.
Generational Perspectives: Rating Medicare
There is a striking difference between older and younger Americans when it comes to rating Medicare: 74 percent of those 65 and older say Medicare is doing a “good job,” compared with 44 percent of those under age 65. However, Medicare is rated better by young and old alike (49% of all Americans say “good job”) as compared to health insurance companies (36% “good job”) and HMOs and other managed care plans (30% “good job”). When it comes to evaluating their own health plan, seniors (41%) are more likely to give an “A” grade than are those under age 65 with private insurance (29%).
The survey also found that 60 percent of those 65 and older say they trust the current Medicare program to provide health insurance to seniors, compared to less than a third (38%) of those under age 65. Younger generations are more likely to trust privately-run health plans to provide insurance (46%), compared to 14 percent of those age 65 and older.
Methodology
The Kaiser/Harvard National Survey on Medicare is a product of the Kaiser-Harvard Program on the Public and Health/Social Policy, which regularly conducts surveys on health and other national issues. It was designed and analyzed by researchers at the Kaiser Family Foundation and the Harvard School of Public Health. The survey was conducted by telephone by Princeton Survey Research Associates with 1909 adults (age 18 or older) nationwide between August 14 and September 20, 1998. The margin of sampling error for the national sample is plus or minus 3 percent. The margin of sampling error may be higher for some of the sub-sets in this analysis.
The Kaiser Family Foundation, based in Menlo Park, California, is a non-profit, independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries.
Copies of the questionnaire and top line data for the findings reported in this release available by calling the Kaiser Family Foundation’s publication request line at 1-800-656-4533 (Ask for #1442). These documents are also available on the Kaiser Family Foundation website at http://www.kff.org.
A survey of Americans on their knowledge and opinions about the proposed options for Medicare reform finds that most Americans know Medicare faces problems, but are not ready to make hard choices and are not well informed on the options, including Medicare+Choice. The Kaiser/Harvard National Survey on Medicare is a product of the Kaiser-Harvard Program on the Public and Health/Social Policy, which regularly conducts surveys on health and other national issues. It was designed and analyzed by researchers at the Kaiser Family Foundation and the Harvard School of Public Health. The survey was conducted by telephone by Princeton Survey Research Associates with 1909 adults (age 18 or older) nationwide between August 14 and September 20, 1998.
A public education brochure describing basic facts about the current Medicare program and how it works. This fact sheet is included in a full packet of information as part of a joint public information project between Kaiser Family Foundation and League of Women Voters of public meetings held across the United States in October 1998 (#1427 – available in print).
A fact sheet on HIV, how it is transmitted, how to protect yourself against HIV, and information on testing and treatments for HIV. This fact sheet is available as part of a partnership with BET Teen Summit Town Hall specials.
This report presents the results of eight focus groups conducted in several languages throughout California to explore the knowledge and opinions of parents of potentially eligible children about the Medi-Cal program, California’s Medicaid program. The study found that participants were confused about eligibility requirements, found the enrollment process onerous and demeaning, and had suggestions about how they could be better educated about the program.
Medicare: The Basics
Part Two
A Henry J. Kaiser Family Foundation Report
Coverage Under Managed Care Plans and Other Options
The vast majority of Medicare beneficiaries have their health care bills paid directly by Medicare’s traditional fee-for-service program. The rest-nearly 6 million people-are covered under managed care plans, mostly HMOs, which contract with Medicare. Since the mid-1980s, a growing number of beneficiaries have elected to receive the benefits covered by Medicare Parts A and B under managed care plans, or health maintenance organizations (HMOs). Compared with traditional fee-for-service Medicare, Medicare HMOs typically have lower cost-sharing requirements and offer more generous benefits, such as outpatient prescription drug coverage.
This picture may change in the future due to the expansion in the number and types of plans that will soon be available to beneficiaries. A new program called Medicare+Choice permits Medicare to contract with other types of private health plans, in addition to Medicare HMOs. Under Medicare+Choice, beneficiaries will have the option to enroll in preferred-provider organizations (PPOs), provider-sponsored organizations (PSOs), and private fee-for-service plans, if offered in their area. They may also choose to be covered by medical savings accounts (MSAs) coupled with high-deductible insurance plans. Beneficiaries who enroll in Medicare+Choice plans will continue to pay the monthly Part B premium, but must get all Medicare-covered benefits through their private plan.
When these new options become available, people on Medicare will have a broader choice of health plans but will not be obligated to make a change in their health insurance coverage. Beneficiaries who are satisfied with their existing coverage, including those who are in the traditional fee-for-service Medicare program, will not be required to change plans.
Under the new Medicare+Choice program beneficiaries will continue to be able to enroll in a plan, switch plans, or disenroll from a plan at any time during the year until 2002 when certain restrictions will go into effect. Beginning in 2003, they will generally be required to stay in their plan until the next annual enrollment period.
HMO: Beneficiaries enrolled in an HMO obtain services from a designated network of doctors, hospitals, and other health care providers usually with little or no out-of-pocket payments.PPO: Beneficiaries obtain services from a network of health care providers established by a health plan. Unlike an HMO, beneficiaries can choose to go to providers who are not in the plan’s network and the plan will pay a portion of the costs.PSO: PSOs are similar to HMOs except they are set up by a group of doctors and hospitals who assume the financial risk of providing comprehensive services to Medicare enrollees.Private Fee-for-Service: A private indemnity health insurance policy does not limit beneficiaries to using a network of providers. Under this type of plan there is no limit on the monthly premium that beneficiaries may be charged for basic Medicare benefits.MSA: With this option, offered on a demonstration basis, beneficiaries select a high deductible catastrophic plan. Medicare pays the monthly premium for this plan and makes a deposit into a tax-free medical savings account on behalf of the beneficiary. A beneficiary may draw from their MSA to meet any health care expenses.
What’s the Medicare Debate About?As you may already know, Medicare reform is being debated widely. Given the program’s popularity and achievements, what’s the debate all about? In a nutshell, it is being driven by concern over the cost of the program and financing health coverage for an aging population.With the growth in the Medicare population, advances in medical technology, and the rise in medical costs generally, Medicare spending has consumed more and more of the federal budget, increasing from nearly 6 percent in 1980 to12 percent today. Rising health care costs under Medicare have resulted in higher payroll taxes to support the program, from 1.05 percent in 1980 to 1.45 percent. Yet even as Medicare’s costs are escalating, its benefits package barely covers half of beneficiaries’ health care expenses. Nor does it include coverage for extended long-term care services that are important for elderly people.The Balanced Budget Act of 1997 eased the short-term financial crisis that was facing Medicare only a short while ago by making revisions that extended the life of the Hospital Insurance Trust Fund to cover Part A services for the next decade. Beginning in 2008, as the program is currently structured, there will be insufficient revenues to cover all Part A expenses unless policymakers take action, as they have in the past, to shore up the trust fund. With the decline in the number of workers per Medicare beneficiary, there will be proportionately fewer people contributing payroll taxes to support the growing number of Medicare beneficiaries. This will result in a shortfall for the Part A Trust Fund, but does not affect Part B financing which relies on premiums and general revenues.In the longer term, Medicare’s rolls are projected to swell to 76 million by the year 2030-about twice as many beneficiaries as today due largely to aging of the baby-boom generation and longer life spans of Americans. As the population grows, so too will Medicare spending. Medicare spending is expected to more than double as a share of the nation’s economy from 2.6 percent in 1998 to 5.9 percent in 2030.
Policymakers thus face a challenge: finding a way to maintain health insurance coverage for the nation’s elderly and disabled people in the future, without placing too great a financial burden either on Medicare beneficiaries or on American taxpayers.A new 17-member National Bipartisan Commission on the Future of Medicare is charged by the Congress with recommending, in March 1999, ways to strengthen and improve the program in time for the retirement of the baby-boom generation. During its deliberations, the Commission-and indeed the entire nation-will grapple with some tough choices pertaining to Medicare’s future.Should Medicare be restructured into a program that costs less in the future than is currently projected, and perhaps provides less to beneficiaries as a consequence? Or should it be turned into a program that provides better coverage for beneficiaries, but that would probably cost more? Or, are there ways to maintain the current level of coverage under the program while meeting the demands of an aging population?Numerous reform options are being discussed. Some would reduce the growth in Medicare spending while maintaining the program’s basic framework. Examples of this approach include cutting the growth in Medicare payments to hospitals, doctors, and managed care plans; or raising the eligibility age to shrink the number of people on Medicare. Also being debated are ways to generate new revenues, such as asking beneficiaries to pay a greater share of Medicare costs through higher premiums, making wealthier beneficiaries pay higher Part B premiums, or increasing payroll taxes.Others would fundamentally restructure Medicare itself. One proposal-a “defined contribution” system or “voucher” plan-would have Medicare provide beneficiaries with a choice of health plans and pay a fixed amount per person to help pay for whichever plan the beneficiary selects. Another option would fundamentally restructure today’s program, establishing a new system of individual, investment-based health savings accounts. This proposal basically requires workers to save a certain amount of their wages during their working years to pay for medical expenses during retirement.Others call for improving benefits and the level of financial protection under Medicare, although these would be expensive and would therefore require additional financing. For example, some advocate improving the Medicare benefits package by adding prescription drug and long-term care coverage, or by enhancing financial protections from rising health care costs for poor and near-poor beneficiaries.Clearly, this debate is likely to be a front-burner policy issue for some time. Changes to the program could have a big impact on the health and financial security of elderly Americans — today and tomorrow. Whether you are young, old, or somewhere in between, it’s important to understand the basics as the debate over Medicare’s future evolves.
Medicare: The Basics
Part One Part Two Options for Reform
AIDS. . .A Crisis Among African-American Youth
A BET Teen Summit Town Hall
Produced in partnership with the Kaiser Family Foundation
Why is HIV important to ME?
Many people still think HIV doesn’t affect them. What many people don’t know is that heterosexualsex is the fastest growing way HIV is being transmitted today. And, HIV infections are on the riseamong young people – one in every four Americans newly infected with HIV is under 22 yearsold. Among 13 to 24 year olds, 63% of new HIV infections are among African Americans. Mostimportantly, you can keep yourself healthy, because HIV is preventable.
How is HIV transmitted?
The most common ways that HIV is spread are during vaginal or anal intercourse, and by sharingcontaminated needles. HIV can also be transmitted during oral sex, and during pregnancy orbreastfeeding (from HIV-infected mother to child). The virus is transmitted through body fluidssuch as blood, semen, vaginal fluids and breast milk. Certain factors, such as having a sexuallytransmitted disease (STD) like chlamydia or gonorrhea (which often have no symptoms), canincrease your risk of getting HIV… read on for more info.
What should I do?
PROTECT YOURSELF. Use a condom every time you have vaginal, anal or oral sex. You can’t tellby looking at someone whether or not they are HIV-positive or have other STDs. These diseasescan affect anyone, and many don’t have any visible symptoms. For more information on condomsand protection during oral sex, see below, and “It’s Your (Sex) Life.”If you are injecting drugs, know that using “dirty” – or previously used – needles increases yourchances of acquiring HIV.
GET TESTED. Though getting tested for HIV may seem very scary, if you are HIV-positive, it isimportant to know as soon as possible. Treatments are available today that are effective whenstarted early on. It can take up to six months for HIV to be detectable in your blood, so if you ifyou’ve had unprotected sex within the last six months, you should play it safe and get testedagain after six months have passed. Getting tested by your doctor, nurse or clinic, where you canbe tested for other STDs like herpes and chlamydia at the same time (you have to ask for thesetests, they don’t do them automatically) is probably your best option. There are also home testsavailable in drug stores that allow you to send in an anonymous blood sample for HIV testing.For more information about getting tested for HIV, see below, and check out “It’s Your (Sex) Life.” To find a testing center near you, call the CDC National AIDS Hotline at1-800-342-2437 (AIDS).
What factors increase my risk of getting HIV?
If you have any STD (like herpes, gonorrhea, or chlamydia), the sores or irritation around yourgenitals makes it easier to get infected with HIV. Any rash, like an allergic reaction to spermicide,can cause the same problem. Having sex during a woman’s period is riskier because of the contactwith blood. Blood contains more HIV than any other body fluid. Some people have anal intercourseto avoid pregnancy. This is a common way of getting HIV, because anal sex often causessmall tears or irritation that lets the virus into the body.
What about oral sex?
According to the Centers for Disease Control and Prevention (CDC), it is possible to get HIV duringoral sex. Oral sex often involves semen, vaginal secretions or blood – all fluids that can containHIV. During oral sex, the virus could enter the body through tiny cuts or sores in the mouth. TheCDC recommends you use a condom every time you have oral sex, for both men and women. Fororal sex on a woman, the CDC says you can use Saran Wrap, dental dams (square pieces of latexavailable in some drugstores) or cut open condoms as a barrier between the mouth and the vagina.
Do condoms really work?
Outside of abstinence, condoms are the most effective means of preventing the spread of HIV.But, they must be used correctly. It takes practice to learn how to use a condom the right way.Use a new condom each time you have sex. Use them with water-based lubricants made forcondoms, NOT baby oil, vaseline, or other oily lubricants – these cause condoms to break!After sex, withdraw the penis with the condom ON, carefully, so that it doesn’t leak. Learn howto put on a condom the right way (with latex ring on the outside). If you start to put on a condominside-out, throw it away. You can’t turn it over and use it after it has already touched the penis.Practice with condoms before you have sex, and you will be less nervous, and more likely to usethem correctly! Check out “It’s Your (Sex) Life” for more information.
What about some of the new ways to get tested for HIV?
There are lots of new HIV tests. There are tests you can do at home where you prick your fingerfor blood and mail the sample to a laboratory. This is pretty easy, but these kits are expensive($40-$50)! You have to call a number to get your results or to ask questions. At some clinics,there are rapid HIV tests where you can get results within an hour. The main drawback is thatthese tests may not be as reliable as the other kinds. If you hate needles, there are saliva HIVtests available now. The results still take about two weeks. No matter what kind of test youuse, the best way to get tested for HIV is with a trained counselor to support you. To find atesting center near you, call the CDC National AIDS Hotline at 1-800-342-2437 (AIDS).
What about the new HIV treatments?
There are new treatments that work for many HIV-positive people. New medications have beenable to kill the HIV virus and allow HIV-positive people to live longer, healthier lives. However,these medicines are often difficult to take, and have many side effects. The treatments also dono work for everyone. These treatments (also known as “the cocktail”) have given people morehope that we can fight HIV, but they are not a cure.
Resources for more information on HIV/AIDS
CDC National HIV & AIDS Hotline: 1 800 342 AIDS
This hotline will provide information about HIV/AIDS,answer questions about testing and prevention, and willprovide referrals to callers. They will also send out freeliterature on HIV and AIDS.
National Teenage AIDS Hotline: 1 800 440 TEEN
Fridays and Saturdays, 6 pm to midnight, EST.Sponsored by the American Red Cross, this hotline usesa staff of peer educators to provide information aboutHIV/AIDS and other STDs and to refer callers to othernumbers.
CDC National STD Hotline: 1 800 227 8922
This hotline will answer general questions about STDs,their symptoms, transmission, treatment and testing, andcan also provide referrals to clinics and other hotlines.
Planned Parenthood National Hotline: 1 800 230 PLAN
This hotline will automatically connect you to the PlannedParenthood provider nearest you. Planned Parenthood isa source for contraception, testing for sexually transmittedinfections including HIV, pre-natal and post-natal care,pregnancy options counseling, and adoption referrals.