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).

• Report
• Report

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.

• Fact Sheet

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.

• Policy Brief: Medi-Cal Eligibility And Enrollment (.pdf)

• Report: Barriers to Medi-Cal Enrollment and Ideas for Improving Enrollment: Findings (.pdf)

• Report:

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 was prepared for A Public Dialogue on Health Care: The Future of Medicare, a joint project of The League of Women Voters Education Fund and The Henry J. Kaiser Family Foundation, launched in the fall of 1998. This report was edited by Lynn L. Lewis and designed by Gibson Creative.The League of Women Voters Education Fund encourages informed and active participation of citizens in government and works to increase understanding of major public policy issues. It complements the membership and political advocacy activities of The League of Women Voters of the United States.The Henry J. Kaiser Family Foundation is a nonprofit, independent health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries.

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.

• Report:

Fall 1998

• Fact Sheet:

A public education brochure describing Medicare reform options that are being considered by Congress. This fact sheet is also a part of a 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).

• Report
• Report