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.
This policy brief provides an overview of the low-income, uninsured population. Based on an analysis of the March 1998 Current Population Survey, the report discusses the demographic characteristics of this vulnerable population. It also presents information detailing health insurance coverage for low-income children and adults, as well as trends in insurance coverage over the past decade. It concludes with a discussion of recent coverage expansions and policy changes that have affected low-income Americans. The policy brief also includes a set of detailed appendix tables that provide health insurance coverage information by socioeconomic characteristics.
Leading Health Care Consumer Protection Proposals Would Result In Modest Premium Increases for HMOS
New Cost Analysis of Consumer Protections:Major Provisions of President’s Consumer Bill of Rights and PARCA Estimated to Raise Premiums by Less Than 1%
Embargoed for release until: 9:00 a.m., EDT, Wednesday, April 22, 1998
For further information contact:Chris Ferris (202) 347-5270or Matt James (650) 854-9400
Washington, DC – A new independent cost analysis finds that the premium increases likely to result from two leading health care consumer protections proposals currently before Congress are modest. The study, prepared by Coopers & Lybrand for the Kaiser Family Foundation, finds that major provisions of the Consumer Bill of Rights and Responsibilities (CBRR) endorsed by the President are estimated to result in an annual premium increase of 0.61% for a typical HMO policy, adding approximately $31 per year to the cost of an average family insurance policy.
Major provisions of a similar proposal in the Congress, the Patient Access to Responsible Care Act (PARCA), would increase HMO premiums by 0.77%, adding an extra $40 to a family policy per year. The estimated premium increases under PARCA do not include the provision in the legislation that would allow health care consumers to sue their health plan directly; the researchers were unable to attach a dollar figure to this measure because of the high level of uncertainty regarding its potential impact.
The cost of individual consumer protection provisions in both bills range from 12 cents per person per year to assure access to specialists in the CBRR to $6.96 per person per year to require a point of service option in PARCA.
The study estimated the effect of the consumer protection provisions on HMOs, which are the types of plans most likely to be affected. The study finds that other types of health insurance plans – such as Preferred Provider Organizations or Fee for Service plans – would be less affected by the consumer protection provisions, so the average premium increases across all types of health insurance would be lower than the figures found in the study.
The average cost of an HMO policy for a family is approximately $5,160 per year, according to the study. The report uses the HMO policy as the prototype for estimating the effects of the proposals on health insurance premiums. Premium costs are usually shared by employer and employee.
The report, Estimated Cost Effect of Provisions of Consumer Protection Proposals by the President’s Advisory Commission and the Patient Access to Responsible Care Act, is among the first to provide an independent analysis of PARCA. It comes on the heels of similar preliminary estimates of CBRR costs prepared by the Congressional Budget Office in March.
“This study suggests that most of the consumer protection provisions in the bills currently before Congress will have modest price tags,” said Drew Altman, President of the Kaiser Family Foundation. “There should be plenty of room to find common ground as the legislative process moves forward.”
A Comparison of the Two Proposals
Last year, the President appointed a commission – the Advisory Commission on Consumer Protection and Quality in the Health Care Industry – to make recommendations for ways to improve the quality of health care services. The commission issued its report, the Consumer Bill of Rights and Responsibilities, last November. The President endorsed its recommendations earlier this year and required through executive order the application of many of the provisions to all federal health programs.
The Patient Access to Responsible Care Act sponsored by Representative Norwood (H.R. 1415) and the companion bill sponsored by Senator D’Amato (S.644) contain many provisions similar to the CBRR.
“The consumer protection proposals that we examined largely reflect changes that are already underway in the health care market,” said Sandra Hunt of Coopers & Lybrand, the study’s lead author. “We estimate a modest change in HMO costs resulting from these proposals.”
The study sponsored by the Kaiser Family Foundation finds some variation in the costs of the specific measures included in the proposals:
Information Disclosure: Both proposals contain provisions requiring information disclosure, which would require quality and satisfaction data to be made available to consumers. The CBRR recommends greater information reporting than PARCA. Because they are more extensive, the CBRR information disclosure requirements are estimated to cost six dollars per person per year; the PARCA provisions would cost about $1.20.
Emergency Services Access: Both also propose specific levels of access to emergency services, requiring the use of a “prudent layperson” standard for access to these services. This standard generally means that an individual who reasonably believes that emergency treatment is necessary must be provided coverage for the initial treatment costs of emergency care. The study estimates that the emergency care provisions in each of the proposals would increase premiums by about $1.20 per person annually.
Access to Specialists: The CBRR and PARCA include standards for access to specialist services, with the CBRR having more specific standards applying to gynecologists, certified nurse midwives and other routine and preventive services for women. In part because many health plans already allow access to specialists in a way similar to what the proposals call for, this provision would likely raise premiums nominally (by about 24 cents per person each year). Expanded access to women’s health services under CBRR, taken alone, would add about 12 cents per year.
Third Party Appeals: The two proposals include provisions to allow health care consumers to ask for an independent third party review of health plan service requests and utilization decisions. This appeals process is designed to ensure that health plan consumers have a fair and impartial decision-making process to determine the medical necessity of covered services. The estimated cost of this provision is $1.20 per person annually under each of the proposals.
Point of Service Option: Unlike the CBRR, PARCA would require that all network-model health maintenance organizations (HMOs) offer a Point of Service (POS) option to members. This would allow health plan members to chose health care providers that are not in the network by paying higher cost sharing for those services. This option would add an estimated $6.96 per person to annual premiums.
Liability and Malpractice: PARCA also includes an amendment to federal law to permit patients to sue health plans in cases of personal injury or wrongful death. However, the cost implications of this provision are uncertain, and Coopers & Lybrand did not estimate the potential cost because of the high level of uncertainty regarding its potential impact.
Estimated Annual Costs Per Person and Percent Increase in Premium
ProvisionCBRRPARCAPer PersonPercent of PremiumPer PersonPercent of Premium
Information Disclosure $6.00 0.40% $1.20 0.08%
Emergency Service Access $1.20 0.11% $1.20 0.11%
Access to Specialists $0.12 0.01% $0.24 0.02%
Access to Women’s Services $0.12 0.01% Not part of PARCA
Third Party Appeals $1.20 0.08% $1.20 0.08%
Point of Service Option Not part of CBRR $6.96 0.48%
Total$8.640.61%$10.800.77%Note: In some cases the figures cited here are annualized from monthly estimates included in the study.
Other Consumer Protection Proposals:
Since the Kaiser Family Foundation commissioned the report, two other consumer protection measures have been proposed on Capitol Hill, one sponsored by Representative Dingell and Senator Daschle (H.R. 3605/S. 1890), and the other by Senators Jeffords and Lieberman (S. 1712).
More information on the four consumer protection proposals can be found on the Internet:
The report, Estimated Cost Effects of Provisions of Consumer Protection Proposals by the President’s Advisory Commission and the Patient and Access to Care Act, is based on a Coopers & Lybrand analysis of actuarial data, prior research, and interviews with key health plan, association, and industry leaders. Actuarial data were used in those portions of the analysis where certain practices are already in place. Information regarding the level of change in practices that would be required to comply with the proposed standards was obtained from experts in the field and from a review of literature. The estimated premium increases under PARCA do not include the provision in the legislation that would allow health care consumers to sue their health plan directly, since the researchers were unable to attach a dollar figure to this measure because of the high level of uncertainty regarding its potential impact. The estimates also do not include the effects of provisions in PARCA prohibiting health plans from discriminating against certain providers and providing health professionals with a variety of due process rights.
* * *The Kaiser Family Foundation, based in Menlo Park, California, is an independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries.
Additional copies of this report are available by calling Kaiser Family Foundation’s publication request line at 1-800-656-4533 (Ask for document #1391). This press release is also available on the Kaiser Family Foundation website at http://www.kff.org.
Kaiser Family Foundation/Harvard University School of Public Health: Update on Americans’ Views and Experiences in Managed Care
The Kaiser Family Foundation/Harvard University School of Public Health: Update on Americans’ Views and Experiences in Managed Care is based on findings from the April 1998 Kaiser Harvard News Interest Index. The survey was designed and analyzed by researchers at the Kaiser Family Foundation and Harvard University. Nationwide interviews were conducted by telephone with 1,201 adults, 18 years or older, between Arpil 17-April 27, 1998.
Topline/Survey: Kaiser Harvard News Interest Index April 1998
The March/April 1998 edition of the Kaiser Family Foundation/Harvard Health News Index includes questions about major health issues covered in the news, including questions about Cancer and Social Security. The survey is based on a national random sample of 1,201 Americans conducted April 17-27, 1998 which measures public knowledge of health stories covered by news media during the previous month. The Health News Index is designed to help the news media and people in the health field gain a better understanding of which health stories in the news Americans are following and what they understand about those health issues. Every two months, Kaiser/Harvard issues a new index report.
A joint Kaiser Family Foundation/YM Magazine survey of teens, ages 13-18, on what kinds of sexual situations they face today, how they “negotiate” dating, sex, and intimacy, and what kind f information teens need. The findings from this survey are also reported on in the May issue of YM in a special section of the magazine that provides teens with a guide to sexual decision-making, including whether it is the right choice, contraceptive information, and the risks and consequences of sexually transmitted diseases. The survey was conducted by Princeton Survey Research Associates.
Health Is Fifth Most Common Local News Topic;Coverage Focuses on Disease Prevention and Treatments, Not Health Policy
Embargoed for Release until: 12:00 p.m., ET, Thursday, March 12, 1998
Contact:Chris Ferris at (202) 347-5270 orHeather Balas at (650) 854-9400
Washington, DC — A new analysis of local television news programs documents that crime is indeed the single biggest topic of local news coverage, and most crime stories focus on murders, shootings, and other violent crime. The study, conducted by the Kaiser Family Foundation and the Center for Media and Public Affairs, finds that the five most common story topics in local news are crime (20 percent) weather (11 percent), accidents and disasters (9 percent), human interest stories (7 percent) and health stories (7 percent), with all other topics ranking below the top five.
The report, Assessing Local Television News Coverage of Health Issues, analyzed more than 17,000 local news stories broadcast during a three-month period. During that time, the number of violent crime stories (2,035) was almost double the number of all health stories (1,265), three times the number of foreign news reports (630), and four times the number of education stories (501).
The study also finds that in a typical 30-minute newscast, commercials (8 minutes), crime (4 minutes) and sports (4 minutes) account for more than half the airtime. Typical weather coverage lasts about 3 minutes, while health and accidents and disaster coverage last about 2 minutes per topic. All other topics average one minute or less.
“This study shows that stories on crime outnumber other local news stories two to one,” says Drew Altman, Ph.D., President of the Kaiser Family Foundation. “Local TV news wouldn’t cover crime as much as it does if the public didn’t reward such coverage with high ratings. But does anyone seriously believe that crime is twice as important as any other issue that the public needs to learn about from local television news?”
Adds Robert Lichter, Ph.D., President of the Center for Media and Public Affairs, “If it bleeds it leads on the local news, regardless of the reality of falling crime rates.”
Assessing Local News Coverage of Health Issues is a comprehensive look at the content of local television news broadcasts in 13 U.S. markets. The study, which analyzes nightly newscasts during the last three months of 1996, was conducted primarily to better understand how health issues are covered by local television news shows. The study also compares the content of local television news shows with that of network news broadcasts during the same three month period.
The network news agenda differed substantially from that of local news, with foreign news coverage accounting for the most stories, followed by health stories, 1996 campaign coverage, business and economy, and social issues. Crime finished sixth on the network news agenda.
Local Health News Coverage
When local television covered health issues, it focused a majority (60 percent) of its health stories on the causes and treatments for diseases. The diseases that attracted the heaviest coverage were food-borne illnesses (15 percent of all local disease stories) and cancer (12 percent of all local disease stories). The second most common subjects of health stories were environmental/lifestyle health issues, such as diet and exercise (21 percent of local health coverage). Stories about the health care industry and health insurance ranked a distant third, accounting for 5 percent of health coverage, followed by legal health stories (4 percent), stories about HIV/AIDS (3 percent) and reproductive health and abortion issues (2 percent). Stories about the two major government health insurance programs, Medicaid and Medicare, made up 1% of local health news stories.
Although health stories were more common on network news, the three networks covered health much like local news. As with local news, stories about causes and treatments for diseases accounted for more than half (51 percent) of network health stories, with cancer making up the largest number (16 percent) of all disease stories. Environmental/lifestyle health issues, the second most common topic among network news health stories, made up 28 percent of all health news.
Although health stories were more common on network news, the three networks covered health much like local news. As with local news, stories about causes and treatments for diseases accounted for more than half (51 percent) of network health stories, with cancer making up the largest number (16 percent) of all disease stories. Environmental/lifestyle health issues, the second most common topic among network news health stories, made up 28 percent of all health news.
Local and network health news also mirrored each other in terms of the type of health information they provide to viewers. Almost three-quarters of local health stories (74 percent) and over two-thirds (69 percent) of network health news focused on providing consumer news – “news you can use” – such as how to choose and HMO or the latest approach to prevent heart disease.
Information on health policy information, such as consideration of health care legislation in state capitals or coverage of the Medicare debate, accounted for about one-fourth of local (23 percent) and of network (28 percent) health stories. Health and politics news, in which health issues were discussed in terms of a political strategy on the part of a politician or public official, accounted for 4 percent of local and 3 percent of network health news.
An anchor or reporter without a specified beat reported the vast majority (94 percent) of local health news stories. A dedicated health reporter reported only 5 percent of local health stories.
Methodology
Assessing Local Television News Coverage of Health Issues was designed and analyzed by researchers at the Center for Media and Public Affairs in consultation with the Kaiser Family Foundation. The study is based on content analysis of the top-rated (with one exception) weekday evening newscasts from 13 cities around the country (Seattle, San Francisco, Los Angeles, Phoenix, Denver, Houston, Minneapolis, Chicago, St. Louis, Atlanta, Baltimore, Philadelphia, and New York) during the months of October, November and December 1996. The national evening newscasts from the ABC, CBS, and NBC networks during the same time period were also analyzed for comparison. The resulting sample consisted of 608 hours of local news and 99 hours of network news. A more detailed methodology is included in the report.
The Kaiser Family Foundation, based in Menlo Park, California, is an independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries. The Foundation’s work is focused on four main areas: health policy, reproductive health, and HIV in the United States, and health and development in South Africa.
The Center for Media and Public Affairs is a nonpartisan, nonprofit research and educational organization. It conducts scientific studies of the news and entertainment media, using content analysis. Since it formation in 1985, the Center has conducted and published numerous studies of the media.
Reprints of Assessing Local Television News Coverage of Health Issues are available by calling the Kaiser Family Foundation’s publication request line at 1-800-656-4533. (Ask for document #1374). This press release is also available on the Kaiser Foundation’s home page at http://www.kff.org.
