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Medicaid Managed Care: An Analysis of the Health Care Financing Administration’s Notice of Proposed Rulemaking
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.
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 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).
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.
Fall 1998
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.
Health News Index September/October, 1998
The September/October 1998 edition of the Kaiser Family Foundation/Harvard Health News Index includes questions about major health stories covered in the news, including questions about the Uninsured, Late Term Abortions and Emergency Contraception. The survey is based on a national sample of 1,202 Americans conducted October 10-18, 1998 which measures public knowledge on health stories covered in the 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 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).