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)

Medicare: Options for Reform, A Public Dialogue on Health Care: The Future of Medicare – (Spanish)

• Report: Medicare: Opciones para la reforma

• 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).

• Report
• 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.

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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

Fall 1998

• Fact Sheet:

This study examines whether the ratings assigned to television shows accurately reflect their content, according to the guidelines developed by the industry. The study analyzes the level and intensity of violence, sex or adult language in a show as well as the context in which it was presented.

This full report is available only in print (Publication #1434). The executive summary and chartpack is available below.

A companion survey of parents views on the TV ratings system, Parents, Children and the Television Ratings System: Two Kaiser Family Foundation Surveys (#1398), is available separately.

• News Release: Major New Study of the V-Chip TV Rating System
• Chart Pack
• Executive Summary

Will 1999 Be The Year For Mifepristone (RU-486)?And, An Update on Women’s Other Options for Very Early Abortion

September 16, 1998

Briefing Participants:

Janet Benshoof PresidentCenter for Reproductive Law & Policy120 Wall Street, 18th FloorNew York, NY 10005Press Contact: Margie Kelly212/514-5534

Jacqueline E. Darroch, PhDSenior Vice PresidentThe Alan Guttmacher Institute120 Wall StreetNew York, NY 10005

Vanessa Northington Gamble, MD, PhDAssociate ProfessorHistory of Medicine and Family Medicine, and DirectorCenter for the Study of Race and Ethnicity in MedicineUniversity of Wisconsin-Madison Medical School1300 University AvenueMadison, WI 53706-1532608/265-5996

Elizabeth Newhall, MDPartnerEverywoman’s Health, P.C., and Medical DirectorDowntown Women’s Center401 North Graham, #445Portland, OR 97227503/284-5220

Felicia H. Stewart, MDDirector of Reproductive Health ProgramsKaiser Family Foundation2400 Sand Hill RoadMenlo Park, CA 94025Press Contact: Tina Hoff,650/854-9400, ext. 210

Carolyn Westhoff, MD, MSAssociate Professor of Clinical Obstetrics and Gynecology and Public HealthNew York Presbyterian HospitalColumbia Presbyterian CampusColumbia University630 West 168th Street, Room 16-80New York, NY 10032Press Contact: Karin Eskenazi212/305-5587

Beverly Winikoff, MDSenior Medical AssociateThe Population CouncilOne Dag Hammarskjold PlazaNew York, NY 10017Press Contact: Sandra Waldman212/339-0525

Other Resources:

Mifepristone and Methotrexate Research

Mitchell D. Creinin, MDDirector of Family Planning & Family Planning ResearchDepartment of OB/GYN & Reproductive ScienceUniversity of Pittsburgh School of MedicineMagee-Women’s Hospital300 Halket StreetPittsburgh, PA 15213-3180412/641-1440

David Grimes, MDVice President of Biomedical AffairsFamily Health InternationalPO Box 13950Research Triangle Park, NC 27709-3950919/544-7040

Richard Hausknecht, MDMedical DirectorPlanned Parenthood of New York City208 East 72nd StreetNew York, NY 10021212/369-1116

Mifepristone Clinical Trials

Lawrence LaderPresidentAbortion Rights Mobilization51 Fifth Avenue, 10th FloorNew York, NY 10003212/255-0682

Eric Schaff, MDAssociate ProfessorDepartment of Family MedicineUniversity of Rochester885 South AvenueRochester, NY 14620716/442-7470

Methotrexate Clinical Trials

Michael Burnhill, MDVice President of Medical AffairsPlanned Parenthood Federation of America810 Seventh AvenueNew York, NY 10019-5818Press Contact: Steve Plever212/261-4310

Manual Vacuum Aspiration Research

Paul Blumenthal, MDAssociate ProfessorJHU Department of OB/GYNJohns Hopkins Bay View Medical Center4940 Eastern AvenueBaltimore, MD 21224410/550-0335

Forrest C. Greenslade, PhDPresidentIPASPO Box 100Carrboro, NC 27510919/967-7052

Patients’ Experiences With Medical Abortion

S. Marie Harvey, DrPHCo-DirectorPacific Institute for Women’s Health2999 Overland Avenue, Suite 111Los Angeles, CA 90064310/842-6828

Provider Training

Jodi MageeExecutive DirectorPhysicians for Reproductive Choice & Health1780 Broadway, 10th FloorNew York, NY 10019Press Contact: Ciara Wilson212/765-2322

Vicki SaportaExecutive DirectorNational Abortion Federation1755 Massachusetts, NW, Suite 600Washington, DC 20036Press Contact: Stephanie Mueller202/667-5881

Policy And Politics

Elizabeth CavendishLegal DirectorNational Abortion & Reproductive Rights Action League (NARAL)1156 15th Street, NW, Suite 700Washington, DC 20005202/973-3000

Marie BassProject DirectorReproductive Health Technologies Project1818 N Street, NW, Suite 450Washington, DC 20036202/530-2900

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Will 1999 Be The Year For Mifepristone (RU-486)?

Press Release Fact Sheet Q&A Resource List

The survey was designed and analyzed by researchers at the Kaiser Family Foundation and Harvard University; and was conducted by telephone by Princeton Survey Research Associates with 1,200 adults, 18 years or older, nationwide, between August 6 and August 20, 1998.

While there has been much attention to the few abortions that occur late in pregnancy, there has been little focus on what options are available during the early weeks, even days, of pregnancy, when most women seek abortions. The drugs mifepristone (also known as RU-486) and misoprostol have been available in France, England, and Sweden for much of the last decade as an earlier medical alternative to surgical abortion. Since becoming available, an estimated one-half million women in Europe have used the drugs to end unintended pregnancies. In the United States, mifepristone, is still undergoing the Food and Drug Administration’s (FDA) approval process, and has been available only to a limited group of women participating in clinical trials.

In this Emerging Issues in Reproductive Health Briefing a panel of experts including Janet Benshoof, JD, President, Center for Reproductive Law and Policy and Beverly Winikoff, MD, Senior Medical associate, the Population Council discussed the availibility of mifeprestone, methotrexate, and other very early methods of abortion in this country, as well as what is currently available, what is on the horizon, who provides these options today, and who is likely to in the future. A companion survey also released at this briefing is available separately as #1431 Two National Surveys: Views of Americans and Health Care Providers on Medical Abortion.

• Fact Sheet
• News Release