Q4a. Thinking about where you get information about contraceptionand birth control, was your physician a major source, minor sourceor not a source at all of information about contraception/birthcontrol for you? (Rotate)

NationalMenWomenMajor source 48% 32% 64% Minor source 17% 19% 15% Not a source at all 32% 46% 19% Don’t know 2% 2% * Don’t know 1% 1% * Q4b. Thinking about where you get information about contraceptionand birth control, was nurse or other health professional a majorsource, minor source or not a source at all of information aboutcontraception/birth control for you? (Rotate)

NationalMenWomenMajor source 34% 27% 42% Minor source 23% 24% 23% Not a source at all 39% 46% 32% Don’t know 2% 2% 2% Refused/No answer 1% 1% 1% Q4c. Thinking about where you get information about contraceptionand birth control, was “Women’s or “Men’s magazinesa major source, minor source or not a source at all of informationabout contraception/birth control for you? (Rotate)

NationalMenWomenMajor source 10% 10% 11% Minor source 26% 26% 25% Not a source at all 61% 61% 62% Don’t know 2% 3% 2% Refused/No answer 1% 1% * Q4d. Thinking about where you get information about contraceptionand birth control, was print news like a daily newspaper or weeklynews magazine a major source, minor source or not a source atall of information about contraception/birth control for you?

NationalMenWomenMajor source 13% 15% 11% Minor source 28% 30% 25% Not a source at all 56% 51% 62% Don’t know 2% 3% 2% Refused/No answer 1% 1% * Q4e. Thinking about where you get information about contraceptionand birth control, was television news a major source, minor sourceor not a source at all of information about contraception/birthcontrol for you? (Rotate)

NationalMenWomenMajor source 15% 19% 12% Minor source 33% 34% 31% Not a source at all 49% 43% 55% Don’t know 2% 3% 2% Refused/No answer 1% 1% * Q4f. Thinking about where you get information about contraceptionand birth control, was your friends and family a major source,minor source or not a source at all of information about contraception/birthcontrol for you? (Rotate)

NationalMenWomenMajor source 20% 20% 19% Minor source 31% 30% 32% Not a source at all 46% 46% 47% Don’t know 2% 3% 2% Refused/No answer 1% 1% * Q4g. Thinking about where you get information about contraceptionand birth control, was an advertisement for a specific methodof birth control a major source, minor source or not a sourceat all of information about contraception/birth control for you?(Rotate)

NationalMenWomenMajor source 12% 11% 13% Minor source 27% 29% 24% Not a source at all 58% 56% 60% Don’t know 3% 3% 3% Refused/No answer 1% 1% * Q5. Which one of these sources would you say you refer to mostoften as a source of information about contraception/birth controlover the course of a year?

NationalMenWomenYour physician 38% 25% 51% Nurse or other health professional 12% 10% 14% Your friends and family 10% 13% 7% Television news 10% 16% 4% Print news like a daily newspaper or weekly news magazine 8% 12% 4% “Women’s” or “Mens” magazines 9% 7% 4% An advertisement for a specific method of birth control 1% 2% 1% Don’t know 8% 8% 8% Refused/No answer 6% 7% 5% Q6. Within the last two months, have you heard about new researchregarding the health effects of birth control pills?

NationalMenWomenYes 10% 10% 10% No 88% 88% 89% Don’t know 1% 2% * Refused/No answer * * * Q7. Did hearing this information cause you or your partner todo any of the following things or not (Rotate)?

NationalMenWomenSeek additional information about health effects of birth control pills 14% 11% 17% Discontinue using birth control pills 4% 5% 3% Decide to start using birth control pills 3% 4% 2% I is not applicable to me 44% 37% 51% None of the above 42% 52% 32% Refused/No answer 3% 3% 2% Q8. Do you [for men, Does you partner] currently use birthcontrol pills? Yes, no, or not applicable?

NationalMenWomenYes 11% 12% 11% No 82% 78% 86% Not applicable 6% 9% * Don’t know 1% 1% * Refused/No answer 1% 1% 1% Q9a. Have you ever used birth control pills? Yes, no,or not applicable?

NationalMenWomenYes 60% – 51% No 39% – 47% Not applicable 1% – 1% Don’t know * – * Refused/No answer 1% – 1% Q9b. Has your current or most recent partner ever used birth controlpills? Yes, no, or not applicable?

NationalMenWomenYes 46% 46% – No 44% 44% – Not applicable 5% 5% – Don’t know 4% 4% – Refused/No answer 1% 1% – Q10. How much influence did your partner have in the decisionto use birth control pills? Would you say…

NationalMenWomenA lot 45% 76% 21% Some 14% 10% 16% Only a little, or 8% 6% 10% None 32% 6% 52% Don’t know 1% 2% * Refused/No answer * 1% –

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National Survey on Public Perceptions about Contraception:Press Release Survey Part One Part Two Fact Sheet Q & A Resource List

A national random-sample telephone survey conducted between January 19-21, 1996 on Americans perceptions of the risks and benefits associated with oral contraceptives, or The Pill. The survey finds that many American men and women have at least some concerns about the safety of oral contraceptives. These findings were presented at a briefing in New York on January 31, 1996, co-sponsored by Kaiser Family Foundation, the National Press Foundation and The Alan Guttmacher Institute.

Perceptions and Reality: How Safe Is the Pill? The Role of the Media, Healthcare Providers, and the Pharmaceutical Industry in Shaping American Women’ A fact sheet, Q&A and resource list prepared for a media briefing that focused on public perceptions and knowledge of the safety of birth control pills compared with the real facts about the risks and benefits. In addition, the program addressed how new information about the health effects of contraception is communicated to the public.

• Fact Sheet: Contraception: Trends in Use, Safety, and Effectiveness
• Q&A
• Toplines/Survey: National Survey on Public Perceptions about Contraception

This report compares the provisions designed to guard against risk selection among the Medicare population in both the Congressional Balanced Budget Act of 1995 and in the President’s budget plan released in December 1995. The report also explores provisions in both that may exacerbate the potential for risk selection.

• Report:

Talking With Kids About Tough Issues is a national campaign to support parents by Children Now and the Henry J. Kaiser Family Foundation. This guide for parents offers practical, concrete tips and techniques for talking easily and openly with young children ages 8 to 12 about tough issues: sex, HIV/AIDS, violence, drugs and alcohol.

More about the campaign: Talk With Your Kids…before everyone else does

The Four Americas: Government and Social Policy Through the Eyes of America’s Multi-racial and Multi-ethnic Society

This report is the first of a series of surveys conducted jointly by The Washington Post/Kaiser Family Foundation/Harvard University examining public knowledge, values and beliefs on major issues and challenges facing our nation, such as race, poverty, reducing the deficit, the role of government in our society, and our nation’s obligations in the world. The hope is that this initiative will contribute to a better understanding of public knowledge and perspectives on these important issues, and to more effective efforts by the media to educate, inform, and engage citizens in national debates.

This first survey focused on how the perspectives of different racial and ethnic groups shaped their attitudes toward social policy and the role of government in America. A reprint of the series as it appeared in The Washington Post October 8-11, 1995 is also available (#1098), and also is included in this report.

• Report

The Impact of the “Medigrant” Plan on the Federal Payments to States

The analysis examines the conference agreement plan for the redistribution of federal funds under a block grant for the Medicaid program. It also discusses the implications of the reductions in federal spending for beneficiary coverage.

• Report: The Impact Of The “Medigrant” Plan On Federal Payments To States

Public Attitudes Toward Welfare and Reform: A Focus Group Report

This focus group report provides further insight on some of the findings from a nationwide survey on welfare released by the Kaiser Family Foundation in March 1995 (#1045). This survey suggests that citizens are more concerned with the moral underpinnings of the current welfare system than with the amount of tax money used for the program, and found participant agreement on the importance of job training, education and child care programs.

• Report: Public Attitudes Toward Welfare and Welfare Reform

A National Household Survey of Health Inequalities in South Africa (2 volumes)

The first democratically elected government in South Africa has made improving health and health services for the historically underserved black majority a national priority. As part of this process, in June 1995, the Minister of Health, Dr. Nkosazana Dlamini Zuma, outlined a plan designed to provide free primary health care to all South Africans. This plan aims to improve the health status of South Africans, as well as the quality of care, through increased emphasis on disease prevention and early intervention. To establish a baseline from which to measure the impact of these improvements over time, the Henry J. Kaiser Family Foundation, in June 1994, commissioned this national household health survey, the first of its kind in South Africa. A nationally representative sample of 4,000 households was drawn and the data weighted to the universe of 7,594,000 households in South Africa and for the universe of each age category, taking into account the distribution of households within provinces, population groups and environment such as metro, urban or rural. The survey was coordinated by the Community Agency for Social Enquiry (CASE) and the questionnaire administered by Market Research Africa.

• Report

Long-Term Care Spending

In 1993, Medicaid spent $25.5 billion for long-term care services for elderly beneficiaries (Figure 5). This represents 58 percent of the $44 billion Medicaid spent on long-term care services for all population groups. The majority of spending was for care delivered in nursing facilities (84 percent) and ICFs-MR (2 percent). The remaining 14 percent of Medicaid long-term care spending went towards community-based care, including 3 percent for mental health services and 11 percent for home health and personal care services.

Medicaid plays a fundamental role for institutionalized people and provided nursing home payments on behalf of 1.4 million elderly people in 1993. Often in nursing homes due to severe physical or cognitive limitations, nursing home residents tend to be over 80, female, white, and without a spouse in the community. Most have few choices available to them, and the need for continuous care and monitoring makes remaining in the community unaffordable and impractical.

Medicaid is essentially the only public financing program for long-term care services and accounts for 52 percent of overall nursing home payments and the vast majority of all public spending for these services. In 1993, a total of $90 billion was spent on long-term care in the U.S. for people of all ages, with $70 billion spent on nursing home care and $21 billion on care in the community (Figure 6). Medicaid pays for 16 percent of home health and community-based long-term care. Private payments, primarily out-of-pocket spending by the elderly and their families, account for a major share of long-term care financing.

Less than 5 percent of elderly people have private long-term care insurance. The relatively low penetration of private long-term care policies among the elderly is attributable to two factors. First, premiums can be extremely costly for people who are already 65 and older living on fixed incomes, typically ranging from $650 to $4,200 per year depending on the age when purchased. Second, many elderly people are prohibited from purchasing private long-term care insurance because of a pre-existing condition or disability.

Medicare was not designed to be a long-term care program and provides only minimal long-term care services. In general, Medicare’s home health and nursing home benefits are limited to skilled, rehabilitation-oriented care, with the number of days in a Skilled Nursing Facility (SNF) limited explicitly to a maximum of 100 days. Medicare covers 9 percent of total nursing home expenditures and accounts for over one-third of total home health expenditures. Custodial or personal care services are generally not covered by Medicare, leaving Medicaid as the principal public program to provide these services.

Applying Beneficiaries’ Financial Resources to the Cost of Nursing Home Care

Nursing home care is expensive, with annual costs ranging from $30,000 to $50,000 or higher in some areas of the country. Regardless of whom it affects, nursing home care is a catastrophic expense that is likely to impoverish most middle- and lower-income persons. Medicaid is a means-tested program and, unlike insurance, provides assistance only when financial resources are exhausted. An elderly person must deplete almost all of their assets and apply all of their income, except for a small personal allowance, toward the cost of nursing home care before Medicaid will pay for services. Under the spousal impoverishment provision in the Medicare Catastrophic Coverage Act (MCCA) of 1988, a spouse of a nursing home resident is allowed to keep more income and assets than was previously permitted. Protected assets for spouses range across states from $14,964 up to a maximum of $74,820 and the minimum protected income is 150 percent of the poverty level.

Because the means-tested program is almost always the sole alternative to spending personal funds for nursing home care, some higher-income persons receive assistance by transferring their resources to establish eligibility. Although this situation has attracted attention, the magnitude of this phenomenon has never been well documented. The Omnibus Budget Reconciliation Act of 1993 (OBRA 93) tightened eligibility rules to ensure that nonpoor elderly persons apply their resources toward the cost of care before Medicaid pays for long-term care services. It requires states to delay Medicaid eligibility for institutionalized persons who dispose of assets for less than fair market value during the three years prior to institutionalization; counts trusts as available to cover the cost of care within five years of institutionalization; and mandates estate recovery to cover Medicaid’s long-term care costs. States also have the option to use these rules to delay eligibility for disabled persons in the community before Medicaid will provide assistance for home- and community-based services. These efforts have made it more difficult for elderly people to receive coverage for Medicaid long-term care services. In the absence of adequate private financing alternatives, setting appropriate limits on Medicaid’s ability to help individuals and families with long-term care will continue to be a source of tension in program policy and spending.

Medicaid Payments to Nursing Homes

Medicaid payments for nursing home care are a large component of Medicaid spending, accounting for 20 percent of total expenditures. Nursing home payment levels will become increasingly important as state Medicaid programs search for ways to constrain spending. The Boren Amendment, enacted under the Omnibus Budget Reconciliation Act of 1980 (OBRA 80), permitted states to move from cost-based reimbursement for nursing homes to set payment rates that are “reasonable and adequate” to meet the costs of “efficiently and economically” operated facilities, but did not specify methods or rates. State Certificate of Need (CON) programs, which enabled states to limit the number of nursing home beds, coupled with increased state flexibility in setting payment rates, helped states control the rate of nursing home spending during the 1980s. Recently, providers have used the Boren Amendment provisions to sue state Medicaid agencies, arguing that Medicaid payment rates are inadequate to meet the cost of operating nursing facilities and to accommodate the changes being implemented as part of nursing home reform.

Nursing Home Quality Reform

The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) established protections for nursing home residents in response to Congressional concern about the quality of nursing home care and findings described in a 1986 Institute of Medicine report detailing an unsatisfactory level of care provided by nursing homes. Effective in October 1990, these reforms established requirements for providing care to Medicare and Medicaid beneficiaries related to scope of services, staffing levels and qualifications, residents’ rights, and the physical environment. Nursing facilities must comply with these requirements in order to receive reimbursement from Medicare and Medicaid.

Medicaid Coverage of Community-Based Long-Term Care

Medicaid has played an increasingly important role in covering community-based services for the elderly population with disabilities. Medicaid pays for skilled home health care in all states and 28 states and the District of Columbia have elected to cover the optional benefit of personal care in the home. Through home- and community-based waivers, states have been able to design programs to provide services, such as personal care, homemaker services, and adult day care to specific populations. Many states have implemented innovative programs to deliver coordinated community services to foster independence and provide an alternative to nursing home care, but most programs are small in scope and serve only a small number of frail elderly people. In 1993, Medicaid spent $2.8 billion on these innovative programs under home- and community-based waivers, through which 300,000 people were served.

Finding ways to stimulate the development of home- and community-based alternatives will continue to be a pressing challenge in Medicaid. Although the share devoted to home- and community-based services has been steadily increasing, Medicaid spending on long-term care continues to be directed primarily toward nursing home care. Of total Medicaid long-term care spending in 1993, $6.7 billion (15 percent) went toward community-based care (including skilled home health care, personal care, and home- and community-based waiver services), with most states spending between 5 and 25 percent (Figure 7).

Six states — New Hampshire, New York, Oregon, Vermont, West Virginia, and Wyoming