This commentary reviews Medicaid’s role for low-income women and examines the implications Medicaid managed care on the delivery of health services to this vulnerable population. Today 40% of the Medicaid population, mostly poor women and their children, is enrolled in managed care. Medicaid agencies are hoping managed care will control spending and address longstanding problems with access to care. Low-income women have a number of characteristics that make them doubly vulnerable to have trouble accessing care and place them at high risk for health problems. Furthermore, many beneficiaries have historically experienced non-financial barriers to care under fee-for-service Medicaid. While many look to managed care to overcome these obstacles, the evidence suggests that it does not offer a great improvement over fee-for-service in terms of improved access or reduced long term costs for low-income women. For Medicaid managed care to realize its potential, it will be crucial to assure that financing is adequate, resources for monitoring and oversight are sufficient, and systems and benefits are responsive to the complex and diverse health care needs of low-income women.

This article, written by Alina Salganicoff, appeared in the Journal of the American Medical Women’s Association, Vol.52, no.2, 1997.

A chart pack, press release, and Q&A prepared for a briefing held in New York on March 19, 1997, co-sponsored by the Kaiser Family Foundation, the National Press Foundation and The Alan Guttmacher Institute. This briefing focused on men’s role and responsibility in preventing pregnancy. A survey of men’s and women’s perceptions about men’s role and responsibility when it comes to preventing unplanned pregnancy was released as part of this briefing and is also available, see Survey on Men’s Role in Preventing Pregnancy, #1251.

This Washington Post/Kaiser/Harvard University survey examines American’s knowledge and attitudes on entitlements, particularly Social Security and the Medicare program. The survey findings were reported in The Washington Post on Saturday, March 29th, 1997. The survey was conducted by Chilton Research.

This study is part of a larger initiative, funded by both the Henry J. Kaiser Family Foundation and The Commonwealth Fund. Case studies of seven states that are restructuring their health care systems for the Medicaid and uninsured populations: California, Florida, Minnesota, New York, Oregon, Tennessee, and Texas, are designed to provide early insights and timely analyses that will help states and other efforts shape rapidly evolving managed care systems and health reform programs for low-income populations. This case study, which is still in the early stages of implementing managed care initiatives, assesses the goals of Medicaid managed care initiatives in Texas.

• Report: Managed Care and Low-Income Populations: A Case Study of Texas

• Talking With Kids About Tough Issues

Making Medicaid Managed Care Work: An Action Plan for Persons Living with HIV

This report, by the National Association of People with AIDS (NAPWA) with support from The Kaiser Family Foundation, describes nine key points for people living with HIV to keep in mind when trying to influence the development of a managed care system that will serve them effectively. Senator John Chafee (R-RI), an acknowledged ally of NAPWA, gratefully accepted the report upon its release.

• Making Medicaid Managed Care Work: An Action Plan for Persons Living with HIV
• Making Medicaid Managed Care Work: An Action Plan for Persons Living with HIV

• Report: An Analysis of the Medicaid and Health-Related Provisions of Act (P.L. 104-193)

The February 1997 edition of the Kaiser Family Foundation/Harvard Health News Index includes questions about Government Panel Recommendations on Mammograms, Medicare and Expaning Insurance to Children (CHIP). The survey is based on a national random sample of 1,003 Americans conducted February 21-24, 1997 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 inthe 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.

New National Campaign Encourages Parents To Start Talking With Their Children Earlier About Some Of The Hardest-To-Talk-About Topics, Like Sex

Campaign Provides Resources to Help Parents Begin the Discussion On Tough Issues In Age-Appropriate Way that Incorporates Own Values

Campaign Survey Says Parents Are Not Talking Enough About Sex, AIDS, Violence, and Drug and Alcohol Abuse;And Children Say They Want More Information

Embargoed for release until: 10:00 AM EST, Wednesday, February 19, 1997

New York, NY — Talking With Kids About Tough Issues, is a new joint initiative by the Kaiser Family Foundation, Children Now, and The Advertising Council to encourage and help parents of young children start talking early about life’s tough issues, including sex, AIDS, violence, and alcohol and drug abuse. The campaign encourages parents to impart their own values and, most importantly, to create an atmosphere of open communication with their children on any issue.

The effort centers around a national public service campaign featuring print, television, and radio advertisements developed by J. Walter Thompson New York, which volunteered its services, and local partnerships with Boys and Girls Clubs across the nation, the campaign’s principal community co-sponsors. A booklet, community forums, and other tools are being made available through the campaign to help parents.

A distinguished honorary committee, chaired by Linda Ellerbee, creator and host of Nickelodeon’s Nick News, and including entertainer Rosie O’Donnell, Dr. Alvin Poussaint of the Harvard Medical School, Kobe Bryant of the LA Lakers, and others, has given their support to the effort, which is also endorsed by such organizations as the National PTA, the American Academy of Pediatrics, and the National Council of La Raza.

The Campaign

The first public service messages, which are currently being distributed nationwide, focus on peer pressure to become sexually active and children’s fears about AIDS. One of the ads takes the unique perspective of a young boy struggling to deal with pressures to become sexually active and questioning “is that what girls are for?” Another shows a young child confused and worried about “whether all her friends will catch AIDS and die.” All of the ads encourage parents to talk with their children and to call the campaign’s toll-free number to get a free booklet to help them. Talking With Kids About Tough Issues, a guide for parents, is available free-of-charge by calling 1 800 CHILD 44.

“Sweeping tough issues under the rug will not prepare children for today’s world. Parents do not need to be told they are failing yet again, but they do need the type of encouragement and help this campaign offers,” said Drew E. Altman, Ph.D., President, Kaiser Family Foundation.

Lynne S. Dumas, a social researcher and author of parenting books, wrote the 60-page booklet, which was specifically developed for this campaign to help parents talk about tough issues with their children. The booklet provides general tips about how to initiate difficult conversations with children, as well as age-appropriate guidelines for bringing up specific topics and suggested responses to direct questions about such issues as sex, AIDS, violence, and drug and alcohol abuse.

Ten Tips for Parents from Talking With Kids About Tough Issues

1. Start Early
2. Initiate Conversations with Your Child
3. … Even About Sex and Sexuality!
4. Create An Open Environment
5. Communicate Your Own Values
6. Listen to Your Child
7. Always Be Honest
8. Be Patient
9. Use Television as a Tool
10. Talk About it Again. And, Again

Twenty Boys and Girls Clubs across the nation will help carry the campaign messages to local communities and extend the reach and scope of the campaign through a variety of activities, including holding town halls and parent clinics, and encouraging local newspapers and television and radio stations to support the effort. (See attached materials for a complete list of participating Boys and Girls Clubs and local launch events planned across the country.)

“The real hope of this initiative lies with our community partners, the Boys and Girls Clubs across the nation who will work most closely with parents, children, and the larger community to stimulate better and more frequent discussions on these tough issues,” said Lois Salisbury, President, Children Now.

The Survey of Parents and Children

According to a new survey conducted in conjunction with the campaign, most parents of 8-12 year olds say families today do not talk enough about such important topics as: relationships and becoming sexually active (77%), violence (75%), AIDS (68%), and alcohol and drugs (67%). When conversations do take place, 56 percent also say parents generally wait too long to begin talking with their children about issues like these.

The findings from a companion survey of children also suggests that parents may want to seek out opportunities to open the dialogue on tough issues. When asked about specific topics, majorities of 10-12 year old children of the parents surveyed said they wanted to know more about a variety of issues:

• Being safe from violence (80%)
• Protection against AIDS (73%)
• Avoiding potentially violent situations (71%)
• Sexually-transmitted diseases (66%)
• Dealing with peer-pressure to have sex (58%)
• Knowing when they’re ready to have a sexual relationship (54%)

While alcohol and drugs (94%) and violence (84%) are topics most parents of 8-12 year olds say have come up in conversations with their children, fewer say they have talked about AIDS (69%) or the basics of reproduction, the “birds and the bees” (62%). When it comes to such key issues as handling pressure to have sex, becoming sexually active, and preventing pregnancy, most parents of 8-12 year olds say they have not yet had these conversations with their children. By the time their child is a teenager, only 31 percent of parents will have talked about peer pressure to have sex, 30 percent about how to prevent an unwanted pregnancy, and 23 percent about when they might be ready to have a sexual relationship.

The survey also indicates that an opportunity exists for parents to have a more significant impact on their children’s lives if conversations about difficult subjects start earlier. Most 10-12 year olds (54%) say their parents are an important resource for “other kids their age” on issues like sex, AIDS, violence, and drugs and alcohol. Teens, however, are less likely to name parents (40% of 13-15 year olds), and more likely to name friends as a common resource for other kids their age about topics like these (60% of 13-15 year olds as compared to 36% of 10-12 year olds).

Both children and teens say many youth today find out about issues like sex, AIDS, violence, and drugs and alcohol from the entertainment media — television, movies, and music (57% of 10-12 year olds and 61% of 13-15 year olds say kids their age get “a lot” of information from these sources). Another helpful booklet, entitled Television As A Tool, is also available through this campaign. It focuses on opportunities presented by television and other media to complement parent and children’s conversations about tough issues.

More Findings from the Surveys:

• Many children surveyed say they would talk with their parent if they had a question about some tough issues, like the basic facts about sex (90%), how to prevent pregnancy (90%), and becoming sexually active (84%).
• But, close to half — 48 percent — of 10-12 year olds agree they at least sometimes “try to avoid talking about these subjects with their parents” and 52 percent agree they at least sometimes “feel uncomfortable when a parent brings up one of these subjects.”
• Most parents of 8-12 year olds who have talked about sexual subjects with their children say they did so only in response to something their child said or did: 62 percent who had discussed the “birds and bees,” 56 percent who had discussed preventing pregnancy, and 54 percent who had discussed becoming sexually active.
• Almost half of parents surveyed (48%) say they have been caught off guard by something their child asked about sex.

Contacts:

Matt James or Tina Hoff, Kaiser Family Foundation (415) 854-9400Margaret Lyons or Ann Skinner, Children Now (916) 441-2444Day of Release (212) 446-9325

Visit the Children Now website at http://www.childrennow.org

Methodology:

The Kaiser Family Foundation, Children Now, and Princeton Survey Research Associates (PSRA) designed three surveys for the Talking with Kids About Tough Issues campaign. Overall, 1,961 people were interviewed by telephone by PSRA during the development of this campaign. The results reported here represent the responses of : 1) national random-sample of 421 parents of 8-12 year olds (margin of sampling error is plus or minus 8 percent; 2) national random-samples of 164 children ages 10-12 years and 201 teens ages 13-15 years, whose parents were interviewed (margin of sampling error for both groups is plus or minus 8 percent); and 3) a national random sample of 143 parents of 8-12 year olds (margin of sampling error plus or minus 9 percent). The first two surveys were conducted between October 3-29, 1996. (Children under the age of 10 were not able to be interviewed by telephone, and therefore were not included in the sample). The third survey was conducted November 6-10, 1996.

* * *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.

Children Now is a nonpartisan, independent voice for America’s children, paying particular attention to the needs of children who are poor or at risk. Children Now uses innovative research and communications strategies to pioneer solutions to the problems facing children.

The Advertising Council, a private non-profit organization, is the leading producer of public service advertising in the United States. The Council supports campaigns for the public good, which are national in scope, generating strong, measurable results for the causes it serves. (Contact: Paula Veale at (212) 922-1500 ext. 230.)

J. Walter Thompson (JWT) New York is the flagship office of one of the nation’s largest global communications companies. JWT was instrumental in the founding of the Advertising Council, and the agency maintains a strong commitment to public service advertising. (Contact: Dorothy Marcus at (212) 210-7285.)

The questionnaire and toplines for the survey reported on in this release are available by calling the Kaiser Family Foundation’s publications request line at 1-800-656-4KFF. (Ask for #1230.)

Single copies of Talking With Kids About Tough Issues, the Kaiser Family Foundation and Children Now booklet to help parents discuss sensitive topics including sex, drugs and violence with their children, are available free-of-charge by calling 1-800-CHILD 44. (Television As A Tool, a second booklet, is available through the Foundation’s publications request line at 1-800-656-4KFF. Ask for #1229.)

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Talking With Kids About Tough Issues:Press Release Survey Children Now Booklet

Survey of Women About Their Knowledge, Attitudes, and Practices Regarding Their Reproductive Health

Glamour; Kaiser Family Foundation; Princeton Survey Research Associates

Summary of Major Findings

February 1997

The Kaiser Family Foundation partnered with Glamour magazine on a national survey to find out how much women know about their reproductive health care needs and whether they are taking important steps to protect their reproductive health, covering such critical issues as: routine gynecological exams,contraception, emergency contraception, sexually transmitted disease, HIV/AIDS, the patient-physician relationship, health insurance coverage, and communication with sexual partners. To explore women’s awareness of these issues and others, Glamour and the Kaiser Family Foundation designed and Princeton Survey Research Associates conducted a nationally representative telephone survey of 1,001 women in the U.S., ages 18 to 44. The survey was conducted between July 10 and July 28, 1996. The margin of error for results based on the total sample is plus or minus four percentage points. The results of the survey are reported in the February 1997 issue of Glamour.