SUMMARIES OF  
KAISER   REPORTS
May 2005 - Nov 2005

• Trends And Indicators In The Changing Health Care Marketplace
• Views On The Medicare Prescription Drug Benefit
• Medicaid Spending And Enrollment Of Low-Income Medicare Beneficiaries
• Health Care, Second Most Important Problem For Government To Address
• Premiums And Cost-Sharing In Medicaid And SCHIP
• 2001 Medicaid Payment Totals
• And The Distribution Of Medicaid Enrollees By Eligibility Group
• Americans View Medicaid Positively
• Medicaid Still Faces Long-Term Budgetary Challenges
• Ten State Medicaid Waivers For Hurricane Katrina Evacuees
• Growth In Uninsured Americans Outpacing Federal Spending
• Threadbare:  Holes In America’S Health Care Safety Net
• Are Immigrants Responsible For Most Of The Growth Of The Uninsured
• How Will The New Medicare Drug Benefit Impact Hispanics?
• How Will The New Medicare Drug Benefit Impact African Americans?
• Challenge For Seniors To Derive Benefit From Medicare Drug Benefit

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  TRENDS AND INDICATORS IN THE CHANGING HEALTH CARE MARKETPLACE ONLINE CHARTBOOK

  Information on key health care marketplace trends, including health insurance enrollment, premiums, and benefits; the structure of the health care marketplace; and consumers and the safety net.  Highlighting national health expenditures, health care spending and costs, employer and retiree health coverage, HMO enrollment, hospital data, and public views on topics such as managed care, worries about health care, and medical errors and quality information.

  The full report may still be available at CLICK HERE

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  VIEWS ON THE MEDICARE PRESCRIPTION DRUG BENEFIT

  The Kaiser health poll includes public opinion data related to prescription drugs is based on polling conducted in early April 2005. More than three out of four adults in the US (77%) say that Congress should allow patients to buy prescription drugs imported from Canada, and the same majority (77%) say that Congress should change the law to allow the federal government to negotiate with drug companies to reduce drug prices for people on Medicare.
  
  In each case, nearly eight in 10 people (79%) say the change would have a lot or some impact in reducing prescription drug costs in the US. Majorities also disagree with common arguments against such policies, including that they would lead US drug companies to do less research and development. The poll also found a decline in the share of seniors with unfavorable views towards the new Medicare drug benefit from 55% in February 2004 to 34% in April 2005. But the percentage of seniors viewing the new benefit favorably remains largely unchanged. A growing proportion of seniors is either neutral toward the new benefit (25%) or did not know enough to offer an opinion (20%).

  The full report may still be available at CLICK HERE.

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  MEDICAID SPENDING AND ENROLLMENT OF LOW-INCOME MEDICARE BENEFICIARIES

  Medicaid spent roughly $105 billion on the 7.5 million Medicare enrollees who were eligible for Medicaid in 2003.  The report includes detailed charts and state-by-state data tables on enrollment and eligibility group and spending by service, which can also be viewed on State Health Facts Online http://statehealthfacts.org/r/duals.cfm.
  
  It also provides new state-by-state estimates of the impacts on federal and state Medicaid spending of shifting the full cost of selected Medicaid services for dual eligibles to the federal government: 1) About two-thirds of dual eligibles are individuals age 65 and over with the remaining one-third consisting of younger persons with disabilities; 2) 58 % of aged and disabled Medicaid enrollees are dual eligibles; 3) States with the highest expenditures on dual eligibles are California, Florida, Illinois, Massachusetts, New York, North Carolina, Pennsylvania, and Texas; 4) The average Medicaid spending per dual eligible in the nation is $14,114 in 2003, ranging from $7,793 in Nevada to $27,920 in Connecticut; 5) 66 % of Medicaid spending on dual eligibles is for long-term care services; and 6) Among all dual eligibles, 20 % had more than $20,000 in health care spending and this group accounted for more than three-fourths (76 percent) of all dual eligible spending.

  The full report may still be available at CLICK HERE

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  HEALTH CARE, SECOND MOST IMPORTANT PROBLEM FOR GOVERNMENT TO ADDRESS

  Americans rank health care (22%) behind only war and foreign policy issues (28%) and just ahead of the economy (20%) as the most important problem for the government to address according to the July/August Kaiser Health Poll Report of 2005. Fewer people name terrorism (9%), tax and budget issues (6%), education (5%), and crime (3%) as the most important problem.
  
  When asked about seven specific health care problems, people age 65 and older (23%) are more likely than young adults (14% of ages 18-29, 13% of ages 30-49, and 14% of ages 50-64) to say lowering the cost of prescription drugs is the most important issue for the President and Congress to address. Younger Americans are more likely to pick lowering the cost of health insurance as the most important health issue (26% of ages 18-29, 30% of ages 30-49, and 27% of ages 50-64).

  The full report may still be available at CLICK HERE

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  SURVEY FINDS STEADY DECLINE IN BUSINESSES OFFERING HEALTH BENEFITS TO WORKERS SINCE 2000

  One in Five Firms Offer High-Deductible Health Plan Option; 2.4 Million Workers With Insurance Enrolled In Consumer-Driven Plans. The percentage of businesses offering health insurance to their workers has declined steadily over the last five years as the cost of providing coverage continues to outpace inflation and wage growth. Three in five firms (60%) offered coverage to workers in 2005, down significantly from 69% in 2000 and 66% in 2003.  The drop stems almost entirely from fewer small businesses offering health benefits, as nearly all businesses (98%) with 200 or more workers offer such benefits. It is low-wage workers who are being hurt the most by the steady drip, drip, drip of coverage draining out of the employer based health insurance system.
  
  Premiums increased an average of 9.2% in 2005.  The 2005 increase is still more than three times the growth in workers’ earnings (2.7%) and two-and-a-half times the rate of inflation (3.5%).  Since 2000, premiums have gone up 73%. The annual premiums for family coverage reached $10,880 in 2005, eclipsing the gross earnings for a full-time minimum-wage worker ($10,712).  The average worker paid $2,713 toward premiums for family coverage in 2005 or 26% of the total health premium.  While premium increases slowed in 2005, they continue to rise much faster than inflation and other economic indicators.  As a result, workers and businesses alike are finding it harder to afford health coverage. 20% of employers who offer health insurance now provide a high-deductible health plan option.  The survey defines high-deductible health plans as those with at least a $1,000 deductible for single coverage or at least a $2,000 deductible for family coverage.

  The full report may still be available at CLICK HERE

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  PREMIUMS AND COST-SHARING IN MEDICAID AND SCHIP

  "Increasing Premiums and Cost Sharing in Medicaid and SCHIP: Recent State Experiences" examines the impact of recent state experiences with implementing new or increased existing out-of-pocket costs for beneficiaries in their Medicaid, SCHIP, or other public coverage programs.  The report documents that: 1) Increases in beneficiary costs may have created savings for states, but they accrue more from reduced coverage and utilization rather than increased revenue and 2) Premiums disproportionately impacted those with the lowest incomes, but also led to disenrollment among those with incomes above 150% of poverty.

  The full report may still be available at CLICK HERE

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  2001 MEDICAID PAYMENT TOTALS

  2001 Medicaid payment totals for children, adults, elderly, and individuals with disabilities are now available by state and by region.

  The full report may still be available at CLICK HERE

  and Updated Medicaid spending per enrollee data ­ total and by enrollment group -- are also now available.

  may still be available at CLICK HERE

  AND THE DISTRIBUTION OF MEDICAID ENROLLEES BY ELIGIBILITY GROUP

  Total enrollment in Medicaid and the distribution of Medicaid enrollees by eligibility group are available by state for 2001.

  may still be available at CLICK HERE

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  DESPITE CONCERNS WITH THE COSTS OF MEDICAID, AMERICANS VIEW THE PROGRAM POSITIVELY AND ARE RELUCTANT TO SEE STATE AND FEDERAL CUTS

  Perhaps surprisingly given years of debate about Medicaid, frequent references to the program as the "Pac Man" of state budgets, and periodic calls for reform, public attitudes toward Medicaid are remarkably positive, and opposition to cuts is reasonably strong. While two-thirds of the public think their state has major budget problems, a substantial majority are reluctant to cut Medicaid to balance state budgets, and a majority think the federal government should maintain (44%) or increase (36%) federal spending on Medicaid; only 12% of the public prefer seeing federal funding of Medicaid cut.
  
  Nearly three-quarters (74%) of adults say Medicaid is a "very important" government program, ranking it close to Social Security (88%) and Medicare (83%) in the public’s mind, equal to federal aid to public schools (74%), and above defense and military spending (57%).  About 8 in 10 Democrats (82%) and Independents (79%) view Medicaid as an important government program, while fewer, but still 6 in 10 Republicans (61%) express that view.  A majority of Americans (56%) report having some interaction with Medicaid, either having been enrolled themselves at some point (16%) or knowing a friend or family member who has received health coverage or long-term care assistance through the program (40%).  Additionally, if they needed health care and were eligible, nearly 8 in 10 Americans (78%) say they would be willing to enroll in Medicaid.  This view is consistent across different party identifications.

  The full report may still be available at CLICK HERE

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  IMMEDIATE STATE FISCAL CRISIS SUBSIDES, BUT MEDICAID STILL FACES LONG-TERM BUDGETARY CHALLENGES

  After several years of extreme fiscal stress, state budgetary pressures are easing as the gap between Medicaid spending growth and state tax revenue growth declined to 2.6%, its lowest level since 1999. This survey found that the economic recovery combined with sustained state cost containment actions has contributed to the improved outlook for Medicaid and the State Children’s Health Insurance Program (SCHIP). However, state Medicaid officials expressed concern that much of Medicaid’s cost growth is due to rising health costs declining employer-based coverage, demographic trends, and other factors beyond Medicaid’s control. The study also affirmed the basic countercyclical nature of Medicaid.  Its costs increase most rapidly when it is most in demand ­ in a sluggish economy.  "While the fiscal crisis has subsided, state budget pressure remains because the nation relies on Medicaid to forgive the failures of our larger health system."   To limit pharmaceutical costs in Medicaid, 16 of the 37 surveyed states imposed limits on prescription refills and states automatically denied refills that surpassed hard (arbitrary) limits. [Note all of the factors which could control cost mentioned here are not strictly beyond government control and if there was truly a planned national health care system of any sort, costs could be controlled.]

  The reports and a summary of findings are online CLICK HERE

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  TEN STATE MEDICAID WAIVERS FOR HURRICANE KATRINA EVACUEES

  This news brief examines the variation in eligibility, benefits, and cost sharing criteria in Medicaid waivers states were granted by the federal government to provide Medicaid coverage to Hurricane Katrina evacuees. In the coming weeks a new brief will examine Hurricane Katrina’s implications for the Medicare program and its beneficiaries.  Key health and demographic statistics of the affected states, a survey of evacuees, webcasts and audiocasts of briefings on the health needs and responses, and daily updated news summaries on health coverage and Hurricane Katrina related stories are available.

  The resources are collected together on a web page dedicated to Hurricane Katrina related CLICK HERE .

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  GROWTH IN UNINSURED AMERICANS OUTPACING FEDERAL SPENDING ON THE HEALTH CARE SAFETY NET

  The south is home to more than half of uninsured growth; immigrants not driving recent growth. Five reports highlight the growing uninsured population and portray the health care safety net as increasingly straining to meet uninsured people’s needs. "In the absence of providing health insurance coverage for our nation’s growing uninsured population, some have said that the uninsured can receive care when they need it through the nation’s health care safety net.  The new studies and personal stories released today document the increasing burden health providers are facing in delivering needed care" [i.e. that the 'safety net is a myth, since many people fall right through]. As the number of uninsured Americans increased by 4.6 million from 2001 to 2004, federal safety net spending per uninsured person fell from $546 to $498 during the same period.  After adjusting for inflation, total federal spending for care for the uninsured increased by 1.3 % from 2001-2004 while the number of uninsured increased by 11.2 %.  These trends resulted in an 8.9 % decline in spending by the federal government per uninsured person. [Note these numbers are all based on the misleading census data which only count people who are uninsured for an entire fiscal year. Those uninsured Feb 2003 through Oct 2004, 20 months, are not officially 'uninsured' in either year.]

  These reports and a summary of findings are available CLICK HERE

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  THREADBARE:  HOLES IN AMERICA’S HEALTH CARE SAFETY NET

  Federal support for community health centers increased by more than 50 % over the past four years [increased reliance on charity care] but still only accounts for less than 3 % of total federal spending on the health care safety net [and providing a tiny amount of the care low-income uninsured Americans need].  The authors noted that because more than 70 % of federal support for the uninsured flows through Medicare and Medicaid, which are both under budgetary pressures, "it is unlikely that future funding will be able to close the gap or make up the difference" in the increase in the uninsured and funding for their care. Another Commission study finds that all of the six million increase in the number of uninsured from 2000-2004 was among adults and two-thirds of the increase was among people with incomes below 200 % of poverty (about $39,000 for a family of four in 2004).  Both adults and children were affected by the 4.6 percentage point drop in the share of the nonelderly with employer coverage (67.8% to 63.3%), but children were able to obtain alternative coverage through Medicaid and the SCHIP.

  These reports and a summary of findings are available CLICK HERE

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  ARE IMMIGRANTS RESPONSIBLE FOR MOST OF THE GROWTH OF THE UNINSURED

  About half of the growth in the uninsured was among young adults (ages 19-34) who experienced sharp declines in employer coverage rates.  54% of the growth occurred in the Southern region of the country which experienced the greatest growth in both the general population and low-income population combined with the largest decrease in employer coverage.  This contributed to the 3.2 million increase in uninsured people in the South alone.   Another report found that immigrants are disproportionately likely to be uninsured due to their employment in low-wage jobs that are less likely to offer health coverage and restrictions on their eligibility for public coverage.  Generally, from 1994 and 2003, the growth in the number of uninsured has largely been among native citizens.

  These reports and a summary of findings are available CLICK HERE

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  HOW WILL THE NEW MEDICARE DRUG BENEFIT IMPACT HISPANICS?

  Medicare is about to undergo big changes that will have a major impact on nearly 3.1 million Hispanic seniors and younger people with permanent disabilities who rely on Medicare for their health coverage. More than one in three Hispanics with Medicare lack coverage for their prescription drugs for at least part of the year.  Many others will need to make decisions about their existing coverage and the new Medicare benefit. Starting Jan. 1 2005, Medicare will cover outpatient prescription drugs, but many people with Medicare don’t even understand the basics about what this means for them.  Getting accurate, timely, and useful information to Hispanics who rely on Medicare is critical to ensuring they make the right decisions about new Medicare benefits.  Consider that: 1) hispanics suffer more from certain illnesses, such as diabetes, than their white counterparts. 2) hispanics on Medicare are far more likely than whites to have low incomes.  In fact, about six in 10 Hispanic beneficiaries have incomes below 150 % of poverty and 3) In 2005 nearly one in three Hispanics with Medicare rely on state Medicaid programs for their drug coverage.  That will end Jan. 1, when Medicare instead will cover their drugs.

  These reports and a summary of findings are available CLICK HERE

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  HOW WILL THE NEW MEDICARE DRUG BENEFIT IMPACT AFRICAN AMERICANS?

  In early 2006 Medicare will undergo big changes that will have a major impact on nearly 4 million African American seniors and younger people with permanent disabilities who rely on Medicare for their health coverage.  More than four in 10 African Americans with Medicare lack coverage for their prescription drugs for at least part of the year.  Many others will need to make decisions about their existing coverage and the new Medicare benefit. Medicare will cover outpatient prescription drugs, but many seniors don’t even understand the basics about what the new benefit offers or how it works.  Consider: 1) African Americans suffer more from certain illnesses, such as diabetes and hypertension, than their white counterparts. 2) African Americans on Medicare are far more likely than whites to have low incomes.  In fact, six in 10 African American beneficiaries have incomes below 150 % of poverty, which means they are more likely to qualify for additional help paying for their drugs ­ but only if they know how to apply for it. 3) In 2005 more than one in three African Americans with Medicare rely on state Medicaid programs for their drug coverage.  That will end Jan. 1, when Medicare instead will cover their drugs.

  These reports and a summary of findings are available CLICK HERE

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  SURVEY UNDERSCORES CHALLENGES FOR SENIORS TO DERIVE BENEFIT FROM MEDICARE DRUG BENEFIT

  Many seniors say they don't understand the benefit, don't know if they will enroll, and are wary of the large number of plan choices and those who say they understand the benefit are more likely to view it favorably. With the new Medicare drug benefit’s open enrollment period set to begin Nov. 15, many seniors remain uncertain about how the law will affect them and unsure about whether they will enroll.  The results highlight the critical importance of ongoing education efforts to successful implementation of the new program next year. [More importantly the wasted time and energy in helath departments, universities, doctors offices and among patients trying to nagivate a piecemeal health system. The vast savings of having every American covered for needed medical treatments becomes clearer with every additional poorly conceived patch to the current chaos we call our health care system.] When asked how well they understand the drug benefit 61% say "not too well" or "not at all," while 35% say "very" or "somewhat" well.  When asked whether the Medicare drug benefit would help them personally, more seniors say it would not (49%) than say it would (39%).  More than four in 10 seniors do not yet know if they will enroll in a Medicare drug plan for 2006; 37% say they do not plan to enroll; and merely one in five (20%) say they plan to enroll.  Most seniors substantially underestimate the number of drug plan choices that they will have, with just 5% correctly identifying that they will have more than 20 options for receiving their drug coverage.  Later they are informed that "most people on Medicare will have at least 40 different drug plans to choose from".

  The survey results are available online CLICK HERE

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