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SUMMARIES OF 12 RECENT
KAISER REPORTS
Jan - June 2003
86% of AMERICANS SAY MAKING HEALTH CARE AFFORDABLE IS VERY IMPORTANT
When asked in an open-ended question to name the most important problem in health or health care for the government to address, people give a diverse list of responses.
Between December 2002 and February 2003...
When given a list and asked more specifically about the importance of health care issues that are actually before the President and Congress, large majorities (two-thirds or more) say each issue is "very important." When forced to choose the most important priority, four in ten (44%) chose making health care more affordable. Smaller shares chose helping people age 65 and over pay for prescription drugs (16%), increasing the number of Americans covered by health insurance (14%), making Medicare more financially sound for future generations (12%), and protecting patients' rights in HMOs and managed care plans (4%). In nearly all demographic groups, a plurality of people chose making health care more affordable as the most important issue.
Comments (Deb Socolar): In this February 2003 poll, 86% said that "making health care more affordable" is "very important," and this doesn't even include those that believe it is "somewhat important." Another recent poll indicated that the combined total of those that believe this issue is important is 98%. There are very few issues on which Americans demonstrate this level of agreement.
There is now a consensus that reform is needed. But other polls have shown that there is greater support for employment-linked insurance than for a universal public program. However, those polls have used pejorative phrasing ("tax," "government-run," etc.) which would provoke a negative response about a publicly funded and administered program.
Ironically, the public does not understand that what they are looking for in health care (affordability, cost containment, lower out-of-pocket expenses, adequate access to modern technology, equity in both funding and access, stability of coverage, choice of health care providers, etc.) would be achieved by adopting a universal public program that is funded at our current level of health care spending. The employment-linked model that they support is only going to compound their concerns since it continues to waste resources in administrative excesses, and it is shifting more and more of the financial risk to the individual, not to mention the other problems such as losing coverage with unemployment, etc.
When will the pollsters begin to ask honest questions about the policy implications of universal versus incremental models of reform? 98% of Americans want to know the answers now. Isn't it time to begin to ask the right questions?
CLICK HERE for the original Kaiser document (ACROBAT).
COST IMPLICATIONS OF HEALTH PLAN OPTIONS FOR PEOPLE ON MEDICARE
Medicare beneficiaries face wide variations in out-of-pocket costs associated with supplemental insurance options. For example, out-of-pocket costs for a prototype 50-year-old man with disabilities range from an estimated $6,010 to $21,857, depending on where he lives and the supplemental plan he chooses. Out-of-pocket health spending varies by the type of supplemental coverage selected by the beneficiary, e.g. Medigap or Medicare+Choice. Geographic location can also make a big difference in beneficiaries’ access to supplemental coverage, premiums and other out-of-pocket costs even for policies that cover identical benefits. While beneficiaries often focus on premiums when choosing supplemental coverage, premiums are often a poor barometer for gauging future annual out-of-pocket health spending.
CLICK HERE for the original Kaiser document (ACROBAT).
CONSUMER GUIDE TO HANDLING DISPUTES WITH YOUR EMPLOYER OR PRIVATE HEALTH PLAN, 2003 UPDATE
With a vast majority of Americans getting their health care through some form of managed care plan, understanding how managed care plans work and how to resolve disputes is important for consumers. Today, 41 states plus the District of Columbia have legislated procedures for resolving disputes outside the health plan through external review systems, yet studies show these systems are not well utilized. Also, new federal requirements for the processing of employer health plan claims and appeals of denied claims are effective January 1, 2003.
Almost half (48%) of privately insured adults under age 65 had a problem with their health plan in the last year with a range of consequences from minor hassles to adverse effects on their health.
CLICK HERE for the original Kaiser document (ACROBAT).
HOW MUCH MEDICAL CARE DO THE UNINSURED USE, AND WHO PAYS FOR IT?
The report and accompanying study showing that the country spent $35 billion in 2001 to care for the uninsured [direct costs only], with government picking up most of the tab. In addition, the study shows that those uninsured for a full year receive half as much care in dollar terms as fully insured people. [This estimate of the cost of uninsurance includes only direct costs (procedures and services reimbursed to provider) - does not include any of the indirect costs to society of having people develop more serious conditions, public health problems, indirect costs from untreated substance abuse, losses from productivity, or indirect costs from having untreated mental disease roaming freely through society etc. etc.]
CLICK HERE for the original Kaiser document (ACROBAT).
More Americans are worried about health care costs than about losing their job, paying their rent or mortgage, losing money in the stock market, or being a victim of a terrorist attack.
* Nearly four in 10 Americans (38%) say they are very worried that the amount they pay for health care services or health insurance will increase over the next six months;
* A similar number (37%) is very worried that their income might not keep up with rising prices in the coming six months;
* These two worries eclipsed all others asked about, including being very worried about losing money in the stock market (22%), not being able to pay their rent or mortgage (19%), being a victim of a terrorist attack (19%), or losing their job (15%).
CLICK HERE for the original Kaiser document (ACROBAT).
Key data resources have been updated on health insurance coverage in America utilizing the latest U.S. Census Bureau survey. National and state-level health insurance data for 2001 is now available from a new Kaiser Commission on Medicaid and the Uninsured report, and online at State Health Facts Online.
The Foundation’s Commission on Medicaid and the Uninsured has updated its annual chartbook on health insurance coverage and a fact sheet describing the uninsured population and the policy challenges involved in providing them access to care.
* Health Insurance Coverage in America: A 2001 Data Update CLICK HERE
* The Uninsured and Their Access to Care CLICK HERE
State Health Facts Online, new data are NOW available on the health insurance and demographic characteristics of all 50 states and the U.S., based on the Census Bureau’s most recent Current Population Survey. This includes nearly 50 topics, shown in easy-to-use ranked tables and color-coded maps, on:
* State-level health insurance coverage information.
* Coverage of population subgroups. New data on insurance by age, race/ethnicity, poverty level, and gender.
* Characteristics of the uninsured, and those covered by employer-sponsored coverage, individuals with Medicaid, and those with Medicare.
* Demographics such as the employment status and median family income of a state’s population.
CLICK HERE for the original Kaiser document
.
-- Employer-sponsored coverage decreased as the economy
slowed-primarily because so many people (3.1 million) moved
into the lowest income group (those earning less than 200% of
the federal poverty level).
-- Almost all of the increase in the uninsured (over 90%)
occurred among low-income people (<200% of the poverty level).
-- Growth in Medicaid and the State Children’s Health Insurance
Program roughly offset the decline in employer-sponsored
insurance for children, but not for adults.
-- The number of uninsured workers increased by 700,000 in 2001,
nearly all of whom worked for small firms.
CLICK HERE for the original Kaiser document (ACROBAT).
THE NEW MIDDLE-CLASS OF UNINSURED AMERICANS -- IS IT REAL?
-- The middle- to upper-classes did not account for most of the growth in the uninsured in 2001, instead the large majority of the newly uninsured were low-income individuals.
-- The number of high-income uninsured (400%+ of poverty or $56,512 for a family of three in 2001) grew by about 300,000 due to a loss of employer-sponsored coverage, but this is substantially less than unadjusted data from the U.S. Census Bureau’s report might indicate.
-- Data from the Census Bureau’s 2002 annual report has been misinterpreted when the majority of the newly uninsured are characterized as either middle- or high-income people. The Census Bureau used household income that does not account for the number of people and different family units within the household or the effect of general inflation on income.
CLICK HERE for the original Kaiser document (ACROBAT).
VERY WORRIED ABOUT PAYING FOR HEALTH CARE
A survey was conducted April 2003. When asked how worried they are about a variety of personal concerns, more than one-third of Americans (36%) said they were very worried that the amount they pay for health care services or health insurance will increase. The survey found that more than twice as many people were concerned about health care costs than were very worried about not being able to pay their rent or mortgage (17%), losing money in the stock market (16%), being a victim of a terrorist attack (14%), or losing their job (13%).
The poll found that the public was also worried about a wide range of other health concerns: 34% said they were very worried that their health plan will be more concerned about saving money for the plan than about what is best for them; 27% were very worried that the quality of health care they receive will get worse; 26% were very worried about affording prescription drugs; and 24% were very worried that they might not be able to get health care services they think they need.
In addition to their personal worries, the poll also asked Americans about the top health care priorities facing the President and Congress. Americans rank expanding health coverage for the more than 40 million people without insurance higher than other national health care priorities, such as malpractice reform.
CLICK HERE for the original Kaiser document.
"Action has been stymied in large part because of the budgetary investment needed to make coverage affordable to more Americans. No one has systematically analyzed the costs of not expanding health insurance coverage, however. Hadley's article begins to tally the expenses on the other side of the ledger." - Karen Davis, Commonwealth Fund
Even in considering an add-on program for the otherwise uninsured, it was found that a substantial amount of the funds needed are alreand in the system - paying for the care of the uninsured, mostly out of public funds (diversions from other programs picking up expenses for "uncompensated care"). This study does NOT look at savings from treating the presently uninsured in a timely manner and in an appropriate setting. Nor does it consider any administrate efficiencies in converting to a UHC system.
Major findings from a April 2003 study include:
-- The uninsured receive less preventive care, are diagnosed at more advanced disease stages, and once diagnosed, tend to receive less therapeutic care (drugs and surgical interventions);
-- Having health insurance would reduce mortality rates for the uninsured by 10-15 percent; and
SLIDES AND A PAMPHLET ARE AVAILABLE demonstrating how we already pay enough in care for the uninsured to more than pay for the costs of insuring them. And in this analysis we aren't even talking about efficiencies in administration. These are savings from programs to provide charity care, uncompensated care at public facilities and other costs incurred directly from care of the uninsured.
CLICK HERE for the original Kaiser documents
CLICK HERE for the full report (ACROBAT)
CLICK HERE for the SLIDES
Five states have been approved to expand prescription-only coverage to otherwise non-Medicaid eligible seniors. The Pharmacy Plus initiative allows states to secure federal Medicaid matching funds for prescription programs for low-income seniors and/or individuals with disabilities. While much of the focus of the initiative has been on providing prescription drug coverage, the waiver would fundamentally change financing care under Medicaid and endanger funding for Medicaid down the road [see many archived news articles on medicaid and funding caps].
-- Funding caps apply to all spending on elderly Medicaid beneficiaries, not just their Pharmacy Plus prescription programs.
-- The generosity of funding caps varies markedly across states, but they are generally quite tight.
-- It is unlikely that prescription drug programs for seniors will pay for themselves.
CLICK HERE for the original Kaiser documents
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