SUMMARIES OF 21
KAISER REPORTS
May 2002 - Dec 2002
SURVEY FINDS SIZABLE SHARE OF WOMEN FACED PROBLEMS WITH THE HEALTH CARE SYSTEM.
A national survey by the Kaiser Family Foundation finds that a sizable share of women faced problems with the health care system. One in four (24%) nonelderly women reported delaying or going without care in the past year due to costs, compared to 16% of men. One in five (21%) nonelderly women did not fill a prescription because they could not afford it. This compares with 13% of men. Women are also more likely than men to express concerns about the quality of health care they received.
CLICK HERE for webcast, transcript, and related resources, a summary and key findings.
SICKER AND POORER: THE CONSEQUENCES OF BEING UNINSURED
A report by the Kaiser Commission on Medicaid and the Uninsured (KCMU) synthesizes the major findings of the past 25 years of health services research assessing the most important effects of health insurance. The report, evaluates thousands of citations and 230 research articles to assess the consequences of being uninsured for health status and economic opportunity. The report concludes that the weight of this large body of research makes a compelling case that health insurance does lead to improved health and better access to care.
The major findings from the paper 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
-- Better health would improve annual earnings by about 10-30 percent (depending on measures and specific health condition) and would increase educational attainment.
While much of the policy debate on the uninsured has focused on the costs of various coverage expansions, little attention has been paid to the economic impact of leaving 40 million people uninsured. This report demonstrates that lack of health insurance affects more than health care utilization it ultimately affects the health and well being of the uninsured.
This report assesses the considerable evidence developed in the last few decades establishing that having health insurance has a measurable impact on both mortality and earning potential for the uninsured population.
CLICK HERE to read the report at Kaiser's website.
CAN MEDICAID WORK FOR LOW-INCOME WORKING FAMILIES?
Since the welfare reform law of 1996, states have had more flexibility to cover low-income working families under Medicaid. Two-thirds of the 39 million uninsured Americans are in low-income working households (under 200 percent of the federal poverty level or less than $30,000 annual income for a family of three.) Low-income working families are at greatest risk for being uninsured since they generally earn too much to qualify for Medicaid, but do not have access to job-based coverage.
This publication provides state-by-state information on actions to improve Medicaid access for states’ low-income working populations. Some of the findings include:
-- 39 states have increased their income eligibility levels by exempting certain earnings;
-- 16 states have eliminated their asset test; and
-- Only 12 states consider Medicaid eligibility for families with income at 100 percent of the federal poverty level or above.
CLICK HERE to read the report at Kaiser's website.
STORIES AND TALK OF THE NATION PROGRAM IN JUNE 2002 HIGHLIGHT PROBLEMS AMERICANS HAVE IN ACCESSING AND PAYING FOR HEALTH CARE.
Findings from a national survey on health care by National Public Radio, the Kaiser Family Foundation, and Harvard’s Kennedy School of Government are highlighted in a series of seven news stories and a Talk of the Nation program in June 2002.
The survey found that many Americans have real problems when it comes to accessing and paying for health care, and even if they haven’t yet faced a problem, many worry about getting and paying for care in the future. The survey also shows that, while people think helping seniors with the cost of prescription drugs should be a priority, most seniors would not be willing to pay significantly more than they pay now for drug coverage under Medicare.
CLICK HERE to view and listen to these NPR stories here
BUILDING ON MEDICAID: WHAT WORKS AND WHAT MORE CAN BE DONE?
The Kaiser Commission on Medicaid and the Uninsured highlighted two new reports at the policy briefing, Building on Medicaid: What Works and What More Can Be Done?, and released several related publications at the event. The briefing and the reports detail the states’ successes in increasing enrollment into the Medicaid and CHIP programs in recent years.
Also released at the event were:
-- Medicaid Program Enrollment: Data Update September 2001,-- SCHIP Program Enrollment: December 2001 Update,
-- Acceleration of Medicaid Spending Reflects Mounting Pressures,
-- and Medicaid Update: What Changes Are States Considering In The Face of Fiscal Pressures?
CLICK HERE to read the report at Kaiser's website.
STATES SEE GROWTH IN THE AVERAGE PRICE OF PRESCRIPTIONS
The Kaiser Family Foundation has released an analysis of prescription drug costs and spending based on data provided by Verispan Scott-Levin, a pharmaceutical market research firm. The data show that while total spending for prescription drugs grew 17.3% nationally in 2001, there is wide variation in spending by state -- ranging from a low of 12.0% growth in Maine to a high of 25.2% in Alaska. Data for every state, as well as national and regional comparisons, are available.
Growth in drug spending is influenced by increases in the number of prescriptions and growth in the average price of a prescription. The average price is on the rise due to increases in the prices of existing drugs, and replacement of older, cheaper drugs with more expensive drugs. States saw growth in the average price of prescriptions last year, and for most states (42), the increase in total spending was attributable more to average price increases than to the number of prescriptions used. While all states had increases in the number of prescriptions used last year, the growth varied substantially from a low of a 4% increase (Arkansas, New Mexico, Kentucky, and New Jersey), to more than 10% growth (Louisiana, Nevada, Idaho, Mississippi, and Alaska). Growth in the average price of a prescription varied from less than 8% to more than 11%.
CLICK HERE for the Foundation’s online state data resource, State Health Facts Online
CHARTPACK: THE WIDE CIRCLE OF CAREGIVING
The Kaiser Family Foundation helped conduct a national survey of over 1,000 informal caregivers in 1998 to assess the policy issues involved with this new, growing role for many family members and friends. Nearly one of every four adults (23 percent) is an informal caregiver, and, as the American population ages, it is likely families will take on an even greater responsibility to keep their loved ones at home and in communities.
Some of the major findings of the survey include:
-- Forty percent of informal care recipients could not afford professional help;
-- The majority of caregivers are under age 45 (54 percent), employed full-time (53 percent), and married (60 percent);
-- Nearly half (49 percent) of caregivers have incomes under $35,000 and may not be able to financially help the person they are caring for;
-- About one-third (32 percent) of caregivers report having their own serious health problem;
-- Two-thirds (68 percent) of caregivers are helping close family members (parents, grandparents, or spouse), but only 28 percent of recipients of care live with their primary caregiver; and
-- Over half (54 percent) of recipients of care were hospitalized in the past year.
CLICK HERE to read the report at Kaiser's website.
STATE BUDGETS UNDER STRESS
Governors and state legislatures, confronting reduced revenues, rising health care costs, and budget shortfalls, are looking to constrain current and projected funding for their Medicaid programs. The Kaiser Commission on Medicaid and the Uninsured commissioned a survey of the 50 states and DC. They found that 18 states plan to reduce or restrict eligibility, up from 7 states implementing eligibility restrictions in 2002. Furthermore, 28 states plan to cut or freeze payment rates for some providers during 2003 (which will undoubtedly result in more physicians limiting the number of medicare patients they will accept).
CLICK HERE to read the report at Kaiser's website.
NEW YORK’S DISASTER RELIEF MEDICAID
In a study Kaiser cosponsored with the United Hospital Fund of New Yorkers who enrolled in Disaster Relief Medicaid (DRM) it was discovered that most participants said their motivation for enrolling in the program was simply to obtain health coverage; many had chronic conditions and previously were uninsured and rarely received health services because they could not afford the cost of doctor visits or medications. Many participants reported obtaining check-ups and dental and vision exams, seeing specialists, and getting prescriptions filled--use reflective of a pent-up need for medical care. Most participants are confused about the process for keeping health coverage. Higher income eligibility levels and no asset test, an easier enrollment process, application assistance, and positive word-of-mouth were all attributes of the DRM program that may be translated to other public health programs (or to a UHC system in the future).
CLICK HERE to read the report at Kaiser's website.
STRONG CONSENSUS FOR HEALTH SYSTEM REFORM BUILDING
The United States has a "stronger consensus for radical reform" among the public, employers, providers and others in the health care industry, according to a Harris Poll released Aug. 21. According to the survey, 56% of the public, 46% of physicians, 48% of employers, 50% of health plan managers and 51% of hospital managers said that the health care system requires "radical change." The survey predicted that "dissatisfaction" with the health care system would increase over the next few years as a result of increased out-of-pocket costs, concerns about prescription drug prices and a possible increase in the number of uninsured Americans.
CLICK HERE to read the report at Kaiser's website.
PREMIUM INCREASE UNRELATED TO INFLATION AND SALARY FLUCTUATION 1995 - 2002
This business survey report is in the form of a powerpoint slide show. The fifth slide in the show demonstrates the fluctuations in annual increases of salaries, health care premiums and inflation for the years 1988 - 2002. In the years 1995 - 2002 the average health insurance premium has increased more in each subsequent year (not true for inflation or salaries) and since 1996 has averaged 9.2% for each of the years collected (averaging about 3 and 4% for inflation and salaries respectively during those same years).
CLICK HERE to view the report, downloadable in MS-Powerpoint at Kaiser's website.
CHANGES IN INSURANCE
COVERAGE: 1994-2000 AND BEYOND
This report explores the insurance trends for the latter half of the 1990s and examines why the number of uninsured nonelderly Americans fell in 2000 for the second straight year.
- --Between 1999 and 2000, the number of uninsured adults increased by 130,000. Employer coverage also increased for adults but public coverage did not and the result was an increase in the number of uninsured adults.
- --The main reason for the increase in the rate of employer coverage in the non-elderly population was the huge increase in the number of people living in working families (18.5 million between 1994 and 2000).
- --Another reason for the increase in employer sponsored insurance was the increase in employment in larger firms (1,000+ workers) where the likelihood of employer sponsored coverage was higher. Large firms employed 38.4 percent of workers in 1994 but accounted for 63 percent of the job growth between 1994 and 2000.
- --The trends in health insurance remain bleak. Between 1994 and 2000, a period of great economic prosperity, the uninsured rate was essentially unchanged. Gains were offset by declines in Medicaid and private individual coverage.
- --From 1994 to 2000, the number of uninsured white Americans declined by 900,000 while the number of uninsured blacks increased by 500,000 and uninsured Hispanics by 1.9 million. Each group benefited from the strong growth in employer-sponsored coverage, but blacks and Hispanics were particularly adversely affected by the declines in Medicaid coverage.
CLICK HERE to read the report at Kaiser's website.
MEDICAID SPENDING GROWTH
The vast majority of states faced significant budget shortfalls this year, with many facing their third consecutive year of budget shortfalls. State rainy day funds are rapidly being depleted and state tax revenues are falling dramatically. At the same time, spending on Medicaid is increasing significantly, similar to trends in other public and private health plans.
The Kaiser Commission on Medicaid and the Uninsured sponsored a 50 state survey of Medicaid directors. Medicaid Spending Growth: Results from a 2002 Survey presents the findings of the survey, including state tables. The findings include:
- -- 41 states project a Medicaid budget shortfall in FY 2003;
- -- 40 states are planning to implement prescription drug cost controls in FY 2003, up from 32 states in FY 2002;
- -- 29 states are either reducing or freezing some of their provider payment rates in FY 2003
- -- 18 states are reducing or restricting Medicaid eligibility, including 4 states that are eliminating eligibility for thousands of people, and
- -- 15 states are increasing beneficiary co-payments for services other than prescription drugs.
CLICK HERE to read the report at Kaiser's website.
If you are interested in more information about Medicaid and state budgets, you may view some of Kaiser's related publications at http://www.kff.org/content/2002/20020918/
The rate of Medicaid enrollment growth doubled during 2001. Medicaid enrollment rose by 3.3 million from December 2000 to December 2001, for an annual increase of 9.8 percent compared to the annual increase of 4.9 percent from December 1999 to December 2000. This parallels the recent release by the U.S. Census Bureau showing that while the number of uninsured Americans increased in 2001, so did enrollment in public programs like Medicaid. Overall enrollment increased in all 50 states with positive enrollment growth in the categories of families, children and pregnant women as well as the aged and disabled.
CLICK HERE to read the report at Kaiser's website.
Comparison of the Liability Provisions of House and Senate Patients’ Rights Bills by Gary Claxton
Health plan liability is the legal recourse available to health plan enrollees who have been injured because of a health plan’s failure to authorize or provide needed care. Differing health plan liability in the two versions of bills involves when participants could sue their health plans, what the burden of proof might be, the standard of care against which plan's conduct would be judged and the damages that could be recovered.
CLICK HERE to read the report at Kaiser's website.
While most large employers plan to continue offering their retiree health care coverage in the next three years, many retirees can expect their costs to increase, and about one in five large employers say they are very or somewhat likely to terminate retiree coverage for future retirees. For workers who retire before they are eligible for Medicare, employer-sponsored plans offer access to health insurance coverage that retirees may otherwise have difficulty obtaining. For those ages 65 and older, employer-sponsored health insurance supplements help by paying for health care not covered under Medicare like prescription drugs. The average retiree contribution rose 19% for pre-65 retirees and 20% for age 65+ retirees between 2001 and 2002. [This group of retirees (employed by large companies) has the best coverage in the nation and even they will have a terrible time providing for their medical needs, so much the worse for the self-employed and those employed by small businesses.]
CLICK HERE to read the report at Kaiser's website.
OVER 1/3 OF PHYSICIANS HAVE EXPERIENCED MEDICAL ERRORS
As readers of EINO's news summaries know more injury and death results from medical errors than from Rx errors. Some 42% of the public and more than one-third of U.S. doctors say they or their family members have experienced medical errors in the course of receiving medical care, with significant percentages reporting serious consequences.
Physicians said the leading causes of errors are a shortage of nurses (53%) and overwork, stress or fatigue of health professionals (50%). A majority of the public identified seven causes; the top four they cited are physicians not having enough time with patients (72%); overwork, stress or fatigue of health professionals (70%), health professionals not working together or communicating as a team (67%) and a shortage of nurses (65%).
CLICK HERE to read the report at Kaiser's website.
NEARLY 1/3 OF HISPANICS REPORT THAT THEY OR SOMEONE CLOSE TO THEM HAS EXPERIENCED DISCRIMINATION
Nearly one-third of hispanics report that they or someone close to them has experienced discrimination, 8 in 10 say hispanics discriminating against other hispanics is a problem. Hispanics overall show a strong attachment to the Latin American nations where they or their ancestors were born. While Latinos generally take a positive view of life in the United States, many express concerns about the moral values Latino children are acquiring here.
Latinos overwhelmingly say that discrimination is a problem that keeps Hispanics from succeeding in general (82%) and is a problem in the workplace (78%) and at schools (75%). When asked about personal experiences, one in three (31%) Latinos report that they or someone close to them has suffered discrimination in the past five years because of their racial or ethnic background. About three in ten (29%) Latinos report having problems communicating with their health care providers because of language barriers.
Many Hispanics report experiencing more subtle forms of unfair treatment because of their racial or ethnic background, including being treated with less respect than others (45%), receiving poorer service than others (41%), and being insulted or called names (30%).
CLICK HERE to read the report at Kaiser's
website or CLICK
HERE to download report (Acrobat).
MEDICAID SPENDING GROWTH: A 50 STATE UPDATE FOR FISCAL YEAR 2003
This report is based on a follow up survey and shows that 49 states have planned or implemented Medicaid cuts in FY 2003 and 32 of them have taken action twice.
CLICK HERE to read the report at Kaiser's website.
THE STATE FISCAL CRISIS AND MEDICAID: WILL HEALTH PROGRAMS BE MAJOR BUDGET TARGETS?
These case studies reveal that the seven states studied (California, Colorado, Florida, Michigan, Mississippi, New Jersey, and Washington) have already expended their one time financial sources such as rainy day funds and tobacco settlement money to shore up state budgets and avoid making larger cuts in Medicaid and other large state responsibilities like education.
CLICK HERE to read the report at Kaiser's
website or CLICK
HERE to download report (Acrobat).
THE NORTH CAROLINA HEALTH CHOICE ENROLLMENT FREEZE OF 2001
This report (Pub#4081) finds that over 34,000 children were placed on the waiting list during the freeze, with the majority (60 percent) seeking SCHIP coverage directly after losing Medicaid. Six focus groups held with parents throughout the state revealed that affected children experienced unmet health needs and problems obtaining medications, and that families experienced financial hardship as a result of the enrollment cap.
CLICK HERE to read the report at Kaiser's website.
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