Health reform: Another poll, another confused public
Every month, we all get those embargoed Kaiser Family Foundation tracking polls in our email. As I open it, I ask myself, “Now what did Americans forget they used to like about health reform this month?”
Or (and you may have heard me say this before – but it sums it up well, so allow me to repeat it) when are Americans going to figure out that this unpopular law is the sum of its popular parts?
What questions do you have about health reform and how to cover it?
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
Remember these polls are about opinions about a law that isn’t, by and large, in effect yet. So people hear all sorts of things about it, but they aren’t actually experiencing most of it yet. We don’t know what will happen in 2014 when – if the law survives the political process and the courts – the public may finally reach the “try it you’ll like it” stage.
That brings us to a recent survey from EBRI (Employee Benefits Research Institute) and Mathew Greenwald & Associates, Inc., a Washington, D.C., market research firm. The 2011 Health Confidence Survey, which looks at trends in employer- and union-sponsored health coverage, came out a few weeks ago, based on a telephone survey conducted in May and June.
A press release and EBRI article came out a few weeks ago, but when I looked for more details and data, I found some dated September. Because I’m going to write in pretty broad brush strokes here, including a smattering of numbers without inundating you with them, you can find more specific figures in the press release here, the November article here, and a longer discussion from September here.
Guess what? People were confused – or at least amazingly contradictory – about what they have now, as well as what they expect in the future.
For instance, people were quite satisfied with their own health coverage (amongst those that had coverage) both in terms of their health insurance plan and the actual medical care they receive. But they also thought the whole system is a mess.
Sixty percent were extremely or very satisfied with their plan (a number which surprised me given how much time people – even outside our health policy world – spend complaining about health care) and 29 percent were somewhat satisfied. People also rated the actual care they had received quite high. But more than half say the system is poor or fair; a quarter think it’s good. Only 12 percent deemed it very good and only 5 percent grade it at excellent. Naturally people were not too happy about the costs, either.
They are less confident about the future of employer- or union- provided health benefits than they used to be (NOTE: This slide began, and was sharpest, quite a few years before health reform was enacted. It’s definitely not because of the new law, in case someone tries to spin you that way).
People think that if they lose access to work-related health benefits or their employer/union stops providing them, they will have a really tough time affording their own insurance – even if they are subsidized by the employer or union.
Yet – despite those high unaffordability scores – two-thirds said they would be able to buy it. (You still with me?)
On health reform, those surveyed basically had no idea what a health insurance exchange is – which doesn’t stop them from declaring that the government can’t run them.
Just 1 percent of respondents reported that they were “extremely familiar” with health insurance exchanges in the new law. Double that amount, a whopping 2 percent, was “very familiar” “Somewhat familiar” scored 15 percent (and they can’t all be in Massachusetts). Nearly two thirds - 62 percent - said they weren’t at all familiar.
But guess what. That didn’t stop them from having strong opinions on the inability of either the state or federal government – or even private insurers – to run them.
I wonder, if they go into the exchanges in 2014, will they report being “highly satisfied” with them – and still convinced the government can’t run them? Maybe it will be a variant of “get the government hands off my Medicare.”
Which reminds us – the poll didn’t find a lot of confidence in the future of Medicare either. For what it’s worth.
Related
- Reporters can explore states’ options for creating exchanges
- Study offers context for reporting on health insurance exchanges
State update and hospital workers’ health
We have two unrelated topics to touch on this week.
First, just a brief reference to a recent Washington Post story that was a pretty good snapshot of the progress – and lack thereof – at the state level toward setting up exchanges. As writer N.C. Aizenman makes clear, the delays are partly because of politics.
What questions do you have about health reform and how to cover it?
Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
Hesitant states may decide to speed up implementation as the 2012 political landscape becomes clearer. The hesitation is partly related to uncertainty about what the courts will do about the mandate (and when.) And it’s partly because it’s tough for even a pro-reform state to set up an exchange.
As we’ve noted before on this blog, HHS has offered a sort of hybrid model for states that may make progress but not be where they need to be. Instead of an all-or-nothing approach (state run or federally run) HHS may manage parts of an exchange, but let states do the rest.
The second item that may translate into a good local health reform story is a new Thomson Reuters Healthcare study (hat tip to Reuters’ Deborah Sherman) that found hospital employees, as Sherman put it, ” spend 10 percent more on healthcare, consume more medical services, and are generally sicker than the rest of the U.S. workforce,” This is sort of the un-health reform – we’re supposed to be moving toward smarter health care utilization and better care coordination and hospitals, one would think, would be ahead of the curve. (That maybe the wrong cliché if we’re supposed to be bending the curve … not just getting out in front of it.) The findings also are a rather surprising contrast to what we’ve been reading about healthy hospital workforces at places like the Cleveland Clinic. The study speculates on several reasons for the high use of resources by hospital workers. Among the possibilities:
- Location, location, location. Hospital workers saw their doctors less often but used the emergency department and the hospital itself more.
- Stressful work environment and irregular hours may add to the chronic disease burden and make it hard to maintain healthy lifestyle habits.
- Higher awareness of illness, leading to more treatment.
Taking care of these worker/patients adds to hospital costs, at a time when they may be squeezed given the economic conditions and the pressures on state and local governments. It would be interesting to check out what’s going on with health care workers in your community. Is utilization high? Is the hospital trying to deal with costs the good old-fashioned way (cost shifting, cutting fees or having workers pay more for their care?) Or are local hospitals trying any of the new ways of delivering more coordinated care and managing chronic diseases in ways that preserve – or improve – quality while holding down costs?
Reporters can explore states’ options for creating exchanges
Filed under: Government, Health care reform, Health policy
Give me an f…
… for Flexibility, that is. Flexibility is the buzzword these days, as federal health officials coax states along the road to exchange creation. (See some updated resources at the end of this post.)
Steve Larson, director of the Center for Consumer Information and Insurance Oversight at CMS, is the point person on a lot of the state regulatory issues under health reform. He spoke at a Health Affairs-sponsored breakfast with reporters in Washington, D.C., recently. He was sort of a blend of federal regulator and state cheerleader.
Exchanges under the health law must be up and running on Jan. 1, 2014. States must be certified as “on track” in January 2013. In states that don’t have an exchange, the federal government will step in – “federally-facilitated” is the term of art among administration officials, not “federally-run.” The Department of Health and Human Services hasn’t said exactly what that federal fallback will look like. Meanwhile, a lot of states are still either locked in a political argument over whether to set up an exchange and how to design and regulate it, or have a long way to go to complete the complex tasks required to set one up.
Larson noted that states are making progress. But federal health officials recently made clear (in newly released proposed regulations) that they realize that a lot of states may need a bit of extra help. That’s why “flexibility” has become such a drumbeat. Instead of “yes, we have an exchange ready to go” or “no, we aren’t ready,” states can pursue a middle path - they can be ready in some ways, but let the federal government step in and handle other components.
An example Larson gave: The state may open the exchange, create offices and a website for consumers, the “retail” side of it, but let the federal government step in to determine whether people qualify for Medicaid, or what kind of subsidies they would get in the exchange.
For state reporters, this hybrid raises another dimension to the exchanges. States can assess what they can, most realistically and competently, achieve, and what may take another year or two. It may help smooth over some of the politics, as states might be able to put off some of the contentious aspects of exchange design, such as whether to be an “active purchaser” (setting more criteria for which insurers can operate in the exchange) or to have an open model. Or whether to start open and gradually move to “active purchaser.”
Another open question is what “essential benefits” health plans will have to offer in the exchange. There is some speculation that states will be able to decide, or at least have some leeway, in keeping with the “state flexibility” orientation. Larsen didn’t say how that would play out, but it’s another area that state reporters should pay attention to.
Finally, a lot of states, Larson noted, have beefed up their ability to review proposed insurance rate increases. How much power they have to approve or reject increases varies. But even publicity about high increases can create a public relations/political climate in which insurers may roll back proposed increases. That’s definitely worth watching.
A few extra resources to keep you up to date if you haven’t seen them:
- The HHS release on the exchanges, including the “hybrid.”
- New Kaiser Family Foundation brief on state efforts.
- Here are Commonwealth Fund state exchange resources. Over on the right, here’s the Heritage Foundation’s perspective.
Two new resources for covering health reform
Filed under: Health care reform, Health journalism, Tools
There are two more resources to share with you from two of health journalisms’ ever-helpful friends, the Kaiser Family Foundation and the Alliance for Health Reform.
What questions do you have about health reform and how to cover it?
Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
Kaiser has started posting on its site a series called “Notes on Health Insurance and Reform. Written by Larry Levitt, senior vice president for special initiatives and senior adviser to the president at the Foundation, and Gary Claxton, vice president and director of the health care marketplace project.
They are both very good at tackling all those complicated regulatory and insurance issues that some of us may have just a few itsy bitsy questions about. The posts are short, and clear, very helpful. Two of the initial posts cover topics we’ve addressed here too on Covering Health (the high risk pool program and aspects of the exchanges). Here’s a link to the RSS feed, too.
The Alliance is adding another layer to its online sourcebook, updating the reference book pages with relevant local news stories from around the country. You can click on the sourcebook pages in the table of contents, choose a chapter (here’s the one on health reform) and you’ll see the local news stories on the right hand side of the website. Or you can sign up in the email alerts section of www.allhealth.org (which is how I get them) or naturally, there’s a Twitter feed. We’ll take a look from time to time at some of those local stories and see what lessons they hold for health care reporters elsewhere.
Study offers context for reporting on health insurance exchanges
Filed under: Health care reform, Health journalism, Studies, Tools
The first tip sheet I wrote about covering health reform was pegged to the one-year mark of the Affordable Care Act. One topic I addressed was the creation of state-based health insurance exchanges, or marketplaces. I won’t rehash that here – here’s the link to the brief – but I do want to point out a useful resource that became available just a few days after we posted that first guide.
What questions do you have about health reform and how to cover it?
Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
It’s an in-depth look at the two states that already do have exchanges – Utah and Massachusetts. Those states help illustrate the decisions, both practical and ideological, legislators and governors must make as to how active the exchange is going to be in shaping the local insurance market and the consumer experience.
Those exchanges are of course dramatically different – Massachusetts covers a couple of hundred thousand people, and Utah covers a couple of thousand. Massachusetts was the inspiration in many ways for the national health reform, while Utah is the model for states that want to do a lot less and rely a lot more on the free market. But the study by experts at the Georgetown University Health Policy Institute and the Center for Children and Families also found those two state exchanges also had a lot more overlap than is widely assumed.
For those of you who are writing your first story on exchanges, this report isn’t the place to start. For help with the basics, check out ideas from Sarah Kliff, a Politico health care reporter, and some background from Noam Levey, health policy reporter for the Los Angeles Times. And the Alliance for Health Reform had an event last year that explained the basics (this link includes a webcast, transcript and lots of other resources to help you get started.)
For those reporters who have been tracking the state debate over the size, shape and structure of the exchange, or following the initial phases of implementing the exchange, the Georgetown study should help provide some context for concepts that you may have heard of like “active purchaser” (an exchange that can be more discriminating about which insurers get to sell policies in the exchange and which don’t versus an “open market” (open to any health plan that wants to play.) Here’s a taste:
To many, the Massachusetts and Utah exchanges represent opposite points on a continuum of what exchanges can provide for consumers and small businesses. Yet the stereotype of Massachusetts’ exchange as an “active purchaser” and the Utah Exchange as the open market model is, in the words of one observer, “a false stereotype … perpetuated by … a media that likes simple contrasts.”
So be part of a media that goes beyond simplistic contrasts … dig in.
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