Filling the need for trusted information on national health issues…

Flint, Michigan, Water Contamination and Anxiety Closer to Home

In this Wall Street Journal Think Tank, Drew Altman discusses polling data about the public’s concern about the water crisis in Flint, Michigan, and the deep concern in low income communities.

Column/Op-Ed Read Post

Donald Trump’s Health-Care Plan and Where the ‘Repeal and Replace’ Slogan Falls Short

In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses Donald Trump’s health plan and why “repeal and replace” is not a good description for Republican alternatives that have very different objectives than the Affordable Care Act.

Column/Op-Ed Read Post

Medicare-for-All vs. Single Payer: The Impact of Labels

In this column for The Wall Street Journal’s Think Tank, “Medicare-for-All vs. Single Payer: The Impact of Labels”, Drew Altman uses new polling on a Medicare-for-all or single payer health system to explain how what you call a health reform plan can substantially affect the public’s response.

Column/Op-Ed Read Post

Will Poor Health Status in the South Be an Issue in 2016 Primaries?

Drew Altman discusses whether the presidential candidates will discuss poor health status in the South in this Wall Street Journal Think Tank column.

Column/Op-Ed Read Post

Behind the Challenges to Universal Health Coverage

In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses why political reality and the diverse makeup of the remaining uninsured population mean that the likeliest path to universal coverage is a multi-step approach.

Column/Op-Ed Read Post

What New Data Tell Us About Doctor Choice

Drew Altman explores the rhetoric versus reality on whether choice of doctors is eroding and why the issue resonates with Americans, in this column for The Wall Street Journal’s Think Tank.

Column/Op-Ed Read Post
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This was published as a Wall Street Journal Think Tank column on March 17, 2016.
Kaiser Family Foundation chart of February polling on Americans' concerns over the safety of the water supply in their community.
Michigan Gov. Rick Snyder and Environmental Protection Agency administrator Gina McCarthy testified before the House Committee on Oversight and Government Reform on Thursday about the contaminated water in Flint, Mich., and state and federal regulation of the water supply. Most Americans say they have been following the issue, and many say they are worried about drinking-water safety, polling has found. As with many issues in our country, the poorer people are, the more worried they are likely to be that the system will fail them and their family. In the Kaiser Family Foundation’s Health Tracking Poll in February, nearly two-thirds (64%) of Americans reported closely following news about unsafe levels of lead in the water supply to Flint, Mich. A similar share said that they have heard or read a lot (34%) or some (28%) about it. As the chart above shows, about half of all Americans (47%) say they are concerned about the safety of the water supply in their own community, and 27% say they are very concerned. People with lower incomes are the most worried: 37%, or more than a third, of people earning less than $40,000 a year say they are very concerned about the water supply in their own community, compared with 12% of those who earn $90,000 or more.
 It’s hard to say whether news of the contamination of Flint’s water supply exposed a public worry that lurked beneath the surface or triggered new concerns about something that most people had taken for granted. There is a legitimate debate in this country about the role of government generally, but few argue about government’s obligation to provide safe drinking water. When government fails at this most basic job, the public notices. And when government fails a low-income and heavily-minority community such as Flint, it touches a nerve in other low-income areas across the country.
[post_title] => Flint, Michigan, Water Contamination and Anxiety Closer to Home [post_excerpt] => In this Wall Street Journal Think Tank, Drew Altman discusses polling data about the public’s concern about the water crisis in Flint, Michigan, and the deep concern in low income communities. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => flint-michigan-water-contamination-and-anxiety-closer-to-home [to_ping] => [pinged] => [post_modified] => 2017-02-06 17:01:44 [post_modified_gmt] => 2017-02-06 22:01:44 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=179114 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 178233 [post_author] => 36621681 [post_date] => 2016-03-03 18:28:53 [post_date_gmt] => 2016-03-03 23:28:53 [post_content] =>
This was published as a Wall Street Journal Think Tank column on March 3, 2016.
The health-care plan detailed by Donald Trump begins with the repeal of Obamacare, which it would replace with a series of changes Mr. Trump hopes that Congress would enact. They include: allowing the sale of insurance across state boundaries, turning Medicaid into block grants to the states, allowing people to deduct the cost of their health insurance from their taxes as businesses do, expanding health savings accounts, and–in what I think would be a first–allowing those accounts to be passed on tax-free to heirs. Mr. Trump and some media outlets have characterized the plan as a replacement for the Affordable Care Act, in the spirit of “repeal and replace.” Whatever the pros and cons of these proposals–and they have both, as do the ideas put forward by Democrats–they are not a replacement for the ACA. To be clear: They do not accomplish the same goals through other means; they seek to repeal the ACA and substitute an alternative that has very different objectives.
The Affordable Care Act significantly reduces the number of uninsured by expanding Medicaid and providing government subsidies for people who cannot afford coverage, and it eliminates the worst abuses in the insurance system through reforms and regulation, such as prohibiting the exclusion of people with pre-existing medical conditions.
Mr. Trump’s plan, like ideas put forward by other Republican candidates, aims to reduce regulation and government spending, give people more low-cost insurance options, and lower taxes. Tax-deductibility for those buying insurance on their own would level the playing field for people whether they buy coverage themselves or get it through an employer. But that would do little to help the uninsured, who have lower incomes and don’t pay much in taxes. A plan like Mr. Trump’s, with its savings accounts and proposal to allow insurance purchases across state lines, might give some people wider access to bare-bones lower-cost insurance options. But those still are not options the vast majority of the uninsured would be able to afford, and freezing federal funding to states through block grants and repealing the ACA would roll back coverage gains of about 18 million people made under the ACA; it is also likely to increase the number of uninsured to levels higher than pre-ACA numbers. There is no mention of pre-existing conditions in Mr. Trump’s plan or mechanisms to ensure that sick people can get coverage. Mr. Trump’s promotion of high-deductible plans with savings accounts is an example of an idea that has upsides but different objectives than the ACA. These plans would offer lower premiums–in return for higher deductibles–and encourage more prudent health-care use. Such options are widely available today, including in the ACA marketplaces. But they are generally not a good option for the chronically ill, who use health services more frequently than most or for lower-income people, for whom the deductibles are a barrier to care and an economic hardship. The average deductible for a high-deductible plan with a savings account is $2,196 for single coverage and $4,347 for family coverage. One National Institutes of Health study concluded: “As health reform efforts advance, policy makers must consider how to modify high-deductible plans to reduce the financial burden for families with chronic conditions.” High-deductible plans with savings accounts also are not a good option for most of the uninsured. Eight out of 10 uninsured Americans are in families earning less than four times the federal poverty level–$76,000 for a family of three–and half earn less than two times the poverty level. Mr. Trump’s plan and other proposals from GOP candidates pursue worthy objectives that Republicans favor, including giving people more affordable choices for health insurance. But their ideas are not a replacement for the ACA; they are an alternative to it that would move the health system in a very different direction. “Repeal and replace” is a slogan that itself may need to be replaced.
[post_title] => Donald Trump’s Health-Care Plan and Where the ‘Repeal and Replace’ Slogan Falls Short [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman discusses Donald Trump’s health plan and why “repeal and replace” is not a good description for Republican alternatives that have very different objectives than the Affordable Care Act. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => donald-trumps-health-care-plan-and-where-the-repeal-and-replace-slogan-falls-short [to_ping] => [pinged] => [post_modified] => 2017-02-06 17:05:13 [post_modified_gmt] => 2017-02-06 22:05:13 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=178233 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 177531 [post_author] => 36621681 [post_date] => 2016-02-25 08:48:44 [post_date_gmt] => 2016-02-25 13:48:44 [post_content] =>
This was published as a Wall Street Journal Think Tank column on February 25, 2016.
Results from February Kaiser Family Foundation Health Tracking Poll surveying how Democrats respond to health-care proposals described as Medicare-for-all, guaranteed universal health coverage, single-payer health insurance, or socialized medicine.
Sen. Bernie Sanders describes his health-care proposal as a Medicare-for-all, single-payer plan. The plan, however, would not expand the current Medicare program but replace it, along with Medicaid, private insurance, and other programs with what might be described as a Medicare-like, government-run single-payer plan. New polling shows why Mr. Sanders’s label works well politically in the primary campaign: Among Democrats, the term “Medicare-for-all” generates a much more enthusiastic reaction than does “single-payer.” With this discussion still mostly at the stage of broad concepts and messaging, language matters. As the chart above shows, the latest Kaiser Family Foundation health tracking poll found that 53% of Democrats were “very positive” about Medicare-for-all, compared with 21% who felt that way about a “single-payer national health-care system.” A separate 37% are “somewhat positive ” about the term “single-payer.” Medicare-for-all elicits the strongest positive reaction. About the same percentage were “very positive” about the term “socialized medicine” as single-payer. Medicare is a famously popular and well-known program, and associating any universal coverage plan with it makes that idea more popular. The current debate about single-payer is a discussion of ideas, concepts, and terms that are generally popular with Democrats. There has been coverage in the media and discussion among some experts of the details in Sanders campaign’s outline of his single-payer plan, but a national debate about single-payer legislation–similar to the debate the country had about the Affordable Care Act–would be an entirely different animal. Major topics include how to finance such a system, who wins and who loses, and how to transition from the current system. That broader debate, of course, would engage independents and Republicans, many of whom are far less enamored of single-payer. A partisan debate would also follow should the more incremental approaches to expanding coverage further, such as those favored by former secretary of state Hillary Clinton, be on the table. A lot remains fluid in the presidential contest. But the primary campaign so far has made clear the value of labels and messaging, whether applied to candidates (“Jeb Bush is low-energy”) or health plans (“Medicare-for-all”).  
[post_title] => Medicare-for-All vs. Single Payer: The Impact of Labels [post_excerpt] => In this column for The Wall Street Journal’s Think Tank, "Medicare-for-All vs. Single Payer: The Impact of Labels", Drew Altman uses new polling on a Medicare-for-all or single payer health system to explain how what you call a health reform plan can substantially affect the public's response. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => medicare-for-all-vs-single-payer-the-impact-of-labels [to_ping] => [pinged] => [post_modified] => 2017-02-06 17:07:49 [post_modified_gmt] => 2017-02-06 22:07:49 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=177531 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 176931 [post_author] => 36621681 [post_date] => 2016-02-18 19:28:26 [post_date_gmt] => 2016-02-19 00:28:26 [post_content] =>
This was published as a Wall Street Journal Think Tank column on February 18, 2016.
Kaiser Family Foundation chart of health status in four regions of the U.S. finds that the highest share in poor or fair health, at 20%, is in the South.
Before the New Hampshire primary, Democratic and Republican candidates talked a lot about the state’s opioid epidemic, an issue that ranked high among public concerns in Granite State polls. The 2016 campaign has moved south, with South Carolina’s Republican primary on Saturday and votes to follow in 10 more of the 17 southern states by March 15, but there has been little discussion of poor health status in the region. The South has no special ownership of poverty or poor health, but the region has the worst health status in the nation by most measures. Overall, one in five people are in fair or poor health in the South, a higher percentage than any other region in the U.S., the Kaiser Family Foundation has found. Virtually all southern states rank among those with the highest rates of adult diabetes and most of the states with the highest obesity rates are in the South. Infant mortality is higher in the South than any other U.S. region. Cancer death rates are a little lower in the South than in the Midwest, but they are much higher than those in the West and the Northeast. South Carolina has a higher rate of cancer-related deaths than the southern states overall or the U.S. nationally. Fewer people have health coverage in the South: 18% of the adult non-elderly population is uninsured in the South since enactment of the Affordable Care Act, compared with 12% in the rest of the country. The highest uninsured rates are generally in the 10 southern states that have not opted to expand Medicaid under the ACA. In South Carolina, 123,000 residents fall into a coverage gap: They are poor adults who earn too much to qualify for Medicaid but not enough to qualify for premium tax credits, which begin at 100% of the federal poverty level. Southerners are more likely to be poor than people in any other region of the U.S. Blacks account for 19% of the population in the South, compared with 8% in the rest of the nation. A substantially higher share of blacks–13.5%–were uninsured in the South in 2014 than whites (9.3%). More than four in 10 of all people of color live in the South. Talking about the opioid epidemic in New Hampshire was, for many reasons, probably easier than digging into these issues: That was a single health problem that affects whites and minorities and both the middle class and those with lower incomes. By contrast, poor health status in the South, with its deep connections to poverty and race, is more complex and multifaceted. There is political space for candidates in both parties: Democrats might focus on the need for government programs, including Medicaid expansion throughout the region. Republicans, who generally oppose such proposals, might focus on other ways to improve health status at the state and community levels. Public health, and improving care and outcomes, has a connection to many of the things candidates are saying about jobs and the economy, as well as ways to improve race relations and the criminal justice system. We will see, as the SEC primaries get going, how much attention the health status gap gets.
[post_title] => Will Poor Health Status in the South Be an Issue in 2016 Primaries? [post_excerpt] => Drew Altman discusses whether the presidential candidates will discuss poor health status in the South in this Wall Street Journal Think Tank column. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => will-poor-health-status-in-the-south-be-an-issue-in-2016-primaries [to_ping] => [pinged] => [post_modified] => 2017-02-06 17:17:29 [post_modified_gmt] => 2017-02-06 22:17:29 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=176931 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 176545 [post_author] => 36621681 [post_date] => 2016-02-11 08:50:59 [post_date_gmt] => 2016-02-11 13:50:59 [post_content] =>
This was published as a Wall Street Journal Think Tank column on February 11, 2016.
Kaiser Family Foundation chart of eligibility for health coverage under the Affordable Care Act among non-elderly uninsured Americans in 2015.
Both Democratic presidential candidates are calling for universal health coverage, though they disagree sharply on how to get there. Here’s the bottom line: There is no single program or policy likely to achieve full coverage of the complex collection of subgroups who make up the remaining uninsured in the U.S. except for a single-payer strategy. But Sen. Bernie Sanders has acknowledged that single-payer health care is not politically feasible in the foreseeable future and has said that it is unlikely without, among other things, campaign finance reform first. More than 17 million people who previously did not have insurance have been covered so far by the Affordable Care Act. That’s enormous progress on one of health care’s biggest problems. But as the chart above shows, slightly more than 30 million people in the U.S. remained uninsured as of last year. They are not a monolithic group. For example, about 4.9 million were undocumented residents; 8.9 million others were adults and children eligible for Medicaid but who, because of a complex array of factors, were not enrolled in their state’s Medicaid program. Seven million were eligible for tax credits to help them purchase coverage in the ACA marketplaces but had not signed up for coverage. One group that has received a lot of attention is the uninsured who fall in the Medicaid “coverage gap” because their state has refused to expand the program under Obamacare. They represent 2.9 million of the remaining uninsured. Covering them would redress a glaring inequity and cut down the number of remaining uninsured. The entire problem, however, would still be far from solved. About half of the eligible uninsured live in states that have expanded Medicaid under the ACA. The lack of interest some state leaders have in covering their uninsured residents makes getting to full coverage all the more difficult. In the past, Democrats debated how fast to move and how far to go to cover the uninsured. Republicans have focused mainly on repealing or altering Obamacare; their health-care priorities do not feature universal coverage. By contrast, Hillary Clinton and Bernie Sanders have staked out strong positions on universal coverage. The makeup of the uninsured population and political realities suggest that the most likely path to universal coverage is a series of incremental steps–implemented in combination or sequentially–that build on the progress made by the ACA and chip away at the remaining uninsured in the U.S. group by group.
[post_title] => Behind the Challenges to Universal Health Coverage [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman discusses why political reality and the diverse makeup of the remaining uninsured population mean that the likeliest path to universal coverage is a multi-step approach. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => behind-the-challenges-to-universal-health-coverage [to_ping] => [pinged] => [post_modified] => 2017-02-06 17:27:06 [post_modified_gmt] => 2017-02-06 22:27:06 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=176545 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 175987 [post_author] => 36621681 [post_date] => 2016-02-04 08:21:44 [post_date_gmt] => 2016-02-04 13:21:44 [post_content] =>
This was published as a Wall Street Journal Think Tank column on February 4, 2016.
Kaiser Family Foundation polling found that 88% of the insured have not had to change doctors because their provider was not covered by their health plan. Of the 12% who have had to change doctors, 5% said it was a big problem, and 5% said it was not a big problem.
Listening to the political debate about health care, and in conversations with patients and health professionals across the country, I get the sense that some people that feel their choice of doctors–and hospitals–is threatened and that people are losing their regular doctors as insurers narrow provider networks to lower costs. Critics have blamed the Affordable Care Act; in a recent campaign rally in Iowa, Sen. Ted Cruz charged that Obamacare is “taking our doctors.” Data from the Kaiser Family Foundation’s January health-tracking poll, however, indicate that this problem is smaller than conventional wisdom and critics have suggested. Just 4% of the non-elderly with health coverage say that they are “very dissatisfied” with the choice of doctors in their plan’s network; almost nine in 10 say they are satisfied. As the chart above shows, the share who say they had to change doctors because their doctor was no longer covered by their plan’s network is 12%, and just 5% of those said that doing so was a “big problem.” It can, of course, be a problem if people are losing their doctor through the narrowing of networks, even if the overall number of such instances is relatively small. If, for example, cancer patients feel forced to leave their longtime oncologist because they are no longer in the plan’s network, that can be a source of serious concern and stress, and it doesn’t take a lot of such cases to warrant government attention. Yet it’s not always the case that people want unlimited choice of providers; some are more willing to trade broad choice of providers for lower premiums and out-of-pocket costs when they do not have established medical relationships or when their finances are strained. Erosion of provider choice and narrow networks may be more pronounced in certain sectors of the health-care system. Some plans in the ACA marketplaces have sought to keep premiums down by narrowing provider networks, as have some Medicaid managed-care plans. Kaiser polling has found that people value no feature of their health insurance plans more than their ability to see the doctors they want without paying more. The fact that doctor choice has not been widely compromised to date does not mean that the public would stand for broad restrictions on choice in the future. Choice of doctor and especially the ability to keep your doctor if you have one remain a third rail in U.S. health care for anyone proposing reforms.
[post_title] => What New Data Tell Us About Doctor Choice [post_excerpt] => Drew Altman explores the rhetoric versus reality on whether choice of doctors is eroding and why the issue resonates with Americans, in this column for The Wall Street Journal's Think Tank. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => what-new-data-tell-us-about-doctor-choice [to_ping] => [pinged] => [post_modified] => 2017-02-06 17:31:13 [post_modified_gmt] => 2017-02-06 22:31:13 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=175987 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 6 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 179114 [post_author] => 36621681 [post_date] => 2016-03-17 19:47:56 [post_date_gmt] => 2016-03-17 23:47:56 [post_content] =>
This was published as a Wall Street Journal Think Tank column on March 17, 2016.
Kaiser Family Foundation chart of February polling on Americans' concerns over the safety of the water supply in their community.
Michigan Gov. Rick Snyder and Environmental Protection Agency administrator Gina McCarthy testified before the House Committee on Oversight and Government Reform on Thursday about the contaminated water in Flint, Mich., and state and federal regulation of the water supply. Most Americans say they have been following the issue, and many say they are worried about drinking-water safety, polling has found. As with many issues in our country, the poorer people are, the more worried they are likely to be that the system will fail them and their family. In the Kaiser Family Foundation’s Health Tracking Poll in February, nearly two-thirds (64%) of Americans reported closely following news about unsafe levels of lead in the water supply to Flint, Mich. A similar share said that they have heard or read a lot (34%) or some (28%) about it. As the chart above shows, about half of all Americans (47%) say they are concerned about the safety of the water supply in their own community, and 27% say they are very concerned. People with lower incomes are the most worried: 37%, or more than a third, of people earning less than $40,000 a year say they are very concerned about the water supply in their own community, compared with 12% of those who earn $90,000 or more.
 It’s hard to say whether news of the contamination of Flint’s water supply exposed a public worry that lurked beneath the surface or triggered new concerns about something that most people had taken for granted. There is a legitimate debate in this country about the role of government generally, but few argue about government’s obligation to provide safe drinking water. When government fails at this most basic job, the public notices. And when government fails a low-income and heavily-minority community such as Flint, it touches a nerve in other low-income areas across the country.
[post_title] => Flint, Michigan, Water Contamination and Anxiety Closer to Home [post_excerpt] => In this Wall Street Journal Think Tank, Drew Altman discusses polling data about the public’s concern about the water crisis in Flint, Michigan, and the deep concern in low income communities. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => flint-michigan-water-contamination-and-anxiety-closer-to-home [to_ping] => [pinged] => [post_modified] => 2017-02-06 17:01:44 [post_modified_gmt] => 2017-02-06 22:01:44 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=179114 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 159 [max_num_pages] => 27 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => [is_tag] => [is_tax] => [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => 1 [is_404] => [is_embed] => [is_paged] => 1 [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => 4b7c2ddaff8a265c76ffeafcbc11b69e [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [stopwords:WP_Query:private] => [compat_fields:WP_Query:private] => Array ( [0] => query_vars_hash [1] => query_vars_changed ) [compat_methods:WP_Query:private] => Array ( [0] => init_query_flags [1] => parse_tax_query ) )

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.