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Candidate Policy Plans Resonate More With Democrats. Here’s Why.

In this column for The Wall Street Journal’s Think Tank, Drew Altman examines whether there is a difference between Democratic and Republican voters when it comes to how much they care about candidates’ policy plans.

Column/Op-Ed Read Post

In N.Y. Policy on Out-of-Network Medical Bills, a Model for Other States?

In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses surprise bills for out-of-network care, and New York state’s solution to the problem.

Column/Op-Ed Read Post

How Health-Care Bills Hinder Millions of Americans

In this column for The Wall Street Journal’s Think Tank, Drew Altman examines the problems many Americans with health insurance are having paying medical bills based on a new Kaiser-New York Times Survey, and discusses why the issue of the adequacy of insurance coverage is gaining traction.

Column/Op-Ed Read Post

How High Drug Prices Weigh on the Sickest Americans

In this column for The Wall Street Journal’s Think Tank, Drew Altman explores the data behind public concern about prescription drug costs and highlights that the people most in need are the most burdened by the problem.

Column/Op-Ed Read Post

Bernie Sanders, Hillary Clinton, and Medicare for All

In this column for The Wall Street Journal’s Think Tank, Drew Altman explores the differing positions of presidential candidates Hillary Clinton and Bernie Sanders on a single payer or Medicare-for-all health care system and whether Democratic voters consider it an important factor in the 2016 primaries.

Column/Op-Ed Read Post

Prescription Drugs’ Sizable Share of Health Spending

In this column for The Wall Street Journal’s Think Tank, Drew Altman explains why prescription drug spending may be a larger share of health spending than most people think, depending on how you look at it.

Column/Op-Ed Read Post
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This was published as a Wall Street Journal Think Tank column on January 26, 2016.
Former Secretary of State Hillary Clinton and Sen. Bernie Sanders continue to spar over health care and Mr. Sanders’s single-payer plan. Have you noticed that Republican presidential candidates have spent far less time debating differences between their proposals? One reason: Republicans care less about detailed policy plans than do Democrats. As the chart above shows, 61% of registered Democrats say candidates’ detailed policy plans–on health care or other topics–matter to their vote, and 35% say a candidate’s general values and approach to government matters more. For Republicans it’s the reverse: 51% care most about a candidate’s general values and approach to government, and 45% prioritize their policy plans.
It could be that Republicans are more ideological and values-oriented and less focused on policy plans. Another, and simpler, explanation is that Republicans want government to do less than Democrats want government to do so they care somewhat less about plans for government action. Republican presidential candidates are also competing to appeal to elements of a conservative base most likely to vote; detailed policy plans are unlikely to be the best way to gain support in the primaries.
Even if detailed plans matter less to Republican voters, sometimes a controversial policy idea from a Republican candidate can grab attention and become the focus of debate, as has happened with Donald Trump‘s suggestions to build a wall between the U.S. and Mexico and to temporarily ban Muslims from entering the U.S. When both parties have nominees and the campaign moves into the general election, the candidates will face greater pressure to produce policy plans on major issues, such as immigration, global warming, and health care, and how to address terrorism and Islamic State. There will be a greater appetite among the electorate for such proposals. Overall, 55% of registered voters say that it matters more to them if a candidate has a detailed plan to address issues they care about than a candidate’s general values and approach to government, vs. 40% saying they care more about general candidate characteristics than policy plans. Independents align more with Democrats than Republicans when it comes to their affection for policy plans. Journalists sometimes struggle with the lack of detail in plans issued by campaigns. For the media, there is a balancing act in taking candidate plans seriously while knowing that proposals can be derailed or substantially changed when they get to Congress. Having watched many debates over health care in election campaigns, I have come to suspect that when fights erupt over the details of policy plans, it’s not the particulars of a plan that matter so much to voters but what voters perceive those plans and details as signaling about the candidates themselves.
[post_title] => Candidate Policy Plans Resonate More With Democrats. Here’s Why. [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman examines whether there is a difference between Democratic and Republican voters when it comes to how much they care about candidates’ policy plans. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => candidate-policy-plans-resonate-more-with-democrats-heres-why [to_ping] => [pinged] => [post_modified] => 2017-02-06 17:34:04 [post_modified_gmt] => 2017-02-06 22:34:04 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=175250 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 173932 [post_author] => 36621681 [post_date] => 2016-01-11 11:22:25 [post_date_gmt] => 2016-01-11 16:22:25 [post_content] =>
This was published as a Wall Street Journal Think Tank column on January 11, 2016.
Medical bills for out-of-network providers can surprise consumers with thousands of dollars in costs they didn’t plan for and sometimes cannot afford. I’m among those who have experienced this surprise despite efforts to determine that all my health-care providers are in-network. As the chart above shows, a significant share of people who had problems paying medical bills say that the issue was charges for providers they did not know were out of network. New York state has a solution to this problem that bears watching. Under the New York policy, patients who are surprised by out-of-network bills pay only the amount of their regular in-network cost-sharing provided they fill out a form authorizing the provider to bill the insurer for the remaining amount. Emergency-care patients are held harmless from out-of-network surprise bills. Self-insured employer plans, which represent a significant share of larger employers, are not bound by the policy. Other aspects of the policy, including an arbitration process for providers and insurers, are described in a new analysis of surprise medical bills by the Kaiser Family Foundation. The key is that providers in New York are prevented from billing consumers for an outstanding balance if a patient discovers after receiving care that providers–say, an anesthesiologist or an assisting surgeon–are not in-network. New York’s approach won’t entirely do away with “balance billing,” but it places the onus on providers and insurers, not consumers, to work out who will pay surprise bills for out-of-network care and how much will be paid. Among the questions raised: Will patients understand the process and be able to follow it? Will the policy lead to fights between insurers and providers over payment rates for out-of-network care? Will costs be passed back to employers and consumers in other ways? How will provider participation in networks be affected? Time will tell about answers to these questions and whether this consumer-first approach to a problem that strikes patients as patently unfair is a model for other states.
[post_title] => In N.Y. Policy on Out-of-Network Medical Bills, a Model for Other States? [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman discusses surprise bills for out-of-network care, and New York state's solution to the problem. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => in-n-y-policy-on-out-of-network-medical-bills-a-model-for-other-states [to_ping] => [pinged] => [post_modified] => 2017-02-06 17:36:20 [post_modified_gmt] => 2017-02-06 22:36:20 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=173932 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 173412 [post_author] => 36621681 [post_date] => 2016-01-05 16:08:07 [post_date_gmt] => 2016-01-05 21:08:07 [post_content] =>
This was published as a Wall Street Journal Think Tank column on January 5, 2016.
The adequacy of health insurance coverage–sometimes called under-insurance–pops up periodically, but the issue has taken a back seat to covering the uninsured and controlling health-care costs. Yet the number of Americans who have problems paying their medical bills in a given year runs into the tens of millions, a survey conducted by the Kaiser Family Foundation and the New York Times found. These are not only people who are uninsured, have low incomes, or are very sick. For many, their uncovered medical expenses affect their ability to meet other basic needs–such as paying for housing, food, or heat–or make it tough for them to pay other bills. As the chart above shows, large shares of the uninsured (53%), the disabled (47%), and people who earn less than $50,000 a year (37%) experienced problems paying medical bills in the last year, as have 26% of those earning $50,000 to $100,000. Significant shares of people who have private insurance with high-deductible plans (26%) and those with private insurance overall (19%) report problems with medical bills in the last 12 months. Among those who experienced problems paying medical bills, 66% say it was for one-time or short-term events–making it difficult to plan ahead for the expense–with the biggest bills going for emergency-room visits and hospital care. Forty-two percent of those with medical-expense problems had bills of $2,500 to $10,000; a separate 13% had bills of $10,000 or more. Charges from out-of-network providers contributed to problems with medical bills about a third of the time, and the majority of people who struggled with out-of-network bills said they did not know the health-care provider was not in their plan’s network at the time they received care. The impact of medical bills can be felt across family budgets. Three in 10 people (35%) said they could not pay for other basic needs such as housing, food, or heat because of their medical bills. Sixty-one percent said the expenses made it harder to pay their other bills. People with medical debt also put off health care for fear of running up more bills. For example, 43% say they did not fill a prescription in the last 12 months because of the cost, about three times the share (14%) of those who did not fill a prescription but did not have bill problems. Slightly less than half of people with problems paying medical bills (47%) also have trouble paying other bills, but some have no problems besides their medical bills (31%) or have had other bill problems only because they needed to pay their medical bills (19%). The Affordable Care Act has insured millions of previously uncovered Americans, improving their financial security and access to health care while establishing new rules for coverage that guarantee many people far better financial protection and more comprehensive benefits. Problems with medical bills would be significantly worse without the ACA. But adequacy of health insurance will become more pressing with so many Americans experiencing problems paying medical bills each year and as deductibles and other forms of cost sharing continue to increase.
[post_title] => How Health-Care Bills Hinder Millions of Americans [post_excerpt] => In this column for The Wall Street Journal’s Think Tank, Drew Altman examines the problems many Americans with health insurance are having paying medical bills based on a new Kaiser-New York Times Survey, and discusses why the issue of the adequacy of insurance coverage is gaining traction. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => how-health-care-bills-hinder-millions-of-americans [to_ping] => [pinged] => [post_modified] => 2017-02-06 17:38:47 [post_modified_gmt] => 2017-02-06 22:38:47 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=173412 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 173232 [post_author] => 36621681 [post_date] => 2015-12-28 09:23:42 [post_date_gmt] => 2015-12-28 14:23:42 [post_content] => This was published as a Wall Street Journal Think Tank column on December 28, 2015. dawsj122815 Kaiser Family Foundation findings of health status among those who take prescription drugs and the share of those who take prescription drugs and have trouble paying for them. The more drugs people take and the sicker they are, the more likely they are to experience problems paying for prescription medicines–or to forgo them altogether because of cost. It may not be surprising that people who use more drugs have the greatest problems paying for them. It’s also never a good thing when people with the greatest need struggle the most to pay for health care. Eighty percent of people who are in excellent, very good, or good health and who are currently taking prescription medicine say it is easy or somewhat easy to pay for their prescription drugs, Kaiser Family Foundation polling has found. But, as the chart above shows, 43% of people in fair or poor health and 38% of those taking four or more drugs a year say it is somewhat or very difficult to pay for their medications. An identical 43% of those in fair or poor health and 35% of those taking four or more drugs say they did not fill a prescription or say they cut pills in half or skipped doses because of cost. The pattern holds for seniors on Medicare as well. Twenty percent of seniors taking prescription medicine report difficulty paying for their drugs. Among seniors taking four or more medications, the share rises to 29%. A relatively small number of people on Medicare also take high-priced specialty-tier drugs that have been in the news. Even when a specialty medication is covered by a Medicare drug plan, patients can pay thousands of dollars out of pocket for just one drug unless they get cost assistance from government or a drug company. While insurance companies and drug companies tussle over the high cost of drugs and policy makers debate potential actions, the fact that people with the greatest needs bear the brunt of high drug prices adds urgency to the problem. [post_title] => How High Drug Prices Weigh on the Sickest Americans [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman explores the data behind public concern about prescription drug costs and highlights that the people most in need are the most burdened by the problem. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => how-high-drug-prices-weigh-on-the-sickest-americans [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:37:40 [post_modified_gmt] => 2017-02-06 21:37:40 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=173232 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 173050 [post_author] => 36621681 [post_date] => 2015-12-20 11:40:48 [post_date_gmt] => 2015-12-20 16:40:48 [post_content] => This was published as a Wall Street Journal Think Tank column on December 20, 2015.dawsj122015 Kaiser Family Foundation data from December polling on Democrats’ views of Medicare for all. A skirmish broke out recently between Hillary Clinton and Bernie Sanders about the merits of single-payer health care, an idea that Mr. Sanders has long advocated. The candidates jousted about the financing of single-payer health care during the Democratic debate Saturday night. The differences between the two candidates on single-payer health care paint Mrs. Clinton as more moderate and Mr. Sanders as more liberal (no surprise there). The question is: Do any Democratic primary votes turn on this issue? Single-payer health care and the Medicare-for-all variant of the idea has generally been popular among the left, but not many votes will be moved by this issue alone. Most Democrats either strongly favor (52%) or somewhat favor (24%) the general idea of Medicare for all. Meanwhile, 62% of Republicans either strongly or somewhat oppose the idea. But, as the chart above shows, even though single payer has long been a cause celebre for many on the left, just 5% of Democrats are pure “single-payer voters” who favor Medicare for all and say that the candidate’s stand on the issue will be the single most important factor in their vote. Thirty-four percent say it would be an important factor but not the most important, and 36% say that it would be just one of many factors they would consider. The poll did not test how much support for Medicare for all might diminish among Democrats in the face of arguments for and against the idea. There is a large body of literature about the role of issues and single-issue voting in U.S. elections. In 2012, Gallup found that 17% of registered voters made a candidate’s position on abortion a litmus-test issue. My sense is that voters perceive a presidential candidate’s positions on issues as signals of the candidate’s beliefs and of the direction he or she will attempt to take the nation if elected. Yet voters focus less on the details of candidate’s policy plans, however much candidates and their staffs may slave over those details or the media may scrutinize them. In his advocacy of Medicare for all, a policy that he recognizes cannot be achieved any time soon, Mr. Sanders is signaling his outside-the-box approach to policy and politics, while in opposing the idea Mrs. Clinton may have been signaling her more practical and incremental approach to achieving policy change. [post_title] => Bernie Sanders, Hillary Clinton, and Medicare for All [post_excerpt] => In this column for The Wall Street Journal’s Think Tank, Drew Altman explores the differing positions of presidential candidates Hillary Clinton and Bernie Sanders on a single payer or Medicare-for-all health care system and whether Democratic voters consider it an important factor in the 2016 primaries. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => bernie-sanders-hillary-clinton-and-medicare-for-all [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:37:15 [post_modified_gmt] => 2017-02-06 21:37:15 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=173050 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 172396 [post_author] => 36621681 [post_date] => 2015-12-13 07:31:56 [post_date_gmt] => 2015-12-13 12:31:56 [post_content] => This was published as a Wall Street Journal Think Tank column on December 13, 2015. dawsj121315Kaiser Family Foundation analysis of data from the Centers for Medicare and Medicaid Services and Truven Health Analytics showing that drugs account for 10% of U.S. health spending but 19% of employer insurance benefits. The cost of prescription drugs is the hot health-care issue, but almost every discussion about it includes this caveat: As big a problem as rising drug prices have been for consumers and payers, drug spending represents only 10% of national spending on health. Yet, as the chart above shows, drug spending represents almost double that share of health spending (19%) in employer health insurance plans. That is not too much less than the 23% employers spend on inpatient hospital care. Why the disparity? First, the $3 trillion in national health spending is a broad catchall that includes hospital care, physician services, drugs, research, administrative costs, public health activities, and long-term care. Second, some of the people served by Medicare and Medicaid, whose spending is counted in the national totals, require lots of services not typically used by those covered by employer health insurance plans. Even that 19% figure is understated. It includes prescriptions that patients fill at pharmacies but not many of the expensive drugs administered in physicians’ offices or hospitals. In Medicare, for example, retail prescription drugs represent 13% of overall spending while drugs administered mainly by physicians add an additional 6%. High drug prices have been in the news because of costly drugs to treat Hepatitis C, among other illnesses, and because elected officials and political candidates have been talking about drug costs. Rising drug prices, expanded coverage of the uninsured under the Affordable Care Act, and an improving economy have also contributed to an uptick in the rate of increase in health spending. But depending on what you count and how you count, drug spending may be an even larger problem than many thought. It clearly is for employers, who foot a large share of the nation’s health-care bills. [post_title] => Prescription Drugs' Sizable Share of Health Spending [post_excerpt] => In this column for The Wall Street Journal’s Think Tank, Drew Altman explains why prescription drug spending may be a larger share of health spending than most people think, depending on how you look at it. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => prescription-drugs-sizable-share-of-health-spending [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:31:53 [post_modified_gmt] => 2017-02-06 21:31:53 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=172396 [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] => 175250 [post_author] => 36621681 [post_date] => 2016-01-26 08:57:17 [post_date_gmt] => 2016-01-26 13:57:17 [post_content] =>
This was published as a Wall Street Journal Think Tank column on January 26, 2016.
Former Secretary of State Hillary Clinton and Sen. Bernie Sanders continue to spar over health care and Mr. Sanders’s single-payer plan. Have you noticed that Republican presidential candidates have spent far less time debating differences between their proposals? One reason: Republicans care less about detailed policy plans than do Democrats. As the chart above shows, 61% of registered Democrats say candidates’ detailed policy plans–on health care or other topics–matter to their vote, and 35% say a candidate’s general values and approach to government matters more. For Republicans it’s the reverse: 51% care most about a candidate’s general values and approach to government, and 45% prioritize their policy plans.
It could be that Republicans are more ideological and values-oriented and less focused on policy plans. Another, and simpler, explanation is that Republicans want government to do less than Democrats want government to do so they care somewhat less about plans for government action. Republican presidential candidates are also competing to appeal to elements of a conservative base most likely to vote; detailed policy plans are unlikely to be the best way to gain support in the primaries.
Even if detailed plans matter less to Republican voters, sometimes a controversial policy idea from a Republican candidate can grab attention and become the focus of debate, as has happened with Donald Trump‘s suggestions to build a wall between the U.S. and Mexico and to temporarily ban Muslims from entering the U.S. When both parties have nominees and the campaign moves into the general election, the candidates will face greater pressure to produce policy plans on major issues, such as immigration, global warming, and health care, and how to address terrorism and Islamic State. There will be a greater appetite among the electorate for such proposals. Overall, 55% of registered voters say that it matters more to them if a candidate has a detailed plan to address issues they care about than a candidate’s general values and approach to government, vs. 40% saying they care more about general candidate characteristics than policy plans. Independents align more with Democrats than Republicans when it comes to their affection for policy plans. Journalists sometimes struggle with the lack of detail in plans issued by campaigns. For the media, there is a balancing act in taking candidate plans seriously while knowing that proposals can be derailed or substantially changed when they get to Congress. Having watched many debates over health care in election campaigns, I have come to suspect that when fights erupt over the details of policy plans, it’s not the particulars of a plan that matter so much to voters but what voters perceive those plans and details as signaling about the candidates themselves.
[post_title] => Candidate Policy Plans Resonate More With Democrats. Here’s Why. [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman examines whether there is a difference between Democratic and Republican voters when it comes to how much they care about candidates’ policy plans. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => candidate-policy-plans-resonate-more-with-democrats-heres-why [to_ping] => [pinged] => [post_modified] => 2017-02-06 17:34:04 [post_modified_gmt] => 2017-02-06 22:34:04 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=175250 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 165 [max_num_pages] => 28 [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] => b52f4c1807d60493cf77451dd226d005 [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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