Filling the need for trusted information on national health issues…

What’s the Political Power of Those Newly Insured Under Obamacare?

In this column for The Wall Street Journal’s Think Tank, Drew Altman takes a look at whether the 17 million people newly-insured since 2014 will make an impact in the first presidential election since Affordable Care Act enrollment began.

Column/Op-Ed Read Post

Why Painkiller Addiction and Abuse Are Rising Health-Care Priorities

In this column for The Wall Street Journal’s Think Tank, Drew Altman uses new polling to explore why painkiller abuse and addiction is rising as a health issue among state and federal policymakers.

Column/Op-Ed Read Post

Health Care and the 2016 Debates

In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses the lack of attention to health in the primary debates and last week’s Democratic forum in South Carolina.

Column/Op-Ed Read Post

GOP Views of Medicaid Expansion Differ From Conventional Wisdom

In this column for The Wall Street Journal’s Think Tank, Drew Altman examines Republican attitudes on Medicaid expansion in light of the election of Republican Matt Bevin as Kentucky’s next governor.

Column/Op-Ed Read Post

The Good and Bad of Those Ubiquitous Drug Ads

In this column for The Wall Street Journal’s Think Tank, Drew Altman examines the public’s mixed views about prescription drug ads and their impact on prescribing patterns, based on a new survey.

Column/Op-Ed Read Post

Covering the Remaining Uninsured: Not Just a Red-State Issue

In this column for The Wall Street Journal’s Think Tank, Drew Altman explains why covering the nation’s remaining uninsured population is more than just a red state issue.

Column/Op-Ed Read Post
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                    [post_content] => This was published as a Wall Street Journal Think Tank column on December 3, 2015.


dawsj120315

Kaiser Family Foundation data on voter registration and party identification among the uninsured and newly insured.

An estimated 17 million uninsured have been covered by the Affordable Care Act. As that number grows in the coming years, it could have political implications: How will the newly insured behave at the ballot box? Will they vote? Will they become a Democratic constituency? The ACA may be an issue in the 2016 elections, but the newly insured are unlikely to become an important electoral factor themselves.

One potential indicator of future behavior is how the newly insured behaved politically when they didn’t have health coverage. As the chart above shows, in 2015 slightly more than half of the uninsured (52%) reported that they were registered to vote; among those with insurance coverage, more than three-quarters, or 77%, were registered. We have known for a long time that the uninsured are among the least likely to vote. Perhaps more surprising, while the uninsured shade Democratic as a group, they are a reasonably heterogeneous. Twenty-seven percent of the uninsured report that they are Democrats, 13% Republicans, and 36% call themselves independents. The largest share of uninsured independents describe themselves as not leaning Republican or Democratic. These uninsured independents are the most likely to be disengaged from the political process.

We also know that the uninsured are slightly less favorable toward the ACA than is the public overall. This may seem counterintuitive, as the uninsured benefit most from the ACA. But there are several reasons: By definition the uninsured have not yet been helped; they generally believe that coverage will not be affordable because it never has been before; they may not know that they can get help paying for it under the ACA; and they face a penalty if they do not purchase coverage.

Surveys have found that most of the previously uninsured like their coverage–a Kaiser Family Foundation poll found that 76% do–but it’s not known whether appreciation for that coverage will be a factor when they vote or if they will vote in significant numbers. It is a fair bet that in the short term the newly insured will behave politically much like the uninsured have: Many will not vote, and they will continue to represent a very small slice of the electorate.

Since the days of Republican opposition to Lyndon Johnson‘s Great Society programs–and even before that–many in the GOP have opposed Democratic social programs on policy grounds and because they perceived them as mobilizing liberal advocacy efforts and potentially strengthening Democratic governors, mayors, and other elected officials who could use the support to build larger constituencies. ACA health coverage is different; it’s a direct entitlement to qualified individuals. Unlike those earlier programs, the ACA’s coverage expansion would not seem to present a similar political threat for Republicans or a political tool for Democrats. Over the longer term, however, people with ACA coverage may come to see Democrats as better protectors of their coverage than Republicans, much as seniors do of Medicare coverage, although that has not always translated into support for Democrats at the ballot box.

There is overwhelming evidence that coverage matters to health access and economic security for people who are newly insured. But neither the newly insured or the remaining uninsured are likely to play a significant role at the ballot box anytime soon.
                    [post_title] => What's the Political Power of Those Newly Insured Under Obamacare?
                    [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman takes a look at whether the 17 million people newly-insured since 2014 will make an impact in the first presidential election since Affordable Care Act enrollment began.
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                    [post_content] => This was published as a Wall Street Journal Think Tank column on November 24, 2105.



dawsj112415

Kaiser Family Foundation November 2015 tracking polling results of share of Americans who report a personal connection to painkiller abuse and addiction or know someone who has such an addiction.

Discussion of health care in this country has been dominated by Obamacare since debate about the law began in earnest before its passage in 2010. Now other issues such as rising drug prices and deductibles are edging onto the agenda. This was apparent last week when United Health Care said it would consider pulling out of the insurance marketplaces and a Department of Health and Human Services forum on drug prices also made headlines. A third issue may be joining the others as a top-tier health topic at the state and federal levels: the problem of painkiller and heroin abuse and addiction. Governors and candidates are paying more and more attention to this growing health problem.

The latest Kaiser Family Foundation tracking poll, published Tuesday, looked at this issue, which touches a remarkably broad share of the public. As the chart above shows, more than half of Americans know someone who has died from an overdose of painkillers, have been addicted themselves or know someone who has been addicted, or know someone who has taken painkillers that were not prescribed for them. More than a quarter of the public (27%) say that they or someone close to them has been addicted, and 9% have a family member or close friend who has died from an overdose of painkillers.

One reason this problem is gaining political traction is that it affects a broad cross-section of society. By a significant margin (63%), whites are more likely to report a personal connection to the problem than blacks (44%) or Hispanics (37%).

This is a very different kind of issue than the ACA or rising drug prices and deductibles. It is far less partisan and both more personal and relatable for the public than the intricacies of the Affordable Care Act. Painkiller abuse and other drug abuse and addiction are also problems that can be addressed at the state and local levels, unlike covering the uninsured or controlling rising drug prices.

Our poll found that, across all 50 states, reducing painkiller and heroin abuse ranked in the middle of the public’s priorities for their governors and legislatures. Several governors have declared painkiller and heroin abuse a crisis in their states, and a poll in New Hampshire published last month found it to be the Granite State’s top priority, even ahead of the economy and education.

Painkiller abuse and addiction are rising issues in a health agenda that is now somewhat less dominated by the Affordable Care Act. As the national discussion of health care becomes more multifaceted, will elected officials have the bandwidth to take on yet another big health problem? Many governors seem to feel that they have no choice.
                    [post_title] => Why Painkiller Addiction and Abuse Are Rising Health-Care Priorities
                    [post_excerpt] => In this column for The Wall Street Journal’s Think Tank, Drew Altman uses new polling to explore why painkiller abuse and addiction is rising as a health issue among state and federal policymakers.
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                    [post_content] => This was published as a Wall Street Journal Think Tank column on November 11, 2015.

Until Carly Fiorina criticized Obamacare during Tuesday’s prime-time Republican debate, there hadn’t been much attention to health care in the GOP debates. During last week’s Democratic candidate forum in South Carolina, I didn’t detect a single question about health care or the Affordable Care Act. This is not a knock on hosts and moderators; debates and forums such as the Democratic meeting last week are not the best vehicles for drawing out presidential candidates on the intricacies of health policy. The result, however, is that the public is not learning much from these widely viewed events about what candidates would do regarding one of the country’s most divisive issues should he or she be elected president.

And against that backdrop, some things are notable:

There are big differences between former Secretary of State Hillary Clinton and Sen. Bernie Sanders on health care. Mrs. Clinton favors building on the ACA and, actually, going further with a set of pro-consumer proposals that would take on rising out-of-pocket costs and drug expenses. She is aggressively taking on the drug and insurance industries. Mr. Sanders, by contrast, supports a Medicare-for-all single-payer health-care system, which would represent a far more sweeping change. He mentioned single-payer and Medicaid expansion in response to a question from Rachel Maddow at last week’s forum about how his agenda was relevant to African Americans. His Web site includes a petition that people can sign to support single-payer (and his candidacy), but the document does not lay out a single-payer plan. It describes two other health proposals: one to lower prescription drug costs and another to improve care for veterans. Former Maryland Gov. Martin O’Malley doesn’t feature a health plan on his Web site.

Among Republicans, Jeb Bush, Marco Rubio, and Bobby Jindal have plans for health-care reform, but it’s hard for moderators to single out their proposals for scrutiny amid so many candidates on stage, and with every one of them supporting repeal of the ACA.

Health care won’t disappear from the 2016 primaries altogether. All the Democratic candidates will discuss it on the campaign trail, regardless of whether it is a focus of nationally televised debates and forums. And speculation about whether the election of Republican Matt Bevin in Kentucky’s gubernatorial race last week constitutes a rejection of Obamacare in a state previously viewed as an ACA success story in the South may become a talking point in future Republican debates. It will be a while–probably not until the general election–before a clear and substantive contrast between the two sides on health re-emerges as a focus in campaign debates; when that happens, the contrast promises to be sharp. The eventual Democratic nominee may run against policy ideas expected from House Republicans such as Medicare premium support or Medicaid block grants. In the past, Democrats have had some success portraying these as threats to Medicare and Medicaid. Of course, Republicans in the House will reject those criticisms, and they may decide to wait until after next November to put forward specific plans in an effort to deny Democrats an election issue. [post_title] => Health Care and the 2016 Debates [post_excerpt] => In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses the lack of attention to health in the primary debates and last week's Democratic forum in South Carolina. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => health-care-and-the-2016-debates [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:42:46 [post_modified_gmt] => 2017-02-06 21:42:46 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=169347 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 168699 [post_author] => 36621681 [post_date] => 2015-11-04 11:38:06 [post_date_gmt] => 2015-11-04 16:38:06 [post_content] => This was published as a Wall Street Journal Think Tank column on November 4, 2015. dawsj110415 Kaiser Family Foundation polling in December 2014 found that many Republicans in states that have not expanded Medicaid have favorable views of expansion. We don’t know yet whether Republican Matt Bevin, who was elected governor of Kentucky on Tuesday, will try to abolish the Medicaid expansion put in place by outgoing Gov. Steve Beshear (D.), attempt to cap enrollment, or do nothing at all. But his election sets up new discussion of Republican attitudes toward Medicaid expansion. Thirty states have expanded Medicaid under the Affordable Care Act since the Supreme Court made it a state option in 2012. Ten of them have Republican governors, two of whom are presidential candidates, John Kasich and Chris Christie. If, however, you follow campaign commentary on cable TV you would think expanding Medicaid is a political black mark in the eyes of all Republicans. To be sure, the most activated elements of the GOP base–conservative campaign contributors, super PACs, and conservative legislators–oppose Medicaid expansion, primarily because they see it more as embracing Obamacare than providing federal funding to states to help them expand coverage for low-income residents. But the limited polling the Kaiser Family Foundation has done on the issue has found that most Republicans do not oppose Medicaid expansion. In fact, they favor it. In a December 2014 poll, 52% of Republicans said they had a favorable view of Medicaid expansion, 44% had an unfavorable view, and 3% did not voice an opinion. In the same poll, as the chart above shows, 56% of Republicans in states that had not expanded Medicaid had a very favorable (23%) or somewhat favorable (33%) view of expansion. This survey was conducted too far in advance of the 2016 primary elections to poll likely Republican voters. Views were also different in two strongly anti-expansion states in polling Kaiser did with the New York Times in 2014. A majority of Republicans in Louisiana (66%) and North Carolina (53%) preferred that their state keep Medicaid as is. We don’t know from the polling why most Republicans say they support expansion. Gov. Kasich has argued that expansion is a moral imperative and that he sees it as broadening Ohio’s Medicaid program rather than embracing Obamacare, which he opposes. We do know that 47% of Republicans in a May 2015 poll said Medicaid was a very important program; only 14% said it is not an important program. But that is far fewer than the 69% who said Medicare was a very important program. As might not be surprising, given their generally higher income levels, fewer Republicans (35%) than Democrats (61%) say Medicaid is important to them or their family. That even a slim majority of Republicans favor expansion is notable given the tone of debate on this issue on the campaign trail, where expansion has become like a third rail for GOP candidates. This is not to suggest that Republican candidates or governors who oppose Medicaid expansion in conservative states will be anxious to flip any time soon. But Medicaid may not be as unpopular with Republicans overall as the conventional wisdom suggests, and other issues may be more salient for Republican voters in primary and general elections across the country than opposition to Medicaid expansion. [post_title] => GOP Views of Medicaid Expansion Differ From Conventional Wisdom [post_excerpt] => In this column for The Wall Street Journal’s Think Tank, Drew Altman examines Republican attitudes on Medicaid expansion in light of the election of Republican Matt Bevin as Kentucky’s next governor. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => gop-views-of-medicaid-expansion-differ-from-conventional-wisdom [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:45:38 [post_modified_gmt] => 2017-02-06 21:45:38 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=168699 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 168125 [post_author] => 48746306 [post_date] => 2015-10-28 09:03:44 [post_date_gmt] => 2015-10-28 13:03:44 [post_content] => This was published as a Wall Street Journal Think Tank column on October 28, 2015. We’ve all seen the drug ads on TV and elsewhere. Drug X will make you feel better and help you take control of your life. But almost every drug seems to have an impossibly long list of potential side effects, including in a small number of cases the scariest ones like cancer or death. A new survey of the public out Wednesday suggests the impact of drug ads may be both good and bad. A significant number of people go to their doctors and ask for a specific drug because they’ve seen an ad, but only some people get the drugs after their physicians sort through treatment options with them. Based on a survey of the public, we can’t say how often this is a good thing or a bad thing medically; we almost certainly can say that more drugs are prescribed as a result of the ads. dawsj102815 As the chart shows, 82% of the American people say they have seen a drug ad, and about three in 10 say they have talked with a doctor about the advertised drug. However, doctors don’t automatically prescribe the drug: 15% of those surveyed say the doctor recommended changes in behavior or lifestyle; 14% say the doctor recommended a different prescription drug; 11% say the doctor recommended an over-the-counter option; and 12% say the doctor gave them the drug they saw in the ad. Half of the public (51%) thinks drug ads are mostly a good thing even as most–about six in 10–think the drug companies spend too much on advertising. But the public has mixed views about how informative they think the ads are. Half say the ads do a good job of telling consumers which condition the drug is actually designed to treat; 47% that they tell consumers about the benefits of the drug; and 44% about side effects. Just 24% say they tell consumers how effective the drug is compared to other treatments and just 11% say they are good at telling consumers about their typical cost. It’s a mixed picture on drug ads and we don’t have enough information to say if we would be better off with or without them. But in the end, the public would like greater assurance that drug ads are accurate. A striking 89% of the public, including 90% of Republicans, would like the FDA to review drug ads for accuracy and clarity before they run, which the FDA does not do today. [post_title] => The Good and Bad of Those Ubiquitous Drug Ads [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman examines the public’s mixed views about prescription drug ads and their impact on prescribing patterns, based on a new survey. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-good-and-bad-of-those-ubiquitous-drug-ads [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:50:17 [post_modified_gmt] => 2017-02-06 21:50:17 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org?p=168125&post_type=perspective&preview_id=168125 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 167007 [post_author] => 36621681 [post_date] => 2015-10-14 17:29:59 [post_date_gmt] => 2015-10-14 21:29:59 [post_content] => This was published as a Wall Street Journal Think Tank column on October 14, 2015. dawsj101415 Kaiser Family Foundation analysis of 2015 Current Population Survey data on eligibility for Medicaid or tax credits among the uninsured in California and Texas. About 32 million people in the U.S. remained uninsured as of early 2015, a Kaiser Family Foundation analysis of federal survey data has found, with about half of them eligible for Medicaid or subsidies under the Affordable Care Act. With the high-profile resistance in some states to Medicaid expansion and the ACA generally, you may think those places are the main obstacle to covering more of the uninsured. But the uninsured remain a problem in both red and blue states. About half of the remaining uninsured, 16 million people, are in mostly blue states that have expanded Medicaid. The other 16 million are in states that have not expanded Medicaid and where there is strong anti-ACA sentiment. Consider the examples of California and Texas, the states with the largest populations of remaining uninsured, to understand the different challenges. There were 3,845,000 uninsured in California, a famously blue state, in early 2015. The largest share of those, about 1,428,000, were eligible for Medicaid but not enrolled; 623,000 were eligible for federal tax credits to help purchase coverage in the Covered California marketplace; and 1,795,000 were ineligible because of their immigration status, or an offer of insurance through work, or because their incomes were too high to qualify for assistance. There is no “Medicaid gap” in California. The state has expanded its Medicaid program, called Medi-Cal, under the ACA. The 1.4 million residents eligible for Medi-Cal but not enrolled represent the largest opportunity to extend coverage to a low-income population. But California is already struggling to pay for unexpected and unbudgeted Medicaid enrollment. Proposals in the legislature would make undocumented residents eligible for Medicaid at state expense, but the legislation’s prospects are unclear. Next year California will begin extending Medi-Cal coverage to about 170,000 undocumented immigrant youths up to age 19. Now consider Texas, where there were 4,425,000 uninsured in 2015, the largest uninsured population in any state. Of those, 495,000 were eligible for Medicaid and more than twice that many–1,035,000 people–were eligible for tax credits. About 2,132,000 of the uninsured in Texas were ineligible for ACA assistance, and 766,000 were in the “coverage gap.” Texas is an anti-ACA state that has resisted expanding Medicaid. Aggressive outreach by community organizations and insurers to provide federally funded tax credits to the 1 million eligible Texans to help them purchase coverage on the federally operated marketplace would seem to be the best opportunity to expand coverage in that state, unless political changes create a more favorable environment for Medicaid expansion. Some elements of the remaining uninsured problem are uniquely a red state issue. The most prominent of these are 3.1 million people—or one in 10 of the uninsured—who fall in the “coverage gap” in 20 red states that have chosen not to expand Medicaid coverage.  But as the examples of Texas and California demonstrate, progress on covering the remaining 32 million uninsured will depend on action in both red and blue states. [post_title] => Covering the Remaining Uninsured: Not Just a Red-State Issue [post_excerpt] => In this column for The Wall Street Journal’s Think Tank, Drew Altman explains why covering the nation’s remaining uninsured population is more than just a red state issue. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => covering-the-remaining-uninsured-not-just-a-red-state-issue [to_ping] => [pinged] => [post_modified] => 2017-02-06 16:54:01 [post_modified_gmt] => 2017-02-06 21:54:01 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=167007 [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] => 171665 [post_author] => 36621681 [post_date] => 2015-12-03 07:03:13 [post_date_gmt] => 2015-12-03 12:03:13 [post_content] => This was published as a Wall Street Journal Think Tank column on December 3, 2015. dawsj120315 Kaiser Family Foundation data on voter registration and party identification among the uninsured and newly insured. An estimated 17 million uninsured have been covered by the Affordable Care Act. As that number grows in the coming years, it could have political implications: How will the newly insured behave at the ballot box? Will they vote? Will they become a Democratic constituency? The ACA may be an issue in the 2016 elections, but the newly insured are unlikely to become an important electoral factor themselves. One potential indicator of future behavior is how the newly insured behaved politically when they didn’t have health coverage. As the chart above shows, in 2015 slightly more than half of the uninsured (52%) reported that they were registered to vote; among those with insurance coverage, more than three-quarters, or 77%, were registered. We have known for a long time that the uninsured are among the least likely to vote. Perhaps more surprising, while the uninsured shade Democratic as a group, they are a reasonably heterogeneous. Twenty-seven percent of the uninsured report that they are Democrats, 13% Republicans, and 36% call themselves independents. The largest share of uninsured independents describe themselves as not leaning Republican or Democratic. These uninsured independents are the most likely to be disengaged from the political process. We also know that the uninsured are slightly less favorable toward the ACA than is the public overall. This may seem counterintuitive, as the uninsured benefit most from the ACA. But there are several reasons: By definition the uninsured have not yet been helped; they generally believe that coverage will not be affordable because it never has been before; they may not know that they can get help paying for it under the ACA; and they face a penalty if they do not purchase coverage. Surveys have found that most of the previously uninsured like their coverage–a Kaiser Family Foundation poll found that 76% do–but it’s not known whether appreciation for that coverage will be a factor when they vote or if they will vote in significant numbers. It is a fair bet that in the short term the newly insured will behave politically much like the uninsured have: Many will not vote, and they will continue to represent a very small slice of the electorate. Since the days of Republican opposition to Lyndon Johnson‘s Great Society programs–and even before that–many in the GOP have opposed Democratic social programs on policy grounds and because they perceived them as mobilizing liberal advocacy efforts and potentially strengthening Democratic governors, mayors, and other elected officials who could use the support to build larger constituencies. ACA health coverage is different; it’s a direct entitlement to qualified individuals. Unlike those earlier programs, the ACA’s coverage expansion would not seem to present a similar political threat for Republicans or a political tool for Democrats. Over the longer term, however, people with ACA coverage may come to see Democrats as better protectors of their coverage than Republicans, much as seniors do of Medicare coverage, although that has not always translated into support for Democrats at the ballot box. There is overwhelming evidence that coverage matters to health access and economic security for people who are newly insured. But neither the newly insured or the remaining uninsured are likely to play a significant role at the ballot box anytime soon. [post_title] => What's the Political Power of Those Newly Insured Under Obamacare? [post_excerpt] => In this column for The Wall Street Journal's Think Tank, Drew Altman takes a look at whether the 17 million people newly-insured since 2014 will make an impact in the first presidential election since Affordable Care Act enrollment began. 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