1. Session 9 May 25, 2011 Balancing Access, Cost and Quality through State and Federal Reform

2. Reform Options  Improve access to private coverage by: Subsidizing/reducing cost; Eliminating barriers; and, Requiring coverage of certain groups.  Improve access to public insurance by: Expand Medicaid/S-CHIP (OHP/Healthy Kids); Increase outreach/enrollment efforts; Create/expand state-only programs.  Expand community-based (safety net) clinics.

3. Improve Access to Private Health Insurance  Premium assistance/private health insurance buy-in programs  Publicly-funded reinsurance for private coverage  Tax incentives  Remove benefit/coverage mandates  High-deductible/consumer-directed plans with MSAs  Group purchasing  Small group rating reforms  Individual health insurance market reforms  Continuation of coverage laws  Expand definition of “Dependent”  Expand eligibility for state employee insurance plans  Employer mandate  Individual mandate (college students)  Require coverage for government contracts/vendors

4. Improve Access to Public Insurance  Increase Medicaid/SCHIP income eligibility levels  Expand Medicaid/SCHIP group eligibility  Establish Medicaid/SCHIP premium assistance or buy-in program  Identify/enroll eligible-but-not-enrolled persons  Establish/expand high-risk pool  Establish state-only health insurance program  Establish universal health insurance plan

5. Improve Access to Direct Care Programs  Expand/shore-up the safety net  Support local coverage initiatives National Conference of State Legislatures, 2004.

6. Most Important Provisions to Pass Into Law Expanding high risk insurance pools Expanding Medicaid to cover more low-income uninsured Creating a health insurance exchange/marketplace Providing tax credits to small businesses Reforming the way health insurance works Percent saying it is “extremely” or “very important” that each element be passed into law: Note: Question wording abbreviated Source: Kaiser Family Foundation Health Tracking Poll (conducted February 11-16, 2010) Allowing insurers to sell policies across state lines Helping close the Medicare “doughnut hole” Establishing a new commission to help reduce Medicare cost growth Limiting awards in malpractice lawsuits Limiting future increases in Medicare provider payments Providing financial help for lower/middle income Allowing kids to stay on parents’ insurance through age 25 Extremely importantVery important

7. Note: Question wording abbreviated. Source: Kaiser Family Foundation Health Tracking Poll (conducted February 11-16, 2010) Areas of Agreement in Health Reform Legislation Total DemocratIndependentRepublican At least six in ten in each group believe important 1. Reforming the way health insurance works76% 85%79%64% 2. Providing tax credits to small businesses72% 77%70%67% 3. Creating a health insurance exchange/marketplace71% 78%71%67% 4. Helping close the Medicare “doughnut hole”71% 78%70%66% 5. Expanding high risk insurance pools70% 79%67%61% At least six in ten in two groups believe important 6. Providing financial help for low/middle income68%88%64%48% Percent saying it is “extremely” or “very important” that each element be passed into law:

8. Percent who say hearing the proposed legislation would do each of the following makes them MORE likely to support it: Health insurance exchange Won’t change most people’s existing arrangements Tax credits to small businesses Most Popular Elements Guaranteed issue Note: Question wording abbreviated. See Topline: http://www.kff.org/kaiserpolls/8042.cfm. Only items with responses 60% and over shown here. Source: Kaiser Family Foundation Health Tracking Poll (conducted January 7-12, 2010) Extend dependent coverage through age 25 Medicaid expansion Help close the Medicare doughnut hole

9. Somewhat oppose Support/Opposition for Current Reform Proposals Strongly supportStrongly oppose As of right now, do you generally support or generally oppose the health care proposals being discussed in Congress? Is that strongly or somewhat? Note: “Depends on the proposal” responses not shown. “Don’t know/Refused” responses for total=12%; Democrat=10%; Independent=12%; Republican=10% Source: Kaiser Family Foundation Health Tracking Poll (conducted February 11-16, 2010) Somewhat support Democrat Republican Independent TOTAL

10. I’m going to read some reasons people give for supporting the proposed health care legislation. After I read each one, please tell me if it is a major reason, a minor reason, or not a reason why you yourself support the legislation. To bring down the cost of health insurance and health care To strengthen the country’s long-term economic situation To reform insurance company practices such as making sure they have to sell policies to people with pre-existing health conditions To make sure people can get and afford health insurance coverage Top Reasons for Support AMONG THOSE WHO SUPPORT HEALTH CARE PROPOSALS, percent who say each is a MAJOR reason for supporting: To help fill the coverage gap, or doughnut hole, in Medicare’s prescription coverage Source: Kaiser Family Foundation Health Tracking Poll (conducted February 11-16, 2010)

11. Impact on Own Family: Time Trend Do you think you and your family would be better off or worse off if the president and Congress passed health care reform, or don’t you think it would make much difference? Note: Asked of half sample in Nov09. “Don’t know/Refused” and “It depends (vol.)” responses not shown. Sources: Kaiser Family Foundation Health Tracking polls

12. Feelings Differ Based on Party Identification Source: Kaiser Family Foundation Health Tracking Poll (conducted February 11-16, 2010) DemocratsIndependentsRepublicans Disappointed (72%)Disappointed (53%)Relieved (59%) Frustrated (68%)Frustrated (51%)Pleased (48%) Anxious (48%)Relieved (35%)Frustrated (38%) Angry (43%)Angry (34%)Disappointed (35%) Relieved (18%)Anxious (30%)Anxious (23%) Pleased (15%)Pleased (27%)Angry (22%) Does the fact that health reform has run into some delays make you feel this way, or not?

13. Most popular elements by political party ID (ranked by % saying it makes them MORE likely to support the bill) Most Popular Elements by Party ID Note: Question wording abbreviated. See Topline: http://www.kff.org/kaiserpolls/8042.cfm. * Indicates item is tied with the one directly above it. Source: Kaiser Family Foundation Health Tracking Poll (conducted January 7-12, 2010) Rank DemocratsIndependentsRepublicans 1 Tax credits to small businesses (84%) Tax credits to small businesses (74%) Won’t change most people’s existing arrangements (64%) 2 Medicaid expansion (79%) Health insurance exchange (69%) No federal money for abortion (60%) 3 Health insurance exchange (78%) Won’t change most people’s existing arrangements (66%) Tax credits to small businesses (58%) 4 Guaranteed issue (76%) Help close the Medicare donut hole (65%) Guaranteed issue (55%) 5 Extend dependent coverage through age 25 (74%) Cover at least 31 million uninsured (61%) No federal money for illegal immigrants (55%)*

14. Put health care on hold, so Congress can work on other priorities, and try to deal with it later in the year Move soon to pass the comprehensive legislation that has already been approved by the House & Senate Stop working on health care this year Democrat Republican Independent TOTAL Next Steps for Health Reform: By Party ID Note: “Don’t know/Refused” and “Other (vol.)” responses not shown. Source: Kaiser Family Foundation Health Tracking Poll (conducted February 11-16, 2010) Pull out a few key provisions where there is broad agreement and pass those, even though this won’t be comprehensive reform What do you think Congress should do now on health care reform?

15. Translating Research to Policy What Policymakers Want Brief reports & summaries that are easy to digest. Full reports that enable staff to understand the research & verify its accuracy. Relevant comparative information. Researcher/analyst perspective regarding policy implications and recommendations What Researchers Provide 63% provide brief summaries of research for free, upon request. 60% provide full reports of research projects for free upon request; 40% charge a fee for reports. 34% develop messages that transcend a particular project/report. 33% develop messages that specify possible actions that could be taken. Sorian & Baugh, 2002.Lavis, et al, 2003.

16. What counts as “evidence?” “Major changes in health policy, like major policy changes in any area, are political acts, undertaken for political purposes.” Victor Fuchs