Many Beneficiaries View New Medicare Law Unfavorably, Survey Finds

Nearly half of Medicare beneficiaries have an "unfavorable" view of the new Medicare law, but a majority would prefer that Congress make changes to the law rather than repeal it, according to a new survey by the Kaiser Family Foundation and the Harvard School of Public Health, the Boston Globe reports (Rowland, Boston Globe , 8/11). The telephone survey of 1,223 Medicare beneficiaries was conducted between June 16 and July 21 and has a margin of error of plus or minus four percentage points (Sherman, AP/Las Vegas Sun, 8/10).

The survey found that as of July, 47% of beneficiaries had an unfavorable view of the law, compared with 26% who had a favorable view and 25% who said they did not know enough about the law to form an opinion. Sixty-six percent of respondents said that Congress should change the law to address its shortcomings, while 10% favored repealing it altogether and 13% favored making no changes to the law. Overall, 2% of respondents said they were "enthusiastic" about the law, while 10% said they were angry about it; 31% described themselves as "satisfied, but not enthusiastic," and 41% said they were "dissatisfied, but not angry" (Kaiser Family Foundation release, 8/10).

Although 53% of respondents said they thought the new Medicare law would be helpful for most Medicare beneficiaries, only 28% said the law would be helpful to them personally (Lueck, Wall Street Journal, 8/11). Meanwhile, 33% of Medicare beneficiaries with annual incomes below $20,000 and 31% of beneficiaries without drug coverage said they believe the law will be very or somewhat helpful to them personally.

Sixty-two percent of respondents said they do not know enough about the new prescription drug benefit to decide whether they will enroll when it takes effect in January 2006. Sixteen percent of respondents said they plan to enroll in the benefit, and 21% said they will not enroll. Of beneficiaries currently without drug coverage, 23% said they will enroll, 11% said they will not enroll and 65% remain undecided (Kaiser Family Foundation release, 8/10).

Participants who said they view the law unfavorably most frequently cited inadequate help with drug costs as a primary reason. Other reasons included the beliefs that the law is too complicated for beneficiaries to understand and that it benefits private health plans and pharmaceutical companies too much (Wall Street Journal, 8/11). Fewer respondents expressed concern that the law will result in substantial costs to the government in the long term (Kaiser Family Foundation release, 8/10).

Among participants who viewed the law favorably, most said they believe it will help many Medicare beneficiaries pay their prescription drug bills. They also said that the law will help low-income Medicare beneficiaries and beneficiaries with high drug bills (Pear, New York Times, 8/11). Some participants also said they believe the law is a "good start and can be improved over time," according to a Kaiser Family Foundation release (Kaiser Family Foundation release, 8/10).

When asked about the Medicare prescription drug discount card program, which was implemented in June as an interim measure until the full benefit takes effect in 2006, 53% of respondents said the cards "aren't worth the trouble because they don't do enough to help people with their drug costs, and they are too confusing to use," according to the survey. Meanwhile, 34% of respondents said the cards are "worthwhile because they give people on Medicare immediate help" before the full benefit becomes available and because they offer another way to cut their drug costs, according to the survey (New York Times, 8/11). Nine percent of respondents said they had signed up for a drug discount card, and 17% said they planned to do so this year. Sixty percent of respondents said they did not plan to sign up for a drug discount card (Hundley, St. Petersburg Times, 8/11).

Respondents' reasons for not obtaining a card included that they already have a discount card or coverage offered by another sponsor; they do not believe the Medicare card will save them money; they are worried about how the Medicare drug card would affect their existing prescription drug coverage; there were too many cards from which to choose; or they did not know about the cards (Kaiser Family Foundation release, 8/10).

Seventy-nine percent of respondents said they favor repealing a provision in the Medicare law that prohibits U.S. residents from reimporting lower-cost prescription drugs from Canada and other nations unless the HHS secretary certifies their safety. Most respondents said that legalizing reimportation would help reduce the cost of prescription drugs without sacrificing safety or quality. Most respondents also said they disagree with arguments opposing reimportation, including that it will reduce research and development efforts at U.S. drug companies.

In addition, 80% of respondents said they favor repealing a provision in the new law prohibiting the federal government from negotiating directly with pharmaceutical companies to obtain lower prescription drug prices (Kemper, Los Angeles Times, 8/11).

According to the Washington Post, the survey shows that the new Medicare law "has not provided the political boost among seniors that the White House and independent analysts expected" (Connolly, Washington Post, 8/11). Twenty-eight percent of respondents said that the new Medicare law will influence their vote in the November presidential election (Kaiser Family Foundation release, 8/10). Twelve percent of respondents overall said the new law will make them more likely to vote for Democratic presidential nominee Sen. John Kerry (Mass.), and 5% said it will make them more likely to vote for President Bush (Wall Street Journal, 8/10).

According to the AP/Sun, Kerry has said he supports changing the law to allow reimportation of prescription drugs from abroad and direct negotiations between the federal government and pharmaceutical companies. Bush opposes both proposals (AP/Las Vegas Sun, 8/10). The survey found that the Medicare law could have a greater impact on the congressional elections, with 38% of respondents saying it will affect their congressional votes. Twenty percent of respondents overall said it will make them more likely to vote for a Democrat, and 8% overall said it will make them more likely to vote for a Republican (Wall Street Journal, 8/11).

"Fifteen months from implementation" of the full drug benefit, "seniors are mostly negative and very confused, but there is little evidence of a large-scale backlash," Drew Altman, president and CEO of the Kaiser Family Foundation, said (Kaiser Family Foundation release, 8/10). Altman added, "This survey suggests that there will be big debates in the future about the prescription drug law, but they will be about improving it, not repealing it" (Kaiser Family Foundation release, 8/10). Altman said, "So far, it doesn't look like passage of the drug bill has been a positive for the president and Republicans" (MacDonald, Hartford Courant, 8/11). He also said that the survey shows that more needs to be done to educate Medicare beneficiaries about the new drug law, despite "tens of millions" of dollars already spent on advertising, brochures and the 1-800-MEDICARE phone line; 56% of respondents said they understand the new law "not too well" or "not well at all," according to the Los Angeles Times (Los Angeles Times, 8/11).

Robert Blendon, professor of health policy at the Harvard School of Public Health, said, "This issue could prove decisive in a close election. If there is a deadlock after Labor Day, and people are looking for 2 or 3 percent additional votes, it could be found here" (Boston Globe, 8/11). He added that Bush "led an initiative that looks to be helping his challenger" (Washington Post, 8/11). Dee Mahan, deputy director of Families USA, said the Medicare law is "short of delivering what it was billed as doing."

During a campaign stop in Florida on Tuesday, Bush defended the law, saying, "When we came to office, too many older Americans could not afford prescription drugs and Medicare didn't pay for them." He added that in past elections "leaders of both political parties had promised drug coverage. ... We got the job done" (Hartford Courant, 8/11). Bush administration officials said the survey results show that the public has an "open mind about the new law," with only 10% of respondents favoring its repeal, according to the AP/Sun (AP/Las Vegas Sun, 8/10). HHS spokesperson Kevin Keane said, "We find some things in the survey that are quite encouraging" (New York Times, 8/11). He said that the survey shows the "majority think the new law will be helpful. Seniors don't want the benefits taken away. That's a powerful statement." He attributed the respondents' tepid reaction to the new law to a "hurricane of harsh rhetoric and misinformation" from Democrats, but he predicted that it would be a favorable issue for Bush by the November election because the public sees that "he's addressing a challenging health care issue" (Washington Post, 8/11).

Keane also said that the Bush administration "acknowledge[s]" that reimportation is "on [seniors'] mind[s]," but he added that it is "a separate issue" from the Medicare law and said the federal government has to "protect people's safety whether they think it's an issue or not" (Los Angeles Times, 8/11). Senate Finance Committee Chair Chuck Grassley (R-Iowa) said that his experiences at numerous town hall meetings show that Medicare beneficiaries view the law more favorably the more they learn more about it (New York Times, 8/11). Rep. Nancy Johnson (R-Conn.) said, "Seniors are beginning to hear [that the law is] saving them money. Change takes time. This wasn't something that was going to be understood right away" (Hartford Courant, 8/11). The survey results are available online.

NPR's "All Things Considered" on Tuesday reported on the survey. The segment includes comments from Altman; Blendon; Mollyann Brodie, senior researcher and director of special projects at the Kaiser Family Foundation; Bush; and Keane (Rovner, "All Things Considered," NPR, 8/10). The complete segment is available online in RealPlayer.