The majority of the nation’s seniors do not understand the Patient Protection and Affordable Care Act, according to a recent poll from the National Council on Aging (NCOA). The survey found that only 17% of survey respondents could correctly answer half of the 12 questions asked about key provisions of the law. Furthermore, none of the 636 respondents answered all 12 questions correctly.
NCOA found that only 22% of seniors understood that the Affordable Care Act would not cut their basic Medicare benefits. Almost twice as many seniors (42%) held the incorrect view that the law would cut their basic Medicare benefits, while 37% said they did not know. Even among the older adults who said they considered themselves “very familiar” (9%) or “familiar” (12%) with the new law, 65% still got less than half of the answers right, according to the survey.
The Kaiser Family Foundation (KFF) found similar results in their July Health Tracking Poll. According to KFF, 52% of seniors were aware that the new law will result in premium increases for some higher income Medicare beneficiaries, and 50% knew that the new law will gradually close Medicare’s “doughnut hole.” However, only 33% are aware that the Affordable Care Act will eliminate Medicare’s copayments and deductibles for some preventive services.
On the other hand, KFF found that large shares of seniors mistakenly believe the law includes provisions that cut some previously universal Medicare benefits and creates “death panels.” Half of seniors said that the law will cut benefits that were previously provided to all people on Medicare, and 36% incorrectly believe the law will “allow a government panel to make decisions about end-of-life care for people on Medicare.”
For a comprehensive analysis of the Patient Protection and Affordable Care Act, and additional information on health reform and other developments in employee benefits, just click here.
During the year-long debate on health reform, public opinion polls seemed to show a volatile and divided American population. However, a closer examination of these polls and other surveys shows well-established patterns in public opinion that played out in this debate as they have in other debates, according to the study, Liking the Pieces, Not the Package: Contradictions in Public Opinion During Health Reform, published in the June 2010 issue of Health Affairs.
The study showed that while there was majority support for reforming the health care system, opinions did fluctuate on various aspects of the legislation. This mainly happened when individuals recognized that they would be impacted in some way. As the government goes forward with implementation of the Patient Protection and Affordable Care Act, the public's judgment of the law is likely to be based less on political debate, and more on perceived impacts at the personal level as implementation proceeds, according to the researchers.
The study identified several long-standing attributes of public opinion and how they played out during the health reform debate, as follows:
Competing Issues. During the health reform debate, it was easy to forget that health reform is only one of the issues that the public cares about. Following the 2008 election, health care (43%) trailed the economy (73%) and terrorism (48%) as top priorities.
Partisan Contradictions. Public opinion polls throughout the health reform debate show that American's views on health reform were sharply divided by party identification. A poll taken right before the legislation passed found that 75% of Democrats supported the bill, while 80% of Republicans opposed it. However, the study noted that these partisan divisions are nothing new. Polls taken during the 1993-94 health reform debate found that not only were Republicans the least likely to favor the Clinton plan, but they also were the least likely to believe that the health care system needed comprehensive reform.
Persistent Support For Health Reform. Historically, the study noted that Americans have favored addressing problems in the health care system since the mid-1980s. In October 1986, 66% of the public supported completely rebuilding or making major changes to the existing health care system. During the current debate, 54% of the public in January 2010 agreed that economic circumstances made it more important than ever to take on health reform.
Reform Components. The week of the final vote on the Affordable Care Act a poll found that 48% were opposed to the legislation as a whole, 37% were in favor, and 15% were still undecided. However, many were in favor of certain components of the law, such as health insurance reforms (76% said this was "extremely" or "very" important), tax credits for small businesses (72%), and helping close the Medicare drug coverage donut hole (71%).
Personal Impact. The study found that in both the Clinton and Obama health reform debates, Americans were unclear about how reform would affect their families. As the debate progressed, opponents tapped into fears and anxieties about how the proposed solutions might change the status quo, and people became increasingly negative about the perceived personal impact. During the Obama reform effort, those individuals not expecting that health reform would affect their family fell from 43% to 28% over the course of the debate, while those expecting to be harmed increased (from 11% to 32%), and those individuals who expected to benefit from the reforms hovered around 35%.
The study was based on more than fifty nationally representative public opinion polls that have been conducted since 1943. For more information, visit http://www.healthaffairs.org.
For a comprehensive analysis of the Patient Protection and Affordable Care Act, and additional information on health reform and other developments in employee benefits, just click here.
On July 1, the Pre-Existing Condition Insurance Plan (PCIP) program, created under the Patient Protection and Affordable Care Act, went into effect. In the July 30 Federal Register, the Department of Health and Human Service's (HHS) Office of Consumer Information and Insurance Oversight (OCIIO) issued an interim final rule that addresses eligibility qualifications for participating in the program and the premiums that are allowed to be charged.
The Affordable Care Act requires the HHS to establish, either directly or through contracts with states or nonprofit entities, a temporary high risk health insurance pool program to provide affordable health insurance coverage to uninsured individuals with preexisting conditions. The HHS is directly running a PCIP in 21 states, while 29 states have decided to run their own PCIP. This program will continue until Jan. 1, 2014, when Health Insurance Exchanges will be available for these individuals to obtain health insurance coverage.
Eligibility. The interim final rule specifies that an individual eligible to enroll in a PCIP must be a citizen or lawfully present in the U.S., have not had creditable coverage during the six-month period prior to applying for coverage through the PCIP, and have a preexisting condition. An individual must prove that he or she has a preexisting condition. The interim rule states that a PCIP may determine that an individual has a preexisting condition if they satisfy any one of the following criteria:
1. the individual provides documented evidence that an insurer has refused, or has provided clear indication that it would refuse, to issue individual coverage on grounds related to the individual's health;
2. the individual provides documented evidence that he or she has been offered individual coverage but only with a rider that excludes coverage of benefits associated with a pre-existing condition; or
3. the individual provides documented evidence that he or she has a medical or health condition specified by the state and approved by the HHS.
Premiums. The interim final rule requires that premium rates for PCIPs must be at "a standard rate for the standard population." This refers to the premium rates offered in the individual market in the state where the PCIP operates. The OCIIO noted that existing state high risk pools' premiums typically average between 105% to 250% of the standard rate of the individual market. However, the Affordable Care Act requires that premiums in the PCIP program be at the standard rate, rather than at a higher proportion of that rate. In essence, PCIPs are not allowed to charge enrollees premiums at a rate that exceeds 100% of the standard individual market rate in the PCIP service area.
The OCIIO noted that the interim final rule does not mandate a specific formula for calculating this standard rate. Instead, a PCIP is allowed to calculate the standard rate using reasonable actuarial techniques.
The interim final rule is effective on July 30. Comments on the interim rules, which must be received by September 28, may be submitted through the federal eRulemaking Portal at http://www.regulations.gov. Comments should be identified by OCIIO-995-IFC.
For more information, contact Ariel Novick at (301) 492-4290.
For a comprehensive analysis of the Patient Protection and Affordable Care Act, and additional information on health reform and other developments in employee benefits, just click here.
