Public Endorses Need for Medicare Reform, but Is Skeptical of Recent Legislation

GALLUP NEWS SERVICE

PRINCETON, NJ -- The latest CNN/USA Today/Gallup poll finds that most Americans believe major changes to Medicare are necessary and the public strongly endorses adding a prescription drug benefit to the Medicare program. However, the public generally opposes a proposal that would enroll senior citizens in private managed care programs, even if that means they would receive greater benefits than they currently do. And despite backing Medicare reforms in general, most Americans believe that the recently passed Medicare bills will not do enough to help pay prescription drug costs. Older Americans are less likely than younger Americans to believe that Medicare needs major reforms and are also more likely to oppose a managed care plan for Medicare recipients.

At this point, the public views President Bush and the Republicans in Congress -- rather than the Democrats in Congress -- as mainly being responsible for the Medicare bills. But a majority of the public expresses confidence in all three actors when it comes to deciding Medicare policy.

Public Near Unanimous in Seeking Changes to Medicare

The poll, conducted June 27-29, just after the House and Senate passed bills that would add a prescription drug benefit to Medicare, finds that most Americans believe Medicare needs significant changes. Roughly two in three Americans say that Medicare needs either a "complete overhaul" (26%) or "major reforms" (41%). About one in four Americans say it needs minor reforms, and just 4% say no reforms are needed.

Perceptions of the degree of change that Medicare needs vary by age. Older Americans -- those 65 and older and the current chief beneficiaries of the Medicare plan -- are slightly more inclined to believe that Medicare needs only minor reforms (39%) or no reforms (10%) rather than an overhaul (18%) or major reforms (27%). All other age groups show strong majorities preferring a complete overhaul or major reforms. Interestingly, Americans between the ages of 50 and 64, who are nearing the age when they will be eligible for Medicare, are the most likely age group to believe that dramatic reforms are needed.

Opinion of the Need for Medicare Reform: By Age Group

June 27-29, 2003

Gallup finds overwhelming support for the basic outlines of the Medicare reform plans that Congress recently passed: spending $400 billion over 10 years to expand Medicare to help senior citizens pay for prescription drugs. Seventy-six percent of Americans favor this proposal, while 19% are opposed. Views vary little by age, as between 74% and 80% of all age groups express support for the plan.

Majority Opposes Managed Care Approach

It is unclear at this point how familiar the public is with the details of the proposed Medicare reforms. Despite general support for the basic outlines of the proposed changes, the public shows majority opposition to enrolling most Medicare recipients in private managed care plans, as evidenced by the following question:

Do you favor or oppose the following proposal? Instead of most Medicare recipients being enrolled in the traditional fee-for-service Medicare program, most Medicare recipients would be enrolled in private managed care plans. These managed care plans might provide enrollees with additional benefits for no more money, but enrollees would have less choice of doctors and hospitals when seeking care.

Only 37% of Americans say they favor this proposal, while 59% oppose it. Opposition to a managed care plan is greater among Americans aged 50 and older.

Opinion of a Managed Care Approach to Medicare: By Age Group

June 27-29, 2003

Past survey data suggest that support for managed care programs for seniors may be declining. When asked the same question in a 1995 Kaiser/Harvard School of Public Health survey, 49% of Americans favored and 48% opposed the proposal.

Both the House and Senate bills would seek to shift many senior citizens out of the government-run Medicare program and into private managed care plans, in an effort to control costs. Senior citizens who do not join a private health plan would still be covered under Medicare, but it is unclear if the benefits -- especially those for prescription drugs -- would be as generous in the Medicare plan. The government would provide incentives to businesses to cover senior citizens, and may ultimately decide to lure senior citizens to private plans by promising more generous benefits.

Medicare Politics

As is the case among the general public, there is widespread agreement in Washington about the need for providing prescription drug benefits to senior citizens. However, some congressional leaders anticipate that the task of agreeing to a final version of the bill that is acceptable to the president and both houses of Congress will be difficult and may not be completed for many months. Some Republicans are leery about creating a new entitlement program that could becoming increasingly expensive over time, while some Democrats have expressed concern about the degree to which Medicare should be privatized.

Politics will play a crucial role in determining what, if any, the final form of the Medicare changes will take. Currently, none of the key players in the Medicare debate appears to be much better positioned than the others -- Americans put a roughly equal amount of trust in President Bush (56%), the Republicans in Congress (51%), and the Democrats in Congress (55%) on the Medicare issue. Responses to these items are predictably partisan, with Republicans expressing far greater confidence in Bush and congressional Republicans than do Democrats, and Democrats expressing far more trust in congressional Democrats.

Given a choice, Americans are more likely to believe that Bush and the Republicans in Congress (54%) than the Democrats in Congress (26%) are responsible for the passage of new Medicare reforms. Whether that view will benefit or possibly come back to haunt Republicans will be determined as the parties work toward a compromise, and how the public views the specifics of the final bill.

Public, Senior Citizens Skeptical About Impact of Changes

At this stage in the process, relatively few Americans, 19%, expect that the bills Congress is considering would do enough to help pay the cost of prescription drugs. Sixty-seven percent believe the bills should do more in this regard. There is little variation by age; between 63% and 72% of all age groups say the bills should do more to pay the costs of prescription medications.

Americans age 65 and older are dubious that they will personally benefit from the changes to Medicare. Just 20% say the changes will improve their situations, while 18% say they will be made worse. A majority, 51%, says the changes will have no effect on them, personally.

The poll did find that most senior citizens, 64%, currently have a health insurance plan that helps pay for prescription drug costs. This may help explain why senior citizens expect relatively little benefit from an added prescription drug benefit, and why about one in five believe the change will make them worse off.

Survey Methods

These results are based on telephone interviews with a randomly selected national sample of 1,003 adults, aged 18 and older, conducted June 27-29, 2003. For results based on this sample, one can say with 95% confidence that the maximum error attributable to sampling and other random effects is ±3 percentage points. In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.

For results based on the sample of 154 adults aged 18 to 29, the maximum margin of sampling error is ±8 percentage points.

For results based on the sample of 380 adults aged 30 to 49, the maximum margin of sampling error is ±6 percentage points.

For results based on the sample of 257 adults aged 50 to 64, the maximum margin of sampling error is ±7 percentage points.

For results based on the sample of 191 adults aged 65 and older, the maximum margin of sampling error is ±8 percentage points.

27. How much trust do you have in each of the following when it comes to deciding Medicare policy – a great deal, a moderate amount, not much, or none at all? How about – [RANDOM ORDER]?

A. George W. Bush

B. The Republicans in Congress

C. The Democrats in Congress

28. Do you think the Medicare system is in need of – a complete overhaul, major reforms, minor reforms, or no reforms?

29. Would you favor or oppose legislation that would spend $400 billion over the next 10 years to create a new Medicare program that would help senior citizens pay for prescription drugs?

30. Based on what you have heard or read about the changes Congress is considering making to Medicare, do you think these will – improve your situation, have no effect, or make your situation worse]?

BASED ON –191—ADULTS AGED 65 YEARS AND OLDER

31. Thinking about your own situation now, do you currently have a health insurance plan that helps pay for the cost of prescription drugs, or not?

BASED ON –191—ADULTS AGED 65 YEARS AND OLDER

32. Do you think the new Medicare bills being considered by Congress would do enough to help pay the cost of prescription drugs, or should it do more?

33. Who do you think is most responsible for the new Medicare bill – [ROTATED: President Bush and the Republicans in Congress (or) the Democrats in Congress]?

34. Do you favor or oppose the following proposal? Instead of most Medicare recipients being enrolled in the traditional fee-for-service Medicare program, most Medicare recipients would be enrolled in private managed care plans. These managed care plans might provide enrollees with additional benefits for no more money, but enrollees would have less choice of doctors and hospitals when seeking care.

Trend for Comparison: Henry J. Kaiser Family Foundation, Harvard School of Public Health