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Two-thirds of Voters Say a Candidate’s Position on Pre-existing Conditions is Important to their Vote, More than Say the Same about Drug Costs, ACA Repeal or Medicare-for-All

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Kaiser Health Tracking Poll – June 2018: Campaigns, Pre-Existing Conditions, and Prescription Drug Ads

Key Findings:

  • Health care continues to be one of the top issues that voters want to hear candidates talk about during their 2018 congressional campaigns. One-fourth of voters say health care is the “most important issue” for 2018 candidates to discuss during their campaigns, which is similar to the share who say the same about the economy and jobs (23 percent). While health care is a top issue for Democratic and independent voters, it remains a second tier issue for Republican voters.
  • Few voters (about one in ten) say a candidate’s support for a variety of different health care positions will be the “single most important factor” in their 2018 vote choice. But among the health care issues provided, majorities of Democratic voters, independent voters, and Republican voters say a candidate’s support for continued protections for people with pre-existing health conditions is either the “single most important factor” or “very important, but not the most important factor” to their vote.
  • In light of a recent federal lawsuit and subsequent decision by the Trump administration, this month’s tracking poll finds most of the public – including majorities of Republicans, Democrats, and independents – say it is “very important” to them that the ACA’s provisions protecting those with pre-existing conditions remain law. Three-fourths say it is “very important” that the ACA provision prohibiting insurance companies from denying coverage due to someone’s medical history remains law, and seven in ten say the same about the ACA provision prohibiting insurance companies from charging sick people more. Nearly six in ten Americans say they live in a household where someone has a pre-existing medical condition.
  • A majority of the public – including eight in ten Democrats – support President Trump’s plan to require drug manufacturers to publish list prices for their prescription drugs in television advertisements.
  • While most have seen or heard advertisements for prescription drugs, about one in seven say they have talked to their doctor as a result of seeing an advertisement for a prescription drug. Yet, among the fourteen percent of the public who have talked to their doctor about a drug they saw advertised – more than half (55 percent, 11 percent of adults) say they were prescribed the drug they asked about and half (48 percent, 10 percent of adults) discussed the price of the drug with their doctor.

 

Top Issues for 2018 Congressional Campaigns

Health care continues to be one of the top issues that voters want to hear candidates talk about during their 2018 congressional campaigns. One-fourth of voters say health care is the “most important issue” for 2018 candidates to discuss during their campaigns, which is similar to the share who say the same about the economy and jobs (23 percent). Slightly fewer say gun policy (20 percent), immigration (18 percent)1, and foreign policy (13 percent) are the most important issues for 2018 candidates to talk about during their campaigns.

Health Care and Republican Voters

While health care is a top issue for Democratic and independent voters, it remains a second tier issue for Republican voters. One-fourth (27 percent) of Republican voters say the economy and jobs is the most important issue for candidates to talk about during their campaigns, followed by immigration (19 percent), and health care (18 percent). However, the share of Republican voters who say health care is the most important issue has risen slightly since January 2018 when one in ten (13 percent) Republican voters said it was the most important issue.

Which Health Care Issues Matter Most to Voters?

Few voters (about one in ten) say a candidate’s support for a variety of different health care positions will be the “single most important factor” in their 2018 vote choice, but about two-thirds say a candidate’s support for continued protections for people with pre-existing health conditions is either the “single most important factor” or “very important, but not the most important factor.” Fewer – but still a majority – say a candidate’s support for passing legislation to bring down prescription drug costs (58 percent), support for repealing the Affordable Care Act (ACA) (53 percent), or passing legislation to stabilize the ACA marketplaces (52 percent) is either the single most important or a very important factor. Half (48 percent) say a candidate’s support for passing a national health plan, or Medicare-for-all is very or most important to their 2018 vote choice.

Partisans Differ on Top Health Care Positions for Candidates

Partisan voters have different views on how a candidate’s support for various health care positions will affect their vote choice. For Democratic voters, a candidate’s support for continued protections for people with pre-existing conditions is at the top of the list with eight in ten (81 percent) Democratic voters saying it is the most important or very important factor to their 2018 vote choice. This is followed by a candidate’s support for stabilizing the ACA marketplaces (69 percent), support for passing a national health plan, or Medicare-for-all (68 percent), and support for passing legislation to bring down the price of prescription drugs (66 percent). Fewer (57 percent) say a candidate’s support for repealing the ACA will be very or most important to their vote.

Among Republican voters, nearly six in ten say a candidate’s support for repealing the ACA is very or most important to their 2018 vote choice. Half say the same about a candidate’s support passing legislation to bring down the price of prescription drugs (52 percent) and support for continued protections for people with pre-existing conditions (51 percent). Across all other issues, less than half of Republican voters say it will be very or most important to their 2018 vote.

Public Supports ACA Protections for Those With Pre-Existing Conditions

President Trump’s administration announced earlier this month that it will no longer defend the ACA’s protections for people with pre-existing medical conditions. These provisions prohibit insurance companies from denying coverage based on a person’s medical history (known as guaranteed issue), and prohibit insurance companies from charging those with pre-existing conditions more for coverage (known as community rating). The Trump administration argues that both of these protections are unconstitutional and should be deemed invalid once the individual mandate penalty goes away starting January 1, 2019. The majority of the public – including majorities of Republicans, Democrats, and independents – say it is “very important” to them that the ACA’s provisions protecting those with pre-existing conditions remain law.

Three-fourths of the public (76 percent) say it is “very important” to them that the provision that prohibits health insurance companies from denying coverage because of a person’s medical history remains law. An additional fifteen percent say it is “somewhat important” this provision remains law. Similarly, seven in ten (72 percent) say it is “very important” that the provision that prohibits health insurance companies from charging sick people more remains law, while an additional one in five (17 percent) say it is “somewhat important.”

Majorities Across PArty Lines Support Protections for Those With Pre-eXisting Conditions

Majorities, across party identification and household health status, say it is “very important” that these protections remain law. Nine in ten Democrats (88 percent), 77 percent of independents, and 58 percent of Republicans say it is “very important” that insurance companies cannot deny coverage because of a person’s medical history. Similarly, a majority (85 percent of Democrats, 70 percent of independents, and 58 percent of Republicans) – say it is “very important” that health insurance companies cannot charge sick people more. Even among those living in households without anyone with pre-existing conditions – therefore, unlikely to be affected negatively by this change in policy – a majority say it is “very important” these protections remain.

This most recent poll finding is similar to previous KFF polling on this issue. Public support for protections for individuals with pre-existing conditions had broad support prior to the passage of the 2010 health care law. A February 2010 Kaiser Health Tracking Poll found three-fourths (76 percent) of the public saying it is either “extremely important” or “very important” that reforming health insurance so that insurance companies can’t deny coverage based on pre-existing conditions is passed into law. Immediately after the election of President Trump, KFF polling found there was still majority support for the requirement that health insurance companies have to cover everyone regardless of medical history, with majorities of Democrats (75 percent), independents (65 percent), and Republicans (63 percent) saying they had a favorable opinion of this ACA provision.

Nearly Six in Ten Say They or Someone in Their Household Has a Pre-Existing Health Condition

Nearly six in ten (57 percent) say they or someone in their household suffers from pre-existing medical conditions such asthma, diabetes, or high blood pressure. Women (61 percent) are more likely to report someone in their household with a pre-existing condition than men (53 percent), as are older individuals (67 percent of those age 65 or older) compared to half (49 percent) of adults 18 to 29 years old.

Broad Support for Requiring Prices in Prescription Drug Advertisements

On May 11, 2018, President Trump announced his plan titled, “American Patients First,” an effort aimed at lowering the price of prescription drugs. One key element of this plan is to require drug manufacturers to publish list prices for their prescription drugs in television advertisements. Three-fourths (76 percent) of the public favor the federal government requiring prescription drug advertisements to include a statement about how much the drug costs. In a rare instance of bipartisanship, this policy proposal is supported by a majority of Democrats (83 percent), independents (73 percent) and Republicans (72 percent).

Prevalence of Prescription Drug Advertisements

Seven in ten (72 percent) say they have ever seen or heard any advertisements for prescription drugs, which is similar to the share who say they saw or heard such an advertisement in the past 12 months (69 percent).

One in seven say they have talked to their doctor as a result of seeing an advertisement for a prescription drug while more than half (56 percent) say they have seen or heard advertisements for prescription drugs but have never spoken to their doctor about these ads.

Among those who have spoken to their doctor about a specific medicine they saw advertised, nearly six in ten (55 percent) say the doctor gave them the drug they asked about, their doctor recommended a different prescription drug (54 percent), or their doctor recommended that they make changes in their behavior or lifestyle (54 percent). Half (48 percent) say their doctor discussed the cost of the drug while four in ten (41 percent) say their doctor recommended an over-the-counter drug instead.

Public’s Views of the Affordable Care Act

Half of the public continue to hold favorable views of the 2010 health care law, known as the Affordable Care Act. This continues the more than a year-long trend of a larger share of the public viewing the law favorably (50 percent) than unfavorably (41 percent).

 

 

Struggling GE to Spin Off Healthcare Subsidiary

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https://www.healthleadersmedia.com/strategy/struggling-ge-spin-healthcare-subsidiary?utm_source=silverpop&utm_medium=email&utm_campaign=20180626_HLM_Daily%20(1)&spMailingID=13762039&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1422371068&spReportId=MTQyMjM3MTA2OAS2

Image result for GE Healthcare

The downsizing over the next 18 months is expected to reduce debts by $25 billion, and comes as the storied company falls off the Dow Jones Industrial Average for the first time in 110 years.

GE announced Tuesday it would separate GE Healthcare into a standalone company and use the proceeds from the sale to pay down its debts.

  • As part of a restructuring, the storied company said it would also sell its stake in the oil and gas company Baker Hughes and refocus on core high-tech areas of aviation, power, and renewable energy;
  • The strategy is expected to reduced debt by $25 billion, and create a “leaner corporate structure” with $500 million in savings by the end of 2020, GE said in a media release.
  • GE said it expects to generate cash from the disposition of approximately 20% of its interest in the GE Healthcare business and to distribute the remaining 80% to GE shareholders.
  • Today’s announcement came on the first day in 110 years that GE was not on the Dow Jones Industrial Average, CNN reports. It was replaced by Walgreens Boots Alliance in the elite 30-stock index Tuesday.
  • GE Healthcare generated more than $19 billion in revenues in 2017 and posted 5% revenue growth and 9% segment profit growth, and accounted for 16% of the company’s total sales.
  • GE has seen its stock value drop precipitously in the past year. However, GE shares jumped 6.4% to $13.57 in early trading Tuesday.

S&P Global Ratings responded to the news by placing GE’s “A” long-term rating on CreditWatch with “negative implications.”

“GE’s divestiture of its core healthcare segment leaves the company with less business diversity, earnings and cash flow and as such, potential for heightened volatility in profits and cash flow. However, debt reduction and substantial cash balances will reduce balance sheet risk,” S&P said.

 John Flannery, chairman and CEO of GE, said in a media release that the spin-offs would “improve our operations and balance sheet as we make GE simpler and stronger.”

“Today’s actions unlock both a pure-play healthcare company and a tier-one oil and gas servicing and equipment player,” Flannery said.

“We are confident that positioning GE Healthcare and BHGE outside of GE’s current structure is best not only for GE and its owners, but also for these businesses, which will strengthen their market-leading positions and enhance their ability to invest for the future, while carrying the spirit of GE forward,” he said.

Kieran Murphy, president and CEO of GE Healthcare, will continue to lead the standalone company under the GE brand.

“As an independent global healthcare business, we will have greater flexibility to pursue future growth opportunities, react quickly to changes in the industry and invest in innovation,” Murphy said.

“We will build on strong customer demand for integrated precision health solutions and great technology with digital and analytics capabilities as we enter our next chapter,” he said.

GE Healthcare’s core business is medical imaging, monitoring, and other high-tech hospital equipment. The company does business in 140 countries.

The sell-offs are expected to be completed over the next 12 to 18 months.

 

 

Rising Uninsured Rate Expected to Stress Margins of Nonprofit Providers

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More than 4 million people have lost coverage in the past two years, including many lower-income adults. That could prove problematic for safety net hospitals in the near future.

The ongoing efforts to destabilize the Affordable Care Act will adversely affect the operating margins of not-for-profit healthcare providers, according to a new analysis from S&P Global.

S&P analyst Allison Bretz said that over time, “a growing uninsured population could be a credit negative for not-for-profit hospitals and health systems, as these facilities would likely see an uptick in self-pay patients, charity care and bad debt.”

Two years into the Trump administration’s efforts to roll back the ACA, the uninsured population has risen from about 12.7% in 2016 to 15.5% in 2018.

A study by The Commonwealth Fund estimates that 4 million people have lost health insurance since 2016, and that the uninsured rate among lower-income adults rose from 21% in 2016 to 25.7% this spring.

“This will be most acute at safety-net providers and other providers with a high concentration of Medicaid patients, as that population is most vulnerable to many of these changes,” Bretz said in remarks accompanying the report.

Beth Feldpush, senior vice president of policy and advocacy for America’s Essential Hospitals, said the report “underscores concerns we’ve had since last year’s attempts to repeal the ACA and, now, with piecemeal changes that have weakened the law.”

“Many of the people who lose coverage seek care at our hospitals, which adds to uncompensated costs and puts more pressure on our members’ already low operating margins,” Feldpush said. “Because essential hospitals, by their mission, turn no one away, this could prove financially unsustainable for some.

Although active efforts to repeal the ACA in Congress have slowed in the past year, it is facing one of its greatest threats, as a federal judge in Texas hears a lawsuit brought by 20 states that challenges the constitutionality of the sweeping healthcare law.

For-profit, Payer Outlook Stable

While the rising uninsured rate could prove challenging for not-for-profit providers, S&P analyst David Peknay said it should have little effect on for-profit providers.

“The for-profit companies we rate have been reporting some increase in uninsured patients, consistent with national trends, but the impact on ratings is also currently immaterial,” he said.

The losses in covered lives for health insurance companies is offset by other factors, said S&P analyst Joseph Marinucci.

“A key contributing factor is the sustained migration of the government-sponsored insurance segments toward coordinated care (Medicare Advantage and managed Medicaid), which is expanding the market opportunity for health insurers,” Marinucci said.

“We expect ratings in the insurance sector to remain relatively stable in the near term despite the growth in the number of working-age uninsured individuals,” he said.

 

 

 

 

 

More Medicare patients dying at home, JAMA study finds

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https://www.healthcaredive.com/news/more-medicare-patients-dying-at-home-jama-study-finds/526477/

Dive Brief:

  • More Medicare fee-for-service and Medicare Advantage beneficiaries are dying at home or in community settings than in acute care hospitals, according to new findings published in JAMA.
  • The study showed proportions of fee-for-service beneficiary deaths occurring in an acute care hospital decreased from 32.6% in 2000 to 19.8% in 2015. Proportions of deaths occurring in the home or in a community setting (foster care home, assisted living facilities) increased from 30.7% to 40.1% in the same time span.
  • Medicare Advantage beneficiaries were less likely to be hospitalized overall than those in traditional fee-for-service plans and, in the last 30 days of life, the difference in the hospitalization rates was 9.3% — a difference study author Joan Teno called “huge.”

Dive Insight:

Although most Americans over 65 say that they’d prefer to die at home, in 2009 only 24% of them actually did. Yet, in recent years, more and more Americans are choosing to live out their last days in their home or community instead of being admitted to a hospital.

The JAMA study reveals a potential patient response to the current inadequacy of end-of-life care as, for some older Americans, ending up in a hospital can mean high-cost and aggressive treatment in their final days.

Such treatment does not always equal better care. When it comes to their elderly patients, incumbent healthcare systems increasingly specialize in expensive, often unnecessary services as opposed to a value-based approach.

The findings come on the tide of the so-called “silver tsunami” as the American population skews ever older. The number of Americans aged 65 or older is projected to more than double by 2060, when they will eventually account for 24% of the total population.

New startups have emerged looking to address the institutional inadequacy of end-of-life care, viewing the aging population as a business opportunity. The growing companies zero in on technology-driven solutions in home health, chronic illness and end-of-life care as they look to scale to combat industry issues.

Such startups are a potential wake-up call for traditional healthcare organizations.

“Innovation comes from the private sector,” Teno, a professor of medicine at the University of Washington, told Healthcare Dive.

“I think the implication of this is that hospitals are going to have to change how they’re practicing. They’re going to have to come into new population-based business models that don’t have their entire survival based on their number of admissions,” she said.

On the hospital side, Teno called for multifaceted interventions that address the issue of care overuse and fragmentation in hospitals, such as care bundling and coordination, surveys measuring patient satisfaction and public reporting of readmission rates.

Despite the challenges, Teno was optimistic about ​study’s implications.

“We’re on the right path,” she said. “We need to wean ourselves off of this fee-for-service world of paying for a procedure and paying for volume, to paying for value.”

“The fee-for-service world provides perverse incentives,” Teno stressed, also noting that it tends to lead to hospital disorganization and miscommunication. 

Teno cited the growth of Medicare Advantage as a program (it accounts for a third of Medicare enrollees and spending), and the 9.3% difference in hospitalization rates between MA and fee-for-service as a good sign for the future of healthcare.