The Commonwealth Fund Health Care Opinion Leaders Survey: Evaluating Medicare Part D

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Country: United States

Survey Organization: Harris Interactive, Inc.

Field Dates: June 1, 2006–June 19, 2006

Sample: Peer-nominated experts in health care policy, finance, and delivery

Sample Size: 180 (survey successfully e-mailed to 1,246 potential respondents; the response rate was 14.4 percent)

Interview Method: Online/E-mail

This survey was conducted online by Harris Interactive on behalf of The Commonwealth Fund among 180 opinion leaders in health policy and innovators in health care delivery and finance. This was the eighth in a series of bimonthly surveys designed to highlight leaders' perspectives on the most effective and timely health policy issues facing the nation. The survey focused on Medicare prescription drug coverage.

Summary
The lack of prescription drug coverage under Medicare has been a concern since the program's inception 40 years ago. The Medicare Modernization Act of 2003 (MMA) finally made drug coverage available to all Medicare beneficiaries beginning in January 2006, but not without serious debate about the structure of the benefit and its availability exclusively through private plans. This debate extended through the months preceding the bill's passage and after its enactment into law. It intensified in the early months of the Part D benefit and around the May 15 deadline for initial enrollment, and continues today. This survey provides an initial assessment of the program and priorities for change from the perspective of health care opinion leaders.

Despite the widespread criticism and controversy surrounding Part D, a majority of the health care leaders surveyed express positive views of the program, with two of three leaders agreeing that enacting Medicare Part D was, on balance, good for beneficiaries. Still, it is notable that there is considerable skepticism about key aspects of the program in its current format, with leaders being critical of the availability of coverage exclusively through private plans and the gap in coverage (the doughnut hole), which leaves beneficiaries responsible for all of their covered costs. The sectors are reasonably consistent in their views about Medicare Part D, except for the business/insurance/other health care industry sector, which is overwhelmingly supportive of the benefit as is.

The leaders surveyed endorse a range of potential changes regarding several key aspects of the program: eliminating the late-enrollment penalty; reducing the complexity of the program; minimizing coverage gaps; providing the benefit through the traditional Medicare program; and giving Medicare the authority to negotiate drug prices on behalf of Medicare Part D beneficiaries.

On the issue of the penalty for late enrollment, the leaders surveyed decisively support removing the penalty (90%), with very little support for leaving the penalty in place (8%).

In order to reduce the complexity of the benefit and better inform beneficiaries, the leaders support requiring plans to use the same terms to describe the same benefits, and standardizing benefits by decreasing variability among plan offerings (88% and 77%, respectively). Only a minority of those surveyed (43%) favor limiting the number of plans in each area.

Leaders support a range of actions designed to reduce gaps in coverage and make more help available to vulnerable beneficiaries. When asked for their highest priority, the top two choices are: filling in the coverage gap by some combination of increased copayments or additional government funding and eliminating the asset test to qualify for a low-income subsidy.

The surveyed leaders' responses indicate skepticism about providing Part D through private plans only: majorities favor offering a comprehensive benefits option that combines all Medicare benefits in one package as an alternative to the current situation (78%) or offering an alternative option that provides prescription drug coverage through the traditional Medicare program, as well as through private plans (64%). Only a few (17%) support leaving the current situation as is.

There is substantial support among leaders for giving Medicare the authority to negotiate drug prices for Part D beneficiaries, with more than four of five favoring this approach.

Overall, leaders surveyed who represent the business/insurance/other health care industry stand out as most supportive of the existing program, with views strongly divergent from those in other sectors.

Methodology
This survey was conducted online by Harris Interactive on behalf of The Commonwealth Fund among 180 opinion leaders in health policy and innovators in health care delivery and finance within the United States between June 1, 2006, and June 19, 2006. No weighting was applied to these results.

The sample for this survey was developed by using a two-step process. Initially, The Commonwealth Fund and Harris Interactive jointly identified a number of experts across different industries and professional sectors with a range of perspectives, based on their affiliations and involvement in various organizations and institutions. Harris Interactive then conducted an online survey with these experts asking them to nominate others within and outside their own fields whom they consider to be leaders and innovators in health care. Based on the result of the survey and after careful review by Harris Interactive, The Commonwealth Fund, and a selected group of health care experts, the sample for this poll was created. The final list included 1,246 people.

Harris Interactive sent out individual e-mail invitations containing a password-protected link to the entire sample. Data collection took place between June 1, 2006, and June 19, 2006. A total of four reminders was sent to anyone who had not responded. A total of 180 respondents completed the survey.

With a pure probability sample of 180 adults one could say with a 95 percent probability that the overall results have a sampling error of +/-7 percentage points. However that does not take other sources of error into account. This online survey is not based on a probability sample and therefore no theoretical sampling error can be calculated.

Health Care Opinion Leaders Survey Part I, Assessing Health Care Experts' Views on Policy Priorities

Health Care Opinion Leaders Survey Part II, Assessing Health Care Experts' Views on Health Insurance Issues

Health Care Opinion Leaders Survey Part III, Assessing Health Care Experts' Views on Health Care Costs

Health Care Opinion Leaders Survey Part IV, Assessing Health Care Experts' Views on Medicare and Its Future

Health Care Opinion Leaders Survey Part V, Assessing Health Care Experts' Views on Medicaid and Its Future

Health Care Opinion Leaders Survey Part VI, Assessing Health Care Experts' Views on Long-Term Care

Health Care Opinion Leaders Survey Part VII, Assessing Congress's Policy Priorities

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Publication Date:
July 14, 2006