Poll: Many Disfavor Medicare Law

Many more people on Medicare have a negative than a positive perception of Congress’ 2003 prescription drug law, according to a survey released last week by the Kaiser Family Foundation and the Harvard School of Public Health (HSPH).

But beneficiaries say they want Congress to fix problems in the law, not repeal it.

The legislation, which drew intense opposition in its initial stages, will significantly revamp Medicare in the coming years. The law offers drug benefits to 40 million disabled and elderly people and enables insurance companies and private health plans to play a larger role in the new program. The new benefit, which will take effect in 2006, is projected to cover around 75 percent of drug costs up to $2,250 a year. This spring, as part of the new law, Medicare drug discount cards were already made widely available.

Respondents cited insufficient help with drug costs, difficulty in understanding the complicated law and the benefits to private health plans and pharmaceutical companies as reasons for their unfavorable impressions of the law.

As of last month, 47 percent of people on Medicare had an unfavorable impression of the law, nearly double the number of people—26 percent—who had a favorable view. Twenty-six percent of respondents said they did not know enough about the new policy to have an opinion.

“At this point in time, the surveys are showing that people on Medicare are not clear on how this change is going to affect them,” said Mollyann Brodie, vice president for public opinion and media research at the Kaiser Family Foundation. “I think part of the unfavorable impression is coming from the uncertainty that comes with the big change.”

Brodie noted that beneficiaries of Medicare still have 15 months before they have to make any choices.

And while the majority of beneficiaries indicated that they thought the new law would be advantageous to most people, only 29 percent said the new law would be “very or somewhat helpful” to them personally.

“The biggest challenge is going to be to explain to people how this law affects them personally,” said Brodie, who was part of the research team that designed and analyzed the survey. “Until people have to go out and make choices, they’re just not going to know how this law will affect them.”

But the unfavorable impressions of the new Medicare law stand in sharp contrast to how people view the Medicare program itself. While just over a quarter indicated that they had a positive view of the law, nearly three-quarters of respondents said they had a favorable opinion of Medicare.

Brodie said the elderly, who often have experience with Medicare, have yet to familiarize themselves with the advantages associated with the new Medicare law.

According to the poll, 28 percent of people on Medicare indicated that the passage of the new law would have an effect on the November elections. But a larger number, 38 percent, said it would affect their Congressional vote.

But Brodie said that while the Medicare law could be a decisive factor in a close presidential election, voters would also be weighing issues such as the war in Iraq and the state of the economy.

“I think the relevance for the election has to be treated with a sort of good degree of caveat in that this issue is very important to the Medicare population—it is a population that is much more likely to show up to the polls and vote,” she said. “On the other hand, there are a lot of other issues on the table.”

The survey also noted that Republicans had not yet reaped any significant benefits from the law’s passage.

“The Republicans, who really worked to pass this law, have not gotten tremendous bounce or tremendous credit for having passed and added a prescription drug benefit in the Medicare program,” Brodie said.

Respondents also indicated their support for two legislative proposals recently debated in Congress. Around 80 percent of beneficiaries of Medicare favored changing the law to allow Americans to buy cheaper prescription drugs from Canada and to allow the federal government to negotiate with drug companies for lower prices.

The survey found that seniors on Medicare were not particularly supportive of the drug discount cards, with a little over half saying that the cards were confusing and didn’t sufficiently reduce drug costs. But 34 percent said the cards were “worthwhile because they give people on Medicare immediate help before the full prescription drug benefit is available in 2006, and they provide another way to cut drug costs.”

“From a policy perspective, [the Republicans] delivered a piece of the program right away,” Brodie said. “It isn’t being appreciated or seen as helpful as perhaps the expectations were.”

For now, Brodie said that people under Medicare need to have a better understanding of how the law operates.

“I think the most important implication from this is that there’s a lot of work to be done from a public education standpoint to get people to understand how this law will affect them personally and the kind of choices they’ll have to make in 15 months,” Brodie said.

Robert J. Blendon, an HSPH professor of health policy who also helped design and analyze the survey, was out of town on vacation and could not be reached for comment.

The poll was administered by telephone between June 16 and July 21, 2004 and surveyed 1,233 Medicare beneficiaries. The margin of sampling error was plus or minus 4 percentage points.

—Staff writer Margaret W. Ho can be reached at mwho@fas.harvard.edu.