Program on International Policy

Americans on Health Care Policy

FINDINGS
August 30, 2000

5. Medicare and Prescription Drugs

In addition to providing basic coverage to specific populations, a strong majority supports providing a wider range of coverage to seniors on Medicare. Strong majorities support helping seniors with the costs of prescription drugs and long-term care.

Though Medicare provides most seniors with basic health insurance, it does not cover the costs of prescription drugs or long-term care. Apparently, a strong majority favors expanding coverage for these purposes.

A September 1999 Harris Interactive poll found that 86% supported "adding a new Medicare drug benefit to cover part of the cost of prescription drugs." In April 2000, an American Viewpoint survey of likely voters found that 85% agreed with the assertion that "Medicare should be reformed to give all beneficiaries a choice of health benefit plans that include comprehensive drug coverage …"49

Support drops somewhat when respondents are asked not simply whether they favor the idea, but whether it is the government’s responsibility to provide drug benefits. However, a clear majority remains supportive. In the July 2000 Washington Post/Kaiser/Harvard study, the following question was presented:

Medicare does not currently pay for prescription medicines. Some people say it is the responsibility of the federal government to make sure people age 65 and over are able to buy the prescription medicines they need. Others say this is not the responsibility of the federal government. Which comes closer to your own view?

In this case, 68% said the government is responsible, while just 29% said they thought it was not responsible.50

In most cases, support also falls slightly below support for the prescription drug benefit in principle when more detailed questions highlight the increased premiums or program costs that may be needed to pay for it. For example, 80% supported the idea in a June 1999 CNN/Time poll that noted it would require "an additional monthly payment." In a July 1999 CBS News poll, 70% supported "paying for the costs of prescription drugs for all beneficiaries, even if this meant an increase in premiums for Medicare patients and increased cost to the Medicare program." An NBC/Wall Street Journal poll in March 1999 found 65% supporting the idea "even if this meant an increase in Medicare premiums." Also, in an April 1999 Kaiser/Harvard poll, 64% favored a program to "guarantee prescription drug coverage to everyone on Medicare – even if it means an increase in premiums or taxes to cover the cost of drug coverage."51

Yet even when the argument against the prescription drug benefit is fully detailed, support stays at roughly two out of three. In September 1998, Kaiser/Harvard asked:

There is a proposal to improve Medicare by covering prescription drugs, something the program does not currently pay for, but which many seniors need. Some people favor this change, even though it means higher costs for the Medicare program, saying that seniors in Medicare use prescription drugs often and pay too much out of their own pockets for medications. Others oppose this change, saying it would require too big an increase in premiums or taxes to cover prescription drugs and that many seniors already have enough coverage from other sources. Which comes closer to your view, do you ... favor or oppose expanding Medicare to include prescription drugs?

Sixty-eight percent favored expanding Medicare to cover prescription drugs, while 26% opposed the idea. A similar pro/con question by Greenwald & Associates found 71% in support and 26% opposed in June 1999.52

Importantly, noting the likely increase in out-of-pocket costs for seniors themselves does nothing to dampen support among the broader public, even though current Medicare recipients appear less willing to pay. For example, in a July 1999 Pew survey, 79% supported "allowing Medicare recipients to buy prescription drug coverage for $24 a month." Only 15% opposed the idea. However, when a CNN/Time survey asked Medicare recipients how much they would be "willing to spend in additional monthly payments" for prescription coverage, only 30% indicated a willingness to spend up to $25. Only at a level of $10 per month was a majority (60%) willing to pay more for prescription coverage.53

Indeed, there remains some debate as to whether the prescription drug benefit should actually become a part of the Medicare program or if this should be done through a private plan. Three recent surveys indicate that the public prefers having it be part of Medicare. The July 2000 Washington Post/Kaiser/Harvard poll asked:

I’m going to read you two proposals to help people age 65 and over to pay for prescription medicines. Please tell me which of these two proposals you would prefer. Having the federal government help people age 65 and over to buy private health insurance plans that would pay part of their prescription medicine, or expanding Medicare to pay directly for part of prescription medicine costs for people age 65 and over. Which do you prefer, expanding Medicare or government help to buy private health insurance plans?

 

Fifty-seven percent favored expanding Medicare, while 36% favored government help to obtain private insurance. Likewise, in April 2000 Gallup found a 57% majority supporting expansion of Medicare "to include coverage of prescription drugs as an entitlement for senior citizens." In this three-way question, another 26% thought the government should "provide financial subsidies to encourage private insurance companies to offer … drug coverage," and 12% wanted "no changes" in coverage. A similar Kaiser/Harvard question from December 1999 revealed that a large plurality (42%) favored expanding Medicare, 27% favored government subsidization of private plans, and 19% opposed doing anything to add a prescription drug benefit.54

Many Americans regard the objective of adding prescription drug coverage to Medicare as a high priority. Indeed, in a January 2000 NBC News/Wall Street Journal poll that asked respondents to say what their highest priority for current legislation is, adding a prescription drug benefit to Medicare, at 23%, was seen as more important than new gun control measures (16%), cutting taxes (16%), passing a patients’ bill of rights (9%) and other issues.55

Long-term Care

Another important issue for seniors is long-term or catastrophic care, which pays for debilitating chronic conditions and nursing-home care. Although long-term care coverage was added to Medicare in 1988, it was repealed a year later and has never been seriously considered by Congress again. Surveys from that era show that strong majorities favored adding the long-term care benefit, and one ABC News/Washington Post poll from October 1989, when Congress decided to repeal the benefit, shows 77% opposing "doing away with" the program.56

Although there is a paucity of recent polling on the issue, it seems support for expanding Medicare by adding long-term coverage remains very strong. For example, in September 1998, Kaiser/Harvard posed the following question:

There is… a proposal to improve Medicare by covering long-term nursing-home care, something the program does not currently pay for, but which many seniors need. Some people favor this change, even though it means higher costs for the Medicare program, saying that many older people need it and cannot afford it. Others oppose this change, saying it would require too big an increase in premiums or taxes and that the country can’t afford it. Which comes closer to your view, do you ... favor or oppose expanding Medicare to include long-term care?

More than two out of three respondents (69%) favored including long-term care benefits in Medicare, while only one in four (26%) opposed the proposal.57

Findings Continued >>

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