The Commonwealth Fund Health Care Opinion Leaders Survey: Assessing Health Care Experts' Views on Medicaid and Its Future

Country: United States

Survey Organization: Harris Interactive, Inc.

Field Dates: August 8–August 29, 2005

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

Sample Size: 252 (survey successfully e-mailed to 1,238 potential respondents; the response rate was 20%)

Interview Method: Online/E-mail

The latest Commonwealth Fund Health Care Opinion Leaders Survey was conducted by Harris Interactive on behalf of The Commonwealth Fund, with a broad group of about 252 opinion leaders in health policy and innovators in health care delivery and finance. This was the fifth in a series of six bimonthly surveys designed to highlight leaders' perspectives on the most important and timely health policy issues facing the nation. This survey focused on Medicaid and its future.

Medicaid, and the growing burden its costs are placing on government budgets, especially at the state level, has been the subject of extensive public debate in recent months. We asked respondents from our leaders' panel to rate the success of both the Medicaid and the State Children's Health Insurance Program (SCHIP) programs and the importance of the Medicaid program in achieving a number of goals that the program was designed to achieve, such as providing access to health care for vulnerable populations and offering financial stability for health care providers who serve these populations. Panelists also were given a list of suggested program changes and asked to indicate if they would favor or oppose each proposal.

Potential respondents for this series of surveys were identified through a two-step process involving 1) a "nomination" survey with a core group of experts in multiple fields to nominate additional leaders both within and outside their areas of expertise and 2) a review of published lists and directories of recognized health experts. Detailed methodology is provided in the Appendix.

Summary

Have Medicaid and SCHIP Been Successful in Meeting Their Goals?
Slightly more than half of panelists representing academia, health care delivery, business/insurance/other health care industry, and government/labor/consumer advocacy felt that Medicaid and the SCHIP have been successful in meeting their overall goals (58% and 62% respectively). Leaders from the business sector were the least positive respondents, with fewer than two in five believing that the program has been successful (39%).

However, when panelists were asked about specific accomplishments of the Medicaid program, majorities across all sectors expressed a strongly positive view about each Medicaid objective that they were asked to evaluate, especially those related to serving the health care needs of low-income adults and children, and the elderly, disabled, and other vulnerable populations. At least nine in 10 opinion leaders said the Medicaid program has been successful in improving access to health care for the low-income population (92%), improving accessibility to nursing home and home care for the elderly and disabled (91%), and insuring high risk populations, special needs children, or disabled adults for whom private insurance is unavailable or missing key benefits (90%). More than three in four also said that the program meets its goal of increasing the financial stability of health care providers serving the poor and uninsured (77%). Fewer panelists, but still a majority, said Medicaid fulfills its objective to help finance high-cost community hospital resources (66%).

Medicaid's Future
When asked about a number of policy changes for Medicaid, respondents showed clear preferences. Simplifying eligibility and re-enrollment rules to improve continuity of coverage emerged as the leading option, with nearly all (95%) respondents favoring this change. The vast majority (85%) of respondents also endorsed federal funding to expand coverage to all uninsured below 150% of poverty level. About three in four were in favor of having the federal government assume responsibility for paying Medicare premiums and cost-sharing for low-income elderly and disabled with incomes below 135% of poverty level who qualify for Medicaid (77%) and moving Medicaid/SCHIP toward pay-for-performance payment incentives (77%). About the same number of opinion leaders liked the idea of requiring employers that do not offer health benefits to pay into a pool to help support Medicaid/SCHIP expansion to low-income workers and assist in enrolling low-wage workers, and letting anyone buy coverage through Medicaid or SCHIP by paying a sliding scale premium (73%). Fewer, but still a majority of respondents, favored permitting benefit designs for beneficiaries with incomes above 100% of poverty level that include some premium or cost-sharing not to exceed 5% of income (61%).

A substantial majority of respondents, regardless of sector, rejected capping the total federal funds per covered beneficiary and allowing states greater flexibility on benefit design. Two in three opinion leaders opposed this proposed policy change, with more than one in three strongly opposing this change (37%).

Although the level of support for some of the proposed policy changes varied somewhat depending on the sector, overall it appeared that only one option—allowing anyone to buy coverage through Medicaid or SCHIP by paying a sliding scale premium—was far less favored by respondents from the business/insurance/other health care industry than by panelists from academia, health care delivery, or government/labor/consumer advocacy (55% vs. 74%-80%).

The goal for this survey is to expand and inform a healthy public and professional debate. As part of that effort to keep the discussion going, we invite you to take the survey yourself.

Methodology
The online survey was conducted by Harris Interactive with 252 opinion leaders in health policy and innovators in health care delivery and finance between August 8th, 2005, and August 29th, 2005.

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 1,281 people.

Harris Interactive sent out individual e-mail invitations containing a password-protected link to the entire sample. Of the 1,281 e-mail invitations, 43 were returned as undeliverable. Harris Interactive determined that the undeliverable e-mail addresses appeared to be randomly distributed among the different sectors and affiliations. Data collection took place between August 8, 2005, and August 29, 2005. A total of three reminders were sent to anyone who had not responded. The response rate was 20 percent. Typically, samples of this size are associated with a sampling error of +/– 6 percent.