Covering the uninsured should be Congress's top health care priority over
the next five years, according to an online survey of opinion leaders in
health care delivery, the health care industry, and health care
Eighty-seven percent of those responding to a Health Care Opinion Leaders
survey by the Commonwealth Fund said that Congress's most urgent priority
should be to provide coverage for the uninsured.
Other top priorities include improving quality and safety of care (69
percent), especially through increased use of information technology, and
reforms to ensure Medicare's long-run solvency (50 percent).
Opinion leaders were nominated by their peers and included experts from
four broad health care sectors: academia and research; health care delivery;
business, insurance, and other health industry; and government and advocacy
groups. Elected officials and media representatives were excluded.
The online survey, the first in a series conducted by Harris Interactive
for the Commonwealth Fund, was delivered by email to a panel of 1,155 experts
of whom 318 responded. According to its Web site, the Commonwealth Fund is a
private foundation that supports independent research on health and social
issues and makes grants to improve health care practice and policy. It was
established in 1918 by Anna Harkness, the widower of a succesful businessman
and early partner in Standard Oil.
The survey revealed substantial agreement on the specific reforms that
might be undertaken to achieve greater access for the uninsured. Allowing
individuals and small businesses to buy into the Federal Employees Health
Benefits Program (FEHBP) or a similar federal group option received the
highest support overall and a majority of votes across all categories of
Expanding existing state-based public insurance programs such as Medicaid
and the State Children's Health Insurance Programs was also supported by more
than half of the opinion leaders overall and across all categories except for
the health care delivery sector.
Establishing a single-payer plan through a new program or Medicare was
rated a priority by 45 percent of the total respondents, but just 29 percent
in the business/insurance sector. Less than one-fourth of respondents said
expanding health savings accounts and tax credits for the uninsured to buy
individual insurance should be considered priorities.
Respondents in all sectors ranked "pay-for-performance"
methods, such as rewarding efficient providers and effective disease
management, and increased use of information technology as either the first or
second priority for controlling health care costs and improving quality.
Negotiating lower drug prices was called the most important next step for
Medicare reform. Sixty-six percent of those in the business and insurance
sector and 80 percent in the government/labor and consumer-advocacy sector
agreed that allowing Medicare to use its purchasing power to negotiate lower
drug prices was a priority for Medicare
"It is not surprising that the survey reveals broad consensus about
expanding coverage to the uninsured," said Gail Wilensky, Ph.D., a
senior fellow at Project Hope and past administrator of the Medicare and
Medicaid programs during the administration of President George H.W. Bush."
It is encouraging that there is substantial agreement that coverage
expansion might allow individuals and small business to buy into the FEHBP.
This is also an idea that need not cost the federal government new monies, and
one that both Democrats and Republicans have championed over the
But Wilensky said it remains unclear how this would be implemented."
Do we mean literally buying into FEHBP or a plan that contains benefit
packages that look like what federal employees have available to them? Would
the cost of such benefits be reasonable and affordable? These and other issues
must be addressed if this approach is to become a viable policy option, but
exploring this notion further makes sense.
"Expanding state-based insurance, another area ranked as a high
priority by survey respondents, is more ambiguous, since support for this idea
is likely to depend on the answers to the question of who should be covered by
such expansions and under what terms," Wilensky said. "Policymaker
support for extending state-based coverage for those under 150 percent of the
federal poverty line, for example, is likely to differ greatly from support
for those who have substantially higher incomes—say, 300 percent or 400
percent of the poverty line."
Wilensky noted that while the 28 percent response rate was not necessarily
bad for an online survey, responders may not be representative of the entire
sample. And she took a swipe at survey respondents' apparent lack of interest
in refundable tax credits and health savings accounts—policy initiatives
that have been especially championed by President Bush and other
"Dismissing (and "dissing") refundable tax credits,
health savings accounts, and association health plans, without any attempt to
gauge the demonstrated effects of these approaches is unhelpful," she
Wilensky's comments and the survey are posted online at<www.cmwf.org/surveys/surveys_show.htm?doc_id=254281>.▪