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Focus Groups Provide Insights Into Understanding Medicare: Americans Need Education About Medicare but are Committed to the Program and Willing to Make Tough Choices

For Immediate Release: February 4, 1999
Contact: Jill Braunstein at (202) 452-8097


WASHINGTON, DC – Americans have a strong desire to learn about Medicare and a great interest in discussing the pros and cons of reform options, according to research conducted by the National Academy of Social Insurance. The results suggest that if armed with a basic understanding of the program and the outlines of reform proposals, people will engage in meaningful discussions that indicate a willingness to consider the trade-offs that may need to be made to secure the program for the future.

NASI sponsored 10 focus groups in three areas of California to learn what people understood about Medicare and their opinions of policy options currently being considered. The videotaped sessions provide a snapshot of the public's understanding of Medicare and their views about possible changes to the program at a crucial time in its history. While the Balanced Budget Act of 1997 was designed to create opportunities for beneficiaries to enroll in a wider range of health plan options, dubbed "Medicare+Choice," it also created a bipartisan Commission to develop proposals for restructuring the program over the longer term.

Analyzing the views of Medicare beneficiaries in California is particularly instructive because the health care market there may foreshadow the future of Medicare nationwide: almost 40 percent of California Medicare beneficiaries are enrolled in managed care plans, about three times the national average. In many respects, California has become the proving ground for managed competition and other competitive bidding approaches to health insurance in both the public and private sector health care markets. The focus groups were conducted in Los Angeles, Sacramento and San Jose by the Kleimann Communications Group. The groups were culturally diverse and included groups of current and future beneficiaries.

Medicare beneficiaries in these groups are generally quite happy with their health plans, and with the added benefits that health maintenance organizations offer. At the same time, however, they indicated that they are often confused about Medicare in general and managed care in particular. Those not yet eligible for Medicare had little experience dealing with choices among health plan options, and very limited understanding of Medicare coverage or benefits.

"The research shows that regardless of how policymakers restructure Medicare, beneficiaries will need clear information about how policy changes may impact them," said NASI Project Director Michael Gluck. "It suggests that Medicare and local consumer advocates need to develop strategies to better inform beneficiaries and those under 65 about how Medicare works."

Despite their problems understanding Medicare, the research illustrates a clear consensus among the participants that the federal government has a responsibility to ensure that the program continues to provide the benefits that citizens feel they have earned. Participants describe how important the program is to them and their families, and express concern about the rising costs of health care, including financial pressures on both low-income beneficiaries and low-wage workers. Despite reservations about the ability of government to deal with Medicare effectively, participants are also concerned about what might happen to quality of care and their choices if policy changes put the private sector in charge of cost controls.

"People evaluate the merits of proposed Medicare reforms in terms of their own values," said NASI Senior Research Associate Jill Bernstein. "These values center on concepts of fairness to themselves, to their families, to wage earners and to all taxpayers and health care providers."

The research also indicates that the Health Care Financing Administration, which administers Medicare, faces challenges in informing beneficiaries about what expanded choices in their coverage means. The focus groups show that beneficiaries are not comfortable sorting through charts and technical descriptions of health plans' coverage. Instead, people choose health plans using whatever they find on what is important to them personally: access to specialty services and what costs they would have to pay regarding their own medical condition, or keeping a particular primary care doctor.

"People exhibited a strong desire to learn more about Medicare and how changes impact them, their children and grandchildren," said Gluck.

Copies of a 29-minute video compilation of Medicare Today and Tomorrow: Views From California, are available from the National Academy of Social Insurance. NASI is a nonprofit, nonpartisan organization of the nation's experts on social insurance. Its mission is to conduct research and enhance public understanding of social insurance, develop new leaders, and provide a nonpartisan forum for exchange of ideas on important issues in the field of social insurance. The California HealthCare Foundation provided funding for the focus group research and production of the videotape.

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