THE PULSE The Texas Medical Center?s Consumer Survey i HEALTH TMC POLICY From the Texas Medical Center Health Policy Institute Arthur “Tim” Garson, Jr., MD, MPH Director Garson@TMC.edu Stephen H. Linder, PhD Associate Director SLinder@TMC.edu Ryan Holeywell TMC Director of Communications RHoleywell@TMC.edu 2 3 The Nation’s Pulse: Year Four • This year, we surveyed 5,038 participants • n=1,018 Texas • n=4,020 National • Surveys were completed June-July 2018 • Luminas, LLC used a standard online protocol • * p<0.05 significant difference – with n=4020 and n=1018, so in both cases “small” differences count Fixing Health Care: Four Key Areas Fixing Health Care: Priorities Fixing Health Care: Health Insurance and Health Care Delivery Fixing Health Care: Healthy Lifestyles Fixing Health Care: Presidential Election Insights 4 Fixing Health Care Priorities 6 Reducing health care costs is the top health care priority, followed by health insurance affordability and universal coverage US Health Care Priorities (Mean Rank) National Highest Priority Reducing health care costs Increasing the affordability of health insurance premiums and deductibles Providing universal coverage so every citizen is insured Supporting medical breakthroughs to develop cures Increasing life expectancy in the United States Simplifying health care paperwork Lowest Priority Having easier-to-understand health care bills BASE: ALL QUALIFIED RESPONDENTS (n=4020) Q100 Below are several statements describing key US healthcare priorities. Based on your opinion, please rank these statements, in the order of priority where 1 is the highest priority and 7 is the lowest priority for the US healthcare system. 7 After costs, Democrats prioritize universal coverage; affordability ranks higher with Republicans and Independents US Health Care Priorities (Mean Rank) National Democrats Republicans Independents Reducing costs Reducing costs Reducing costs UNIVERSAL COVERAGE AFFORDABILITY AFFORDABILITY AFFORDABILITY BREAKTHROUGHS Supporting medical breakthroughs to develop cures Providing universal coverage so every citizen is insured Highest Priority UNIVERSAL COVERAGE Supporting medical breakthroughs to develop cures Lowest Priority BASE: ALL QUALIFIED RESPONDENTS (n=4020) Q100 Below are several statements describing key US healthcare priorities. Based on your opinion, please rank these statements, in the order of priority where 1 is the highest priority and 7 is the lowest priority for the US healthcare system. 8 Nearly two-thirds are likely to only vote for candidates who will make fixing health care a priority; Democrats more than Republicans more than Independents Likelihood to Only Vote for Candidates Who Prioritize Fixing Health Care National 6% Party Affiliation 33% Democrats (A) 33% 61% Republicans (B) Independent (C) 28% Very likely Likely Somewhat likely Not at all likely BASE: ALL QUALIFIED RESPONDENTS (n=4020) Q165 How likely are you to only vote for candidates who will make fixing healthcare a priority? 68% BC 60% C 53% % Important/ Very Important 9 About half report cutting down on other expenses to pay for health care; worse in Texas I have to cut down on other expenses to pay for health care National 18% 21% 27% Texas 23% 56% 49% 31% 23% 24% 33% Strongly agree Somewhat agree Somewhat disagree Strongly disagree BASE: ALL QUALIFIED RESPONDENTS (n=4020 National; n=1018 Texas) Q220 Now please tell us how much you agree or disagree with each of the statements below. . 10 Six in ten say they are paying more out-of-pocket for health care this year than two years ago; Texans worse I’m paying more out-ofpocket for my health care this year than two years ago National Texas 17% 21% 30% 26% 59% 65% 18% 19% 35% 33% Strongly agree Somewhat agree Somewhat disagree Strongly disagree BASE: ALL QUALIFIED RESPONDENTS (n=4020 National; n=1018 Texas) Q220 Now please tell us how much you agree or disagree with each of the statements below. 11 When receiving a costly medical bill, a little more than onethird pay in full right away Action When Receiving Costly Medical Bill National Pay in full right away 38% Pay what I can when I can 24% Pay in agreed upon installments 29% Don’t pay until collection agency Don’t pay 3% 7% BASE: ALL QUALIFIED RESPONDENTS (n=4020) Q217 When you receive a costly medical bill, which of the following best describes how you usually handle it? Select one response only. 12 About half want to discuss costs with PCP, but less than half of them actually have the discussion Topics Discussed with Primary Care Physician Actually Discuss Cost of procedures and tests he/she recommends 23% Cost of drugs he/she prescribes 23% Want to Discuss 53% 50% Whether you can afford procedures and tests he/she recommends 20% 45% Whether you can afford the drugs he/she prescribes 20% 44% BASE: ALL QUALIFIED RESPONDENTS (n=4020) Q255. Does the doctor you see most often discuss the following directly with you…? // Q260. Do you want your doctor to discuss the following directly with you…? National 13 About half report more difficulty choosing their preferred doctors and hospitals than two years ago National Choosing Any Doctor I Want Is Not As Easy As Two Years Ago 23% Choosing Any Hospital I Want Is Not As Easy As Two Years Ago 20% 25% 16% 52% 47% 31% 25% 32% 28% Strongly agree Somewhat agree Somewhat disagree Strongly disagree BASE: ALL QUALIFIED RESPONDENTS (n=4020) Q220 Now please tell us how much you agree or disagree with each of the statements below. Fixing Health Care Health Insurance an Health Care Deliver I HEALTH POLICY In states with Medicaid expansion, support for continuing Medicaid provision is overwhelming; significantly higher among Democrats, Independents, but clear among Republicans as well 15 Support for Medicaid Continuation (% Yes in Expansion States) National Party Affiliation Democrats (A) 76% Republicans (B) 85% 65% Independent (C) Yes BASE: QUALIFIED RESPONDENTS IN EXPANSION STATES (Total n=2693/Democrats n=1140/Republicans n=705/Independent n=667) Q110b Are you in favor of your state continuing Medicaid insurance coverage for low-income adults? 75% B BC 16 In non-expansion states, support for Medicaid expansion is high; higher among Democrats but more than half of Republicans Support for Medicaid Expansion (% Yes in Non-Expansion States) National Party Affiliation BC Democrats (A) 64% Republicans (B) Independent (C) 81% 51% B 59% 60% Texas Yes BASE: QUALIFIED RESPONDENTS IN NON-EXPANSION STATES (Total n=1327/Democrats n=468/Republicans n=407/Independent n=380 NATIONAL Q110a Are you in favor of your state expanding Medicaid insurance coverage to more low-income adults? 17 A majority of Americans in expansion states say it’s important the candidate they vote for feels the same about continuing Medicaid expansion, more so for Democrats Importance that Candidate Feels the Same About Support for Medicaid Continuation Expansion States National 8% Party Affiliation 21% 42% 71% Republicans (B) Independent (C) 28% Very important Important Somewhat important Not at all important 81% BC Democrats (A) BASE: QUALIFIED RESPONDENTS IN EXPANSION STATES (n=2693) Q120 How important is it to you that a political candidate you vote for feels the same way you do on the following…? 58% 66% B % Important/ Very Important 18 In the non-expansion states, about two in three say it’s important the candidate they vote for feels the same about expanding Medicaid Importance that Candidate Feels the Same About Support for Medicaid Expansion Non-Expansion States National 11% Party Affiliation 36% 24% Democrats (A) 65% Republicans (B) Independent (C) 29% Very important Important Somewhat important Not at all important BASE: QUALIFIED RESPONDENTS IN NON-EXPANSION STATES (n=1327) Q120 How important is it to you that a political candidate you vote for feels the same way you do on the following…? 76% BC 57% 61% % Important/ Very Important 19 There is little support for proposed Medicaid changes Support for Proposed Changes to Medicaid Limit the total amount the federal government pays per person for Medicaid Allow states to limit the number of months an adult can receive Medicaid Exclude any poor adults from receiving Medicaid unless they are disabled 18% 14% 10% BASE: ALL QUALIFIED RESPONDENTS (n=4020) Q115 Recently, there have been some changes proposed to the Medicaid program. Which proposed changes to Medicaid listed below, if any, are you in favor of? Please select all that apply. National 20 More than half support providing Medicare for all US adults Importance that Candidate Feels the Same Support for Medicare for All US Adults 5% 34% 32% National Very important 59% Important Somewhat important Not at all important 29% 71% BC Democrats (A) Republicans (B) Independent (C) 46% 55% B BASE: ALL QUALIFIED RESPONDENTS (n=4020) Q122 Are you in favor of the federal government providing Medicare insurance coverage for all US adults? Democrats (A) 71% Republicans (B) 61% C Independent (C) 55% BC 21 Over half are at least somewhat likely to consider a catastrophic health insurance plan Likelihood of Buying/Considering Catastrophic Health Insurance Plan National Overall Likelihood Education Income High School or less (A) 11% A 58% More than High School (B) 15% Under $50K (A) 52% $50K & above (B) 54% 58% A 56% 31% Insurance Status Insured (A) 44% Uninsured (B) Residence Setting Urban (A) 50% Suburban (B) A 74% Rural (C) Party Affiliation Democrats (A) Not at all likely Somewhat likely 53% Republicans (B) 60% A Independent (C) 57% BASE: ALL QUALIFIED RESPONDENTS (n=4020) Q206 If the federal government offered a catastrophic health insurance plan that you could buy that only covered chronic diseases, accidents and pregnancy, BUT not routine illnesses, how likely would you be to consider this plan instead of your current plan/consider buying this plan]? BC 64% 55% 50% C 22 Barely half of Americans get their primary care in a PCP office Health Care Setting National Insurance Status 57%B Insured (A) Uninsured (B) 45% 28% Education 55% High School or less (A) More than High School (B) Income Under $50K (A) 52% 56% A $50K & above (B) Residence Setting Urban (A) Receive care at PCP's office BASE: ALL QUALIFIED RESPONDENTS (n=4020) Q450 Which setting do you go to most often for your healthcare needs? 45% Suburban (B) 59% Rural (C) 59% A A 49% A 58% Fixing Health Care Healthy Lifestyles HEALTH POLICY 24 7 in 10 Americans believe menu labeling will help people eat healthier food Labeling Menus with Nutritional Info Would Help People Eat Healthier Party Affiliation BC 77% Democrats (A) 28% Republicans (B) 69% Independent (C) 70% Education 72% National High School or less (A) More than High School (B) 69% 74% A Residence Setting % Somewhat/Strongly Agree Urban (A) C 74% Suburban (B) 73% C Rural (C) BASE: ALL QUALIFIED RESPONDENTS (n=4020) Q135 How much do you agree or disagree with each of these statements? 67% 25 More than half agree that foods that lead to obesity should cost more; some have called this a “fat tax” Foods that Lead to Obesity Should Cost More Education High School or less (A) 44% More than High School (B) 49% 55% Income Under $50K (A) 51% National 56%* $50K & above (B) 45% 54% A Residence Setting Texas Urban (A) % Somewhat/Strongly Agree Suburban (B) Rural (C) BASE: ALL QUALIFIED RESPONDENTS (n=4020 National; n=1018 Texas) Q135 How much do you agree or disagree with each of these statements? 57% BC C 50% 45% 26 Nearly half of Americans support lowering the legal blood alcohol limit while driving to 0% Lowering the Legal Blood Alcohol Limit While Driving to 0% Party Affiliation Democrats (A) 46% Republicans (B) 48% Independent (C) 43% 46% National 54% Residence Setting Urban (A) 48% Texas % Somewhat/Strongly Support BASE: ALL QUALIFIED RESPONDENTS (n=4020 National; n=1018 Texas) Q145 How strongly would you support or oppose the following approaches to improve road safety? 50% BC Suburban (B) 44% Rural (C) 45% 27 There is widespread support for preventing the sale of all tobacco products to people under 21 Preventing the Sale of All Tobacco Products to People Under 21 Years of Age Party Affiliation 18% Democrats (A) 84%C Republicans (B) 83% C Independent (C) 75% Education 82% National Income High School or less (A) 80% Under $50K (A) 80% More than High School (B) 82% $50K & above (B) 82% 83% Texas Insurance Status Insured (A) Residence Setting 82% % Somewhat/Strongly Support Uninsured (B) BASE: ALL QUALIFIED RESPONDENTS (n=4020 National; 1018 Texas) Q155 How strongly would you support or oppose the following approaches to reduce tobacco-related illnesses…? 79% Urban (A) 82% Suburban (B) 82% Rural (C) 81% 28 Half of Americans support banning the sale of all tobacco products Banning the Sale of All Tobacco Products Party Affiliation Democrats (A) Republicans (B) Independent (C) 48% 52% 54% C 49% Education 52% National Income High School or less (A) 51% Under $50K (A) More than High School (B) 53% $50K & above (B) 49% 54% A 57%* Texas Insurance Status Residence Setting Urban (A) % Somewhat/Strongly Support Insured (A) 52% Suburban (B) Uninsured (B) BASE: ALL QUALIFIED RESPONDENTS (n=4020 National; n=1018 Texas) Q155 How strongly would you support or oppose the following approaches to reduce tobacco-related illnesses? BC 57% 52% Rural (C) 51% 47% 29 Fixing Health Care Presidential Election Insights 30 Nationally, a little over 1/3 are planning to vote for President Trump in 2020 Stated Voting in 2020 Presidential Election US Texas US Texas US Texas US Texas All Rep Ind Dem BASE: QUALIFIED RESPONDENTS WHO CONSIDER THEMSELVES DEMOCRATS, REPUBLICANS OR INDEPENDENT (NATIONAL: Democrats n=1608/Republicans n=1112/Independent n=1047); TEXAS: Democrats n=313/Republicans n=370/Independent n=260) Q170 Assuming President Trump runs for re-election in 2020, which of the statements is most true for how you feel today? 31 Those who plan to vote for Trump in 2020 would change their mind based on Trump’s actions in health policy: 2/3 of Democrats + 1/3 of Republicans & Independents Likelihood that Trump’s Actions on Health Care Would Prevent From Voting for Him in 2020 National (% Likely/Very Likely) Democrats 60% Independents 37% Republicans 35% BASE: QUALIFIED DEMOCRATS, REPUBLICANS, INDEPENDENTS WHO PLAN TO VOTE FOR TRUMP IN 2020 (Democrats / Republicans/ Independents Planning to Vote for Trump in 2020 n=163/838/378 - NATIONAL) Q175 Again, assuming President Trump runs for re-election in 2020, how likely is it that his actions on each of the following will keep you from voting for him? 32 The percentage of those who say they would vote for Trump would change from 37.4% to 22.9% depending upon health policy. 39% Reduction BASE: QUALIFIED RESPONDENTS WHO CONSIDER THEMSELVES DEMOCRATS, REPUBLICANS OR INDEPENDENT (Democrats n=1608/Republicans n=1112/Independent n=1047) Q170 Assuming President Trump runs for re-election in 2020, which of the statements is most true for how you feel today? Texas Medical Center Health Policy Institute