December 2000 • Volume 6 Number 12
Did health care issues make headway?
VOTERS' TOP ISSUES
- The following percentages of voters considered these issues important* in votes for U.S. senators or representatives:
- 90% public education
- 85% crime, illegal drugs
- 85% Social Security
- 83% health care coverage for more families,
children- 83% medical decisions by doctors, not HMOs
- 80% the economy
- 79% seniors' prescription drug coverage
- 77% Medicare
- 76% health care system reform
- 74% tax relief for middle class
- 73% the environment
- 70% patient's bill of rights
- *A selection of issues from a Nov. 9 poll by the Mellman Group and Public Opinion Strategies
Even with the country embroiled in presidential vote-counting at press time, a few policy-watchers could still snatch some hope for health care from the elections.
"Two years ago, Democrats and Republicans didn't agree on much in health care," says Robert Crittenden, M.D., of Seattle. "But in this year's presidential campaigns, both parties made sweeping promises to America about the patient's bill of rights and pharmaceutical benefits for seniors."
Crittenden, a member of the AAFP Commission on Legislation and Governmental Affairs, teaches at the University of Washington medical school in Seattle and practices in a family medicine clinic. "One-third of our patients have commercial coverage, one-third have Medicaid and one-third have 'other,' including many with no coverage at all -- we have this in spades," says Crittenden.
He sees little chance of strong action on access-to-care initiatives from the incoming Congress. However, he holds out hope for strategies under discussion outside the halls of Congress.
For example, the Health Insurance Association of America (traditionally Republican) and Families USA (a coalition led by Democrats) are cosponsoring town forums to discuss coverage for low-income Americans. "These two groups are suggesting that Medicaid should cover more people and are promoting tax credits for employers who provide expanded benefits to employees under 200 percent of the poverty level," says Crittenden, a member of the board governing Families USA.
In the near future, an end run around the U.S. Congress may be the best way to effect change.
"The gridlock, the paralysis in policy-making that we've seen in Congress for two years will get even worse with the parties so narrowly split in both chambers" as a result of the election, says David Mitchell, a partner in the strategic communications firm Greer, Margolis, Mitchell, Burns and Associates in Washington.
Mitchell discounts any chance for progress on a federal patient's bill of rights but says the states are taking steps to control managed care: "In the absence of federal control, when you have a problem that's producing pain, the states take it on."
Voters resonated with health care issues in the election, he adds (see box).
Some of the interest in the prescription drug issue, however, was stimulated by $80 million worth of campaign ads funded by pharmaceutical companies. The industry supported candidates who would vote against a Medicare prescription drug benefit but would favor, for example, prescription assistance for seniors via state-based, low-income programs and a moderate cap on out-of-pocket expenses.
How successful was the pharmaceutical industry's advertising? Twenty-two candidates backed by the industry won House seats, and only four lost.
"Double-digit health premium increases are predicted this year," says Mitchell, "and up to 40 percent of the increases can be attributed to prescription drug costs. Surveys indicate employers will pass the premium increases on to their employees.
"The prescription drug issue will not go away; it will continue to play out at the state level if not the federal level."
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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