Who Thinks That Part D is Too Complicated? Survey Results in the Medicare Prescription Drug Benefit

In 2006, the Medicare prescription-drug benefit (Part D) took effect, allowing beneficiaries federally-subsidized coverage of prescription drugs.  Despite critique of Part D’s structure and ease of beneficiary maneuverability, the benefit marked an important moment in healthcare reform.  Public opinion on Medicare prescription drug benefit (Part D) was surveyed to examine characteristics of individuals who believe that the program is too complicated and those who support one of two policies for program simplification.  One policy proposes that the government decrease the number of Part D plans available, while the other would allow beneficiaries to purchase the drug benefit directly from the government rather than from a third-party company.  Telephone survey yielded a net of 1,876 respondents of adults 18 years and older, with over sampling of adults 65 years and older (718 respondents). In addition to age,  other characteristics included political beliefs and party, gender, race, health and insurance status, socioeconomic status, and region and urban status.

Four of every five adults in the sample perceived that Part D was too complicated, with those 18-64 years old being 1.5-1.6 times more likely than those 65 years and older.  When actual experience with Part D was factored out, however, this finding was no longer significant.  Republicans were less likely to agree that Part D is complicated than other political parties. Whites and those living in the Northeast were more likely to find Part D to be complicated.

Seventy-five percent of older adults were more likely in favor of simplifying the number of plans as compared to 65% of younger adults. Adults age 18-29 were less likely to favor decreasing the number of plans. Similarly, those living in the South and West were less likely to favor fewer plan choices.

Regarding the consideration of purchasing drug plans directly from Medicare, conservatives were less likely to support this policy.  Liberals were 3 times more likely than conservatives to favor direct purchase from Medicare.

In total, nearly 80 percent felt that Part D was too complicated, greater than 66 percent favored simplifying the number of drug plans, and 84 percent supported the idea of direct purchase from Medicare.

Commentary:

This survey highlights an interesting dichotomy. While a majority of those surveyed favored more government involvement in providing a health benefit, an overlapping majority felt that this government-provided benefit was too complicated.  In other words, despite the perception of complexity of this government-provided benefit, the same majority supports increasing government involvement in Part D.  Whether the passing of these two policies proposed in the survey might result in perceiving Part D as less complicated is unknown. Thus, the question arises: how well would a universal health care system be received in this country, even by those in favor of it?

Medical Care Research and Review 2009 (66) 1: 97-115

by

Renée Volny, DO, MBA