On Wednesday, September 15 we held a virtual town hall to review our yearly Part D Satisfaction Survey. We have been doing this survey for 14 years to give seniors across our nation the opportunity to tell us how they feel about Medicare’s prescription drug program. This year, with all the discussion about changing Part D by those who say the program isn’t working, it is especially important to skip over all of the rhetoric and let you, the beneficiary, tell us how you feel about Part D.
You can click here to see the 30-minute video of the virtual town hall. My goal in this blog is to give you the Reader’s Digest version of the Town Hall.
I started off the town hall by giving a short history of the birth of Part D and its subsequent performance. Part D passed Congress by a narrow margin in 2003 after much debate. The debate ranged from creating a single payer government run program, similar to the VA program, to setting up a voucher driven system where patients would use a voucher to buy a prescription drug plan in the commercial marketplace. A public/private partnership was the final program design. When the bill was being debated, the naysayers conjectured that:
- There wouldn’t be enough competition and choices, especially in the rural areas.
- Overall plan premiums would increase dramatically.
- Seniors wouldn’t be able to wade through the complicated sign-up process or the yearly open enrollment.
Part D has proven these predictions to be wrong, today:
- Montana, a very rural state, has 23 Part D plans to choose from.
- Premiums have grown slower than the consumer price index; Part D costs are 40% less than predicted.
- State and local “navigators” helped with initial sign-up and a continually improved website helps with the yearly enrollment.
Not many government programs have been this successful. 1 in 3 Medicare eligible veterans, who have their own prescription drug program, have chosen to sign-up for Part D. The Medicare Prescription Drug program has proven, over the last 15 years, to be very successful.
After my walk down memory lane I turned the time over to Caroline Bye, an Associate Vice President for Morning Consult, to go over the survey offering insights into the survey itself. Caroline leads survey research, advocacy and messaging strategy for multinational nonprofits, advocacy groups, and higher education institutions at Morning Consult.
Caroline began by explaining that the survey was limited to people 65 and over and had prescription coverage through Medicare Part D. The slide below details the three key findings from the survey. You can see Caroline’s entire slide deck here.
The first survey question was how seniors felt about their overall Medicare healthcare coverage. The satisfaction level again this year stayed above 90%. The next question asked the important question of how they felt about Medicare’s prescription drug program. As you can see in the graph below, the satisfaction level stayed strong at 87%. Caroline pointed out that this level of satisfaction was consistent across demographics, race, sex, party affiliation, etc. It is also interesting to note that those who are taking one or more prescription drugs had a higher satisfaction level than those who were not taking any prescriptions.
The survey revealed that over 90% of the seniors feel very fortunate to have a prescription drug program. The next questions were more detailed asking if they felt the program was convenient to use, the copays and/or coinsurance amounts on generic medicines were affordable, the monthly premium was affordable, and whether the plan works well and without hassle. The results were 91%, 86%, 84%, and 86% respectively.
Seniors, to the tune of 83%, thought it was important to have a variety of prescription plans to choose from, while 2/3 of the respondents strongly agree that their out-of-pocket costs would be higher without Medicare Part D. It is also important to note that 62% of seniors said their drug costs had not changed or had gone down over the last year. It’s not surprising that 90% of seniors would recommend Part D to their friends.
The survey asked some questions concerning policy proposals that have been put forth. Respondents were asked to rate their satisfaction with these proposed changes from 0 to 10 with 0 being not at all supportive. The graph below shows the percentage of people that gave the proposal the very low score of 0 or 1. In other words, the number shown is the percentage of respondents who did not want that proposed change implemented.
Remember, these are the percentage of people who gave these proposed changes a 0 to 1 score. There could have been many scores of 5 or lower. It is evident that when the proposed changes included increasing the federal government’s involvement or the possible result of these proposed changes were identified, the proposed changes weren’t as popular as some would have you believe.
The survey then asked the respondents to choose which of the following statements is closer to their own opinion, even if neither is exactly right?
- We should keep the current Medicare law so that the government is prohibited from deciding which drugs are available to seniors and people with disabilities, even if that means the cost of some medicines might not go down.
- We need to reform the current Medicare law so that the government can negotiate costs with drug companies, even if that means the government will decide which drugs are available to seniors and people with disabilities.
50% chose number 1, keep the current law, while 30% chose number 2, change the current law with 19% having no opinion. That’s a pretty positive vote for keeping the current law.
It is interesting to show the above results broken out in different demographics, as shown in the chart below. As you might guess, Republicans are more likely to want to keep the current law 65% to 19% against keeping the law than Democrats. But, even among the Democrats, 40% still want to keep the current law as opposed to the 39% that want to change.
The final question presented a list of proposed changes and asked seniors how concerned they were with each change. Out of the 8 proposed changes, over 80% of the people were concerned with 6 of the changes with last two showing 76% and 61% of the people were concerned. Again, a vast majority of seniors are concerned with changing Part D.
Caroline turned the town hall over to Mary R. Grealy, president of the Healthcare Leadership Council, for her comments. Mary put the survey results into context of the present political environment. She pointed out that some in Congress want to move away from the fundamental design of Part D. She wondered if any of the members of Congress, who are proposing these changes, ever stopped to ask America’s seniors what they wanted? The survey showed that there is really no clamor for change among America’s seniors. Mary pointed out that the average Part D premium has stayed between $30 and $35 dollars for several years. Mary summarized her comments with the question, “if Part D is affordable and seniors are satisfied with it, what is the compelling reason for radical change”?
The town hall was then opened up for questions. The first question for Mary asked if she thought there were improvements in Part D that should be considered. Mary replied that there certainly were changes that would improve the program. She said that the proposal to limit out-of-pocket costs was a needed improvement. She also said that value-based negotiations between drug manufacturers and providers would be an ideal direction to take.
The next question was to Caroline asking how the satisfaction numbers compared year over year. She said that year-over-year the general satisfaction has remained very high.
The next question asked why we were seeing these calls for extreme changes in Part D? Mary thought that the changes were based on a few medicines and anecdotal instances, rather than relying on a broad fact-based experience. The current method of negotiations has resulted in stable, affordable prices.
The next question asked what aspect of this survey jumped out as notable? Caroline indicated that in her work with big companies she has seen surveys that had high satisfaction ratings, like this one, but the willingness of seniors to promote and recommend Part D was unique. Mary indicated that she was impressed with the number of self-identified Democrats who didn’t want to change Part D. I interjected that the slightly lower numbers from last year reflect the white noise and rhetoric that is coming out of Washington, which seeks to confuse seniors. The survey shows that when seniors sit back and ask how Part D performs for them, they are really satisfied. While there are changes that can and should be made, seniors don’t want to make radical changes.