Texas Consumer Health Care TexasCare Survey 2018 Luminas, LLC
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
The Nation’s Pulse: Year Four • This year, we surveyed 4,000 participants • 1,000 from Texas 3,000 from the other 49 states • Survey was completed June-July 2018 • Luminas, LLC used a standard online protocol • * p<0.05 significant difference • – with N=4,000, so “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
Fixing Health Care Priorities
For Texans, similar to all Americans, the top priority is reducing health care costs, followed by health insurance affordability and universal coverage US Health Care Priorities – By Mean Rank Texas National Highest Reducing health care costs (2.5) Reducing health care costs (2.5) Priority Increasing the affordability of health insurance Increasing the affordability of health insurance premiums and deductibles (3.0) premiums and deductibles (3.0) Providing universal coverage so every citizen is Providing universal coverage so every citizen is insured (3.7) insured (3.9) Supporting medical breakthroughs to develop cures Supporting medical breakthroughs to develop cures (4.1) (4.2) Increasing life expectancy in the United States (4.8) Increasing life expectancy in the United States (4.8) Simplifying health care paperwork (4.9) Simplifying health care paperwork (4.9) Lowest Having easier to understand health care bills (4.9) Having easier to understand health care bills (5.0) Priority BASE: ALL QUALIFIED RESPONDENTS (n=1018 Texas; n=3910 National excl. Texas) 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.
In Texas, affordability, supporting medical breakthroughs, and simplifying paperwork rank higher with Republicans; Democrats say universal coverage is the priority US Health Care Priorities – By Mean Rank Texas Democrats Republicans Highest Reducing health care costs (2.5) Reducing health care costs (2.8) Priority Providing universal coverage so every citizen is Increasing the affordability of health insurance premiums and deductibles (2.8) insured (3.0) Supporting medical breakthroughs to develop Increasing the affordability of health insurance premiums and deductibles (3.1) cures (3.7) Supporting medical breakthroughs to develop cures Simplifying health care paperwork (4.6) (4.4) Providing universal coverage so every citizen is Increasing life expectancy in the United States (4.8) insured (4.8) Simplifying health care paperwork (5.0) Increasing life expectancy in the United States (4.8) Lowest Having easier to understand health care bills (5.0) Having easier to understand health care bills (4.8) Priority BASE: ALL QUALIFIED RESPONDENTS IN TEXAS (n=1018 Texas/n=313 Democrats/n=370 Republicans) 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.
Over half are likely to vote for a candidate who will make fixing health care a priority Likelihood to Vote for Candidates Who Prioritize Fixing Health Care Texas (A) National (B) 30% 33% 28% 28% 34% 33% 8% 6% Very likely Likely Somewhat likely Not at all likely BASE: ALL QUALIFIED RESPONDENTS (n=1018 Texas; n=3910 National excl. Texas) Q162 How much do you agree or disagree with the following statements? // Q165 How likely are you to only vote for candidates who will make fixing healthcare a priority?
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 Texas for health care National 18% 21% 23% 27% 49% 56% 23% 31% 24% 33% 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. .
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-of- pocket for my health care this year than two Texas National years ago 17% 21% 30% 26% 65% 18% 59% 19% 35% 33% 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. .
As with the rest of the US, when Texans receive a costly medical bill, only a minority – 37% - can pay it in full right away; over half pay in agreed upon installments or when they can Action When Receiving Costly Medical Bill Texas Males, whites, Texans with higher Pay in full right away income, and insured are much more 37% likely to pay medical bills in full right away Pay what I can 24% when I can Pay in agreed upon 30% installments Don’t pay until 4% collection agency 5% Don’t pay BASE: ALL QUALIFIED RESPONDENTS IN TEXAS (n=1018 Texas) Q217 When you receive a costly medical bill, which of the following best describes how you usually handle it? Select one response only.
Similar to the rest of the country, discussing cost and affordability of tests and procedures is not commonplace in Texas; however, Texans are much more likely than others to already have cost related discussions with doctors and to welcome more of those discussions Topics Discussed with Primary Doctor Texas Actually Discuss Want to Discuss 29% 54% Cost of drugs he/she prescribes Texans are significantly more likely than all other Americans to report discussing cost of Cost of procedures and tests he/she 27% 58% procedures and recommends drugs with doctors; Texans also much more often than the Whether you can afford the drugs he/she 23% 46% rest of the US report prescribes wanting to have cost related discussions with their doctors Whether you can afford procedures and tests 20% 48% he/she recommends BASE: ALL QUALIFIED RESPONDENTS IN TEXAS (n=1018 Texas) 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…?
Similar to most Americans, Texans value physician choice, but they are significantly more likely than others to report difficulty choosing preferred doctors and hospitals compared to two years ago % agree Choosing Any Doctor I Want Is Not 56% B As Easy As Two Years Ago 51% Choosing Any Hospital I Want Is 52% Not As Easy As Two Years Ago B 47% Texas (A) National (B) BASE: ALL QUALIFIED RESPONDENTS (n=1018 Texas; n=3910 National excl. Texas) Q220 Now please tell us how much you agree or disagree with each of the statements below. Q275 Please tell us how important is each of the following to you or your family
Fixing Health Care Health Insurance and Health Care Delivery
A majority of Texans and US adults in other non- expansion states support Medicaid expansion; about two-thirds say it’s important the candidate they vote for feels the same Importance that Candidate Support for Medicaid Expansion You Vote for Feels the Same 11% 34% 60% 25% Very important Texas (A) Important 30% Yes Somewhat important 11% Not at all important 35% 63% National 24% Other Non- Expansion States (B) 30% BASE: QUALIFIED RESPONDENTS IN NON-EXPANSION STATES (n=1018 Texas; n=1217 Non-Expansion States excl. Texas) Q110a Are you in favor of your state expanding Medicaid insurance coverage to more low-income adults? BASE: QUALIFIED RESPONDENTS IN NON-EXPANSION STATES (n=1018 Texas; n=1217 Non-Expansion States excl. Texas) Q120 How important is it to you that a political candidate you vote for feels the same way you do on the following…?
In Texas, support for Medicaid expansion is significantly higher among Democrats, females, minorities, Gen-Xers and Millennials, lower income families, families with children and urban populations Support for Medicaid Expansion (% Yes) Texas Party Affiliation Females, minorities, particularly Black/AAs, younger Texans, BC Democrats (A) 83% households with children, 60% those with lower income Republicans (B) 40% and those living in urban B Independent (C) 57% areas are significantly more likely to support Medicaid expansion Yes BASE: QUALIFIED RESPONDENTS IN TEXAS (Total n=1018/Democrats n=313/Republicans n=370/Independent n=260) Q110a Are you in favor of your state expanding Medicaid insurance coverage to more low-income adults?
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