Americans in favor of end-of-life discussions, split on ACA

Americans overwhelmingly believe that Medicare should cover end-of-life advance planning discussions with physicians, although few have actually engaged in such discussions, according to a September 2015 Kaiser Family Foundation (KFF) poll. However, they remain split in their overall views of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), with 41 percent expressing favorable views and 45 percent expressing unfavorable views. Americans also differ as to their support of various, specific provisions. For example, although they tend to oppose certain ACA-imposed taxes, their views on these taxes are less firm than their views on other aspects of the law. The poll is the latest of KFF’s monthly health tracking polls, which survey Americans on their views of the U.S. health care system overall, and the ACA, in particular.

End-of-life care

In its July 15, 2015, physician fee schedule (PFS) proposed rule, CMS included provisions for Medicare coverage of advance care planning (ACP) discussions with physicians through the use of two new Current Procedural Terminology (CPT) codes (see Proposed rule, 80 FR 41686). The ACA originally encouraged such discussions, and CMS intended to include coverage for APT discussions as part of annual wellness visits, but the regulation was never implemented, as opponents raised discussions of “death panels” (see Medicare wellness coverage no longer includes advance care planning, Health Law Daily, January 11, 2011). According to the KFF poll, conducted from September 17 to September 23, 2015, 89 percent of respondents believed that doctors should engage in APT discussions and 81 percent believed that Medicare should cover such discussions. However, only 17 percent said they had actually engaged in APT discussions, including only 27 percent of seniors and 31 percent of people with debilitating disabilities or chronic conditions. Respondents were significantly more comfortable having APT discussion with spouses, with 83 percent claiming they would be “very comfortable” discussing APT with spouses, as opposed to 57 percent with physicians or other health care providers.

Transparency

The public overall supported various ACA transparency provisions requiring insurance companies to make certain information publicly available. Eighty-four percent are in favor of the release of data on the availability of in-network doctors and hospitals, 83 percent would like to see data on how often claims are denied or appealed, 82 percent believe the public should know how quickly the company pays claims, and 73 percent think insurance companies should release data on what a typical person pays to see a doctor not in the plan network. Roughly 70 percent say they would be at least somewhat likely to use these types of information when seeking insurance.

Taxes

Overall, respondents opposed the Cadillac and medical device taxes authorized by the ACA. Section 9001 of the ACA created the Cadillac tax, which imposes a tax beginning in 2018 on higher-cost employer-sponsored health plans. Only 37 percent of respondents had followed Cadillac tax news in the past month, but 60 percent opposed the tax. However, many were easily swayed by arguments for or against the tax. Twenty-seven percent of those who opposed the tax changed their minds to favor the tax after being told that it could lower health care costs, bringing overall support to 55 percent. Fifteen percent of those in favor of the tax switched to oppose the tax after being told that it would likely cause employees to pay more in out-of-pocket expenses.

Fifty-seven percent of respondents opposed the medical device tax imposed by ACA section 9009, which imposes a 2.3 percent excise tax on medical device manufacturers.