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End-of-Year Report on Public Opinion of Healthcare Reform

The most recent Kaiser Family Foundation Health Tracking Poll has found that the public is still divided in their opinion of the healthcare reform law passed in March 2010. In fact, the latest poll results are essentially the same as those in the spring, immediately following passage of the law: 42% of Americans have favorable views of the law and 41% have unfavorable views. The proportion of the public withholding opinion on the subject has increased slightly in the past 2 months (approximately 18%). Approximately 1 in 5 Americans wants legislators to leave the law as it is, while 1 in 4 wants some parts repealed and others kept, and another 1 in 4 thinks the law should be repealed in its entirety. Most Democrats (54%) still have a favorable view of the law; 34% say the law should be left as it is. Conversely, 58% of Republicans say they are angry about the reform and 55% say the law should be repealed entirely. A small plurality of independents (31%) are in favor of partial repeal of the law, 25% support total repeal, and 18% say the law should be left as is. Since enactment of the reform law, opinions among seniors (those ≥65 years of age) have been more negative than those of younger Americans. Opinions among seniors are still more negative than positive, but the latest poll (December) results have the unfavorable views among seniors at their lowest point since passage of the bill. The proportion of those ≥65 years of age withholding opinion on the reform is up 10 percentage points since the immediate postelection period in November. The December results found that 32% of Americans think their family will be better off with the new law, 33% feel they will be worse off, and 28% say they do not anticipate any change. Since some of the law’s provisions have begun to take effect, 15% of Americans say their family has already benefited from the law, compared with 20% who think they have experienced some negative effect. Of those who reported positive impact, approximately one third said they have better access to healthcare, and 2 in 10 say they have lower healthcare costs. The most frequently mentioned benefit is the extension of dependent coverage. Of those who reported negative impact, nearly half said their healthcare costs had increased or they were concerned about the cost of the law or the increased tax burden. Only 15% said they had experienced cuts in their healthcare benefits. Finally, the poll asked about ways people are learning about the reform law and how it will impact them. Two thirds say they receive information from newspapers, radio news, or other online news services. The most recent survey results show that Americans are also learning about the law from their health insurance companies; 22% report receiving information about the law that way. In addition, 17% overall and 25% of those who are employed say they have received information on health reform from their employer, 17% say they get information from agencies such as the US Department of Health and Human Services, and 14% report getting information from state agencies. Biomarkers Predictors of Mortality A recent study found that including a combination of 3 biomarkers (levels of N-terminal pro-brain natriuretic peptide and glucose, and estimated glomerular filtration rate) to established risk factors improves the prediction of death in patients with ST-elevation myocardial infarction (STEMI) who undergo percutaneous coronary intervention (PCI). Using the biomarkers significantly predicted all-cause mortality in the single-center study, according to an article in Medpage Today. The study, reported in the Journal of the American College of Cardiology, found that adding a risk score based on the 3 biomarkers identified patients at high risk of dying during follow-up who might benefit from additional mechanical and pharmacologic measures during and after PCI. Rash Predictor in NSCLC Development of acneiform rash during an initial cycle of therapy may help to identify patients with non–small-cell lung cancer (NSCLC) most likely to respond to treatment with cetuximab. A large, multicenter clinical trial has found that patients with first-cycle rash lived nearly twice as long as patients treated with cetuximab who did not develop the rash, according to an article in Medpage Today. The rash also predicted improved progression-free survival and a higher response rate to treatment. Complete results of the study were reported online in The Lancet Oncology. Patients treated with cetuximab who developed the first-cycle rash had a median overall survival time of 15 months, compared with a survival time of 8.8 months for patients in the cetuximab arm who did not develop the rash (P<.0001). Birth Rates Down, Proportion of C-Sections Up Other than unmarried women and women in their 40s, fewer American women are having babies, according to 2008 statistics from the Centers for Disease Control and Prevention (CDC). Compared with 2007, the crude birth rate in the United States dropped 2% to 14.0 per 1000 total population. More than 40% of those births occurred among unwed mothers. Births among women ages 40 to 44 “showed the highest rate in 4 decades,” said TJ Mathews, MS, of the CDC’s National Center for Health Statistics in Hyattsville, Maryland. According to an article in Medpage Today, the CDC statistics also reported that the rate of cesarean deliveries (C-sections) has increased by 56% since 1996 (although the pace has slowed in recent years). The report said that the increase in the proportion of C-section births from 2007 to 2008 was consistent across ages, races, and ethnic groups. Self-Referred Imaging A recent analysis has found that there is no benefit to patients when physicians provide referrals for imaging on equipment owned or leased by the physician. An article in Medpage Today reported that a random sampling of Medicare data revealed that imaging self-referral did not shorten the illness and increased costs up to 10% per total episode. The exception was for self-referred x-rays to diagnose chest pain; those did shorten the duration of illness, but did not make any significant difference in total costs. The researchers said the shortened duration of illness most likely occurred because “x-rays are the only type of self-referred imaging that takes place on the same day as an office visit.”

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