A blog covering the health/care ecosystem and people.

“Health comes to your local store,” explains the recently-launched portal, GoHealthEvents. This site is a one-stop shop for health consumers who are seeking health screenings and consults in local retail channels like big box stores, club stores, drug stores, and grocery stores. Events covered include cholesterol, diabetes, heart health, nutrition, osteoporosis, senior health, vaccinations and immunizations. By simply submitting a zip code, a health consumer seeking these kinds of services can identify where and when a local retailer will provide it. I searched on my own zip code in suburban Philadelphia, and found the following opportunities taking place in the

The top reason people in America over 50 don’t fill a prescription is the cost of the drug, according to the AARP 2015 Survey on Prescription Drugs. Eight in 10 people 50+ think the cost of prescription drugs is too high, and 4 in 10 are concerned about their ability to afford their medications. Thus, nearly all people over 50 think it’s important for politicians (especially presidential candidates) to control Rx drug costs. Older consumers are connecting dots between the cost of their medications and direct-to-consumer prescription drug advertising: 88% of the 50+ population who have seen or heard drug

How can digital technologies enable self-healthcare in novel ways? This was the theme of a meeting sponsored by Pfizer Consumer Healthcare and hosted by Google, with the title, “Advancing Consumer Health through New Technology and Next Generation OTC Healthcare” held on 12th April 2016 at Google offices in Manhattan’s Chelsea neighborhood. Pharmaceutical brand drugs switching to over-the-counter packaged goods, the Cellscope Otoscope used by parents checking their young children’s earaches, connected shoes and earbuds for athletic enhancement, and omni-channel retail shopping….these are a few of the signals we see emerging to enable consumers’ to drive healthy behaviors, wellness and self-healthcare. Speakers

Prices for the most commonly used branded prescription drugs grew from a base index of $100 in 2008 to to $264 in 2015, based on the Express Scripts 2015 Drug Trend Report. This is illustrated by the upwardly-sloping blue line in the chart. In contrast, the market basket of the most commonly used generic drugs fell from the $100 index in 2008 to $29.73, shown by the declining black line in the graph. The $112.05 is calculated from a market basket of commonly purchased household goods which cost $100 in 2008, a relatively flat line which puts the 264% rise in

As consumers’ growing financial skin in the health care game compels them to seek care in lower-cost settings, the pharmacy business recognizes the opportunity to provide healthcare services beyond the core business of filling prescriptions. This month, Drug Store News (DSN) published a special section called which profiles several pharmacy companies’ expanding reach into retail health – in particular, re-defining the concept of the “health fair.” A health fair is “an educational and interactive event designed for outreach to provide basic prevention and medical screening to people in the community,” according to the latest Wikipedia definition. But the health fairs described

The rising cost of health care for Americans continues to contribute to self-rationing care in the forms of not filling prescriptions, postponing necessary services and tests, and avoiding needed visits to doctors. Furthermore, health care costs are threatening the livelihood of most American families, according to the Pioneer Institute. “What Will U.S. Households Pay for Health Care in the Future?” asks the title of a study by the Institute, noting that health care costs for an American family of average income could increase annually to $13,213 by 2025 — and as high as $18,251. Pioneer calculates that this forecasted spend will

It’s time to get the tea leaves out and mash up trends in my world of health, health care, technology, policy and people for 2016. We’ll start with the central player: people, consumers, patients, caregivers all. Health consumerism on the rise.  People – call us patients, consumers, caregivers – will take on even more financial and clinical decision making risk in 2016. Growing penetration of high-deductible and consumer-driven health plans will push (not just nudge) people into the role of health care consumers, and the emerging businesses and programs serving the transparency market for price and quality will gain traction

Prescription drug costs have become a front-and-center health benefits cost issue for U.S. employers in 2015, and in 2016 the challenge will be directly addressed through more aggressive utilization management (such as step therapy and prior authorization), tools to enable prescription intentions like DUR, and targeting fraud, waste and abuse. Consumers, too, will be more financially responsible for cost-sharing prescription drugs, in terms of deductibles and annual out-of-pocket limits, as described in the PBMI 2015-206 Prescription Drug Benefit Cost and Plan Design Report, sponsored by Takeda. The Pharmacy Benefit Management Institute has published this report for 15 years, which provides neutral, detailed survey

“What’s in a name?” Juliet asked in Shakespeare’s play. For medicines consumers in the U.S., not much. Most Americans prefer generics products, according to The Harris Poll’s survey. 7 in 10 U.S. adults choose generics over brands when given a choice. 3 in 10 people say they would “always” choose generics, whether a prescription drug or an over-the-counter product (store brand, private label). While most people across all age groups would choose generics over brand ames for meds, parents with children in the households would more likely choose a brand  name (36% with vs. 28% without kids). Still, 66% of

Most Americans support price controls on drug and medical device manufacturers, hospitals, and payments to doctors, along with allowing Medicare to negotiate drug prices. U.S. health citizens, now consumers, have been experiencing sticker-shock when it comes to prices on medical bills upon hospital discharge, leaving the doctor’s office, filling a prescription at a pharmacy or receiving a specialty drug recommended for a serious medical condition. The HealthDay/Harris Poll of 5 November 2015 quantifies their observation that Americans Want Bold Steps to Keep Health Care Costs in Check. The topline of the Poll shows that: 73 percent support price controls on

In the U.S., if you walk 3 miles in any direction, there’s a 3 in 4 chance you’ll find yourself in front of a Walgreens pharmacy. The company often says that 75% of people in the America live within 3 miles of a Walgreens storefront. What’s a pharmacy storefront anymore? Both Walgreens and CVS are re-defining that with a dizzying pace of new announcements. The latest for Walgreens: people in 25 states will be able to use the Walgreens app on their smartphones to access physicians virtually. Consumers living in Alabama, Arizona, California, Colorado, Connecticut, Florida, Indiana, Illinois, Iowa, Maryland,

A growing desire for shared decision making with doctors. Increasing trust and consumption of health care information online, in social media, and report cards. Reliance on technology for monitoring health adn wellness, and medical conditions. Together, these three signals converge, illustrating a growing sense of consumer engagement among U.S. patients, found in the 2015 Deloitte Center for Health Solutions Survey of US Health Care Consumers. In Deloitte’s research summary, the title states that “No ‘one-size-fits-all’ approach” will work, given diversity among American health consumers. The sickest health consumers, Deloitte notes, have higher levels of health engagement and index higher on

American workers are working to pay for health care costs, having traded off wage increases for health premiums, out-of-pocket costs and growing high deductibles. Welcome to the 2015 Employer Health Benefits survey conducted annually by the Kaiser Family Foundation (KFF) and Health Research & Educational Trust (HRET). Premiums are growing seven times faster than wages.  The report calculates that high-deductibles for health insurance have grown 67% from 2010 to 2015. In the same period, wages grew a paltry 10%, while the Consumer Price Index rose 9%. The first chart illustrates that growing gap between relatively flat wages and spirally health

This is the dawning of the Age of Consumer-Driven Health, the tipping point of which has been passed. The data point for this assertion comes from the National Business Group on Health‘s annual 2016 Large Employers’ Health Plan Design Survey. The tagline, “reducing costs while looking to the future,” suggests some of the underlying tactics employers will use to manage their financial burden of providing health insurance to workers. That burden will continue to shift to employees and their dependents in the form of greater cost-sharing: for premiums, co-pays and co-insurance, and the hallmark of consumer-driven health plans (CDHPs): high(er) deductibles.

The FDA approved Novartis’s new heart failure drug Entresto (LCZ696) on July 7, 2015. This product was approved under the FDA fast track program which prioritizes therapies that fill unmet needs for patients with life-threatening conditions. Heart failure affects over 5 million people in the U.S. and is often caused by heart attacks and high blood pressure. So heart failure impacts lots of people and, in aggregate, the CDC says represents about $32 bn of medical spending annually in the U.S. and is a factor in 1 in 9 deaths in America each year. Novartis is looking to price Entresto as much

Digital health is a fast-growing category of consumer electronics, and many new mobile and wearable health devices were featured at the 2015 CE Week held in New York City. The major themes of the “Fresh Gear” unveiled at the meeting included connected cars, connected home devices, 3-D printing, and a growing array of wristbands, apps, and wearable devices focused on the already-crowded health/wellness segment, and the emerging health/care area. The five I’ll focus on are good examples of digital health tech’s aimed at mainstream consumers shopping at retail at the middle of the market: an area that’s ripe to be served.

Patients in the U.S. are transforming into health care consumers, and in 2015 there are 3 underlying forces shaping that new consumer. This week kicks off the annual BIO conference in Philadelphia, and today Klick Health, the digital communications firm, convenes a group of thought leaders in healthcare to brainstorm markets, financing, and the state of pharmaceutical and life science innovation. An underlying theme throughout this meet-up is patient’s role in health/care. Patients are people, consumers, caregivers, mothers, fathers, sisters, brothers, friends, neighbors, community members, taxpayers, all. We’re old, we’re young, we’re mobile and not-so-much, we’re amputees, we’re migraneurs, we’re cancer

The number of people in the U.S. spending over $100,000 a year on prescription drugs tripled in 2014, according to Super Spending: U.S. Trends in High-Cost Medication Use, from The Express Scripts Lab. Express Scripts is a pharmacy benefits management company that manages over one billion prescriptions a year. The company analyzed prescription drug claims for 31.5 million health plan members for this study, in commercially insured, Medicare, and Medicaid plans. The big-dollar story in 2014 was Hepatitis C, with a relatively small patient population but a super-sized drug spend as the first chart shows: a very tall blue bar (Rx

40% of U.S. consumers trust Big Retail to manage their health; 39% of U.S. consumers trust healthcare providers to manage their health. What’s wrong with this picture? The first chart shows the neck-and-neck tie in the horse race for consumer trust in personal health management. The Walmart primary care clinic vs. your doctor. The grocery pharmacy vis-a-vis the hospital or chain pharmacy. Costco compared to the chiropractor. Or Apple, Google, Microsoft, Samsung or UnderArmour, because “digitally-enabled companies” are virtually tied with health providers and large retailers as responsible health care managers. Welcome to The Birth of the Healthcare Consumer according

The top 3 urgent health problems facing the U.S. are closely tied for first place: affordable health care/health costs, access to health care, and the Ebola virus. While the first two issues ranked #1 and #2 one year ago, Ebola didn’t even register on the list of healthcare stresses in November 2013. Gallup polled U.S. adults on the biggest health issues facing Americans in early November 2014, and 1 in 6 people named Ebola as the nation’s top health problem, ahead of obesity, cancer, as well as health costs and insurance coverage. Gallup points out that at the time of

Concerns about Death Panels and government restricting health services for people that have been key arguments used against the Affordable Care Act’s (ACA) detractors and, even before the advent of the ACA, proposed health reforms under President Clinton. But it’s peoples’ self-rationing in the U.S. health system that’s causing true rationing — driven by high deductible health plans (HDHPs) that are fast-growing in the health insurance market, and by the high cost of specialty drugs and prescriptions. There are plenty of data demonstrating the consumer health rationing trend being collected and reviewed by think tanks like RAND here, and by The

The modern view on wellness is “having it all” in terms of driving physical, emotional, mental and financial health across one’s life, according to CIGNA’s survey report, Health & Financial Well-Being: How Strong Is the Link?  The key elements of whole health, as people define them are: – Absence of sickness, 37% – Feeling of happiness, 32% – Stable mental health, 32% – Management of chronic disease, 15% – Financial health, 14% – Living my dreams, 9%. 1 in 2 people (49%) agree that health and wellness comprise “all of these” elements, listed above. This holistic view of health is

It’s de rigueur for any organization marketing a product or service in health care to be “patient-centered” these days. “Patient engagement” and “health engagement” are phrases found on health conference agendas, whether pitching to attendees in pharma and life sciences, health IT, health insurance, or healthcare (to hospitals and physicians, alike). One paradigm for patient-centricity that’s more mature than most is IMS Health’s Patient Journey construct, which the data-driven company has been talking about since 2012. While the concept focused mainly on pharmaceutical marketing and medication adherence, it’s useful for all industry segments looking to motivate behavior change in health

Nations throughout the world are challenged by the cost of health care: from Brazil to China, India to the Philippines, and especially in the U.S., people are morphing into health care consumers. Three categories of health spending in the bulls-eye of countries’ Departments of Health are prescription drugs, and the costs of care in hospitals and doctors’ offices. In the U.S., one tactic for cost containment in health is “switching” certain prescription drugs to over-the-counter products – those deemed to be efficacious and safe for patients to take without seeking treatment from a doctor. Over-the-counter drugs (OTCs) are available every

The rising costs of health care in America, and consumers’ growing cost burdens, has many impacts on the U.S. health ecosystem. In particular, patients have been self-rationing due to costs, without necessarily paying attention to quality or medical outcomes. Doctors have begun to pay more attention to costs and their impacts on patients in their practices, addressed in today’s New York Times article, Treatment costs could influence doctors’ advice to patients. Andrew Pollack writes in the Times about the morphing role of doctors, some of whom are taking on the mantle of being a “steward of society,” as characterized by

There’s a new member in the C-suite in health care, and her name is the Chief Patient Officer (CPO). That new role in health-town is filled by Dr. Anne Beal, appointed by Sanofi, the global biopharma company, to fill this new job description. Here she is, shaking hands with Colin Powell in one of the many awards ceremonies where Dr. Beal’s work in public health has been lauded. But what is a CPO? Because it’s a new job, Dr. Beal can create the role, at least within the environment and mission of Sanofi and the larger life sciences world. Some

That’s a useful and timely question, given the news that Castlight Health will launch its IPO with valuations north of $1 billion. Yes, “billions,” and according to a  MarketWatch analysis, “it’s a bargain at $1 billion.” So then – do we anticipate a bubble? asked Marc Monseau of the Mint Collective, the convener of our panel who brought together Robert Stern, a successful health-tech entrepreneur whose latest venture, @PointofCare, focuses on patient engagement; Marco Smit of Next Innovation Health Partners (parting from the Health 2.0 Conference family where he led Health 2.0 Advisors for several years); and me. Some key

While the prescription drug bill makes up about 10% of U.S. national health spending, the fastest-growing component of pharmacy spending is specialty medications. These are categorized as “specialty” drugs because they rarely have generic equivalents, and treat serious or life-threatening diseases (such as cancer, MS, and rheumatoid arthritis). They are also “special” because specialty pharmaceuticals average $3,000 per patient per month and can surpass $100,000 a year for certain products. As a result, the top two goals for managing specialty medications among employers are #1, to reduce inappropriate utilization, and #2, to reduce drug acquisition costs, based on a survey

Millions of health citizens, consumers, patients and caregivers flock to Facebook, Twitter and Wikipedia every day the world over to seek health information, advocate for patients’ access to a cancer therapy on a health blog, engage in peer-to-peer health care in a social network, and bolster each others’ management of chronic medical conditions in a chat community. Yet the pharmaceutical and medical device industries rank well behind other industries vis-à-vis the use of social media, asserts Engaging patients through social media, with the punchline question: is healthcare ready for empowered and digitally demanding patients? from the IMS Institute for Healthcare Informatics, published on

When the head of the Consumer Electronics Association gives a shout-out to the growth of health products in his annual mega-show, attention must be paid. The #2014CES featured over 300 companies devoted to “digital health” as the CEA defines the term. But if you believe that health is where we live, work, play, and pray, then you can see health is almost everywhere at the CES, from connected home tech and smart refrigerators to autos that sense ‘sick’ air and headphones that amplify phone messages for people with hearing aids, along with pet activity tracking devices like the Petbit. If

We who are charged with forecasting the future of health and health care live in a world of scenario planning, placing bets on certainties (what we know we know), uncertainties (what we know we don’t know), and wild cards — those phenomena that, if they happen in the real world, blow our forecasts to smithereens, forcing a tabula rasa for a new-and-improved forecast. There are many more uncertainties than certainties challenging the tea leaves for the new year, including the changing role of health insurance companies and how they will respond to the Affordable Care Act implementation and changing mandates

Gird your wallets, U.S. consumers: watch the dollars flow out-of-pocket for prescription drugs in 2014, as predicted by the 2013-2014 Prescription Drug Benefit Cost and Plan Design Report published by the Pharmacy Benefit Management Institute (PBMI) this week. Constraints covering most plan members are: Step therapy Prior authorization (to get approvals to fill high-cost drugs, notably growth hormones, injectables, controlled substances, Retin-A, and medications for sleep disorders, and Compulsory 90 day refills at retail (90-day dispensing for chronic meds). This Report, sponsored by Takeda, is the gold standard of drug benefit trends, having been published since 1995. Average 30-day copayments

People who received health care in the U.S. between the second quarters of 2012 and 2013 faced 38% higher out-of-pocket costs, growing from $1,862 to $2,568 in just one year. These were payments for common procedures like joint replacements, Caesarean sections, and normal births. At the same time, consumers’ access to revolving credit lines fell by $1,000 over the twelve months. (Credit lines here include bank-issued credit cards, store credit cards, and home equity loans). The TransUnion Healthcare Report from TransUnion, the credit information company, paints a picture of tightening money for all consumers in the face of rising household

Patient and health engagement is the flavor du jour in health circles these days, from the corridors of hospitals to the caffeinated marketing meetings in Big Pharma’s east coast meet-ups. But there’s no standard agreement on what we mean by peoples’ health engagement, whether by patient or well consumer. In Market Insights: The Evolution of Consumer Engagement in Health Care, Porter Research endeavors to deepen our understanding of this important concept. In the introductory section of the paper, “Understanding Engagement,” Porter proffers that industry – providers, payers and employers – consider engagement as “changing consumer behavior through increased participation in consumers’ own health

Consumers embrace ongoing dialog with the companies they do business with, Varolii Corporation toplines in a survey report, What Do Customers Want? A Growing Appetite for Customer Communications. Across all vertical industries consumers trust for this dialogue, health care organizations – specifically doctors, pharmacists, and insurance companies – are the most trusted. Examples of “welcome-comms” would be reminders about upcoming appointments or vaccinations (among 69% of people), notices to reorder or pick up a prescription (57%), and messages encouraging scheduling an appointment (39%). In banking, notices about fraudulent activity on one’s account is the most welcomed message beating out appointment

The “O” word drives health costs in America ever-upward. Without bending the obesity curve downward toward healthy BMIs, America won’t be able to bend that stubborn cost curve, either. The Economic Impacts of Obesity report from Alere Wellbeing accounts for the costs of chronic diseases and how high obesity rates play out in the forms of absenteeism, presenteeism, and direct health care costs to employers, workers and society-at-large. Among the 10 costliest physical health conditions, the top 3 are angina, hypertension and diabetes — all related to obesity and amenable to lifestyle behavior change. The top-line numbers set the context:

Women and binge drinking…job and financial stress…sleeplessness…caregiving challenges…sex…these were the topics covered in Health 2.0 Conference’s session aptly called “The Unmentionables.” The panel on October 1, 2013, was a rich, sobering and authentic conversation among 7 women and 1 man who kept it very real on the main stage of this mega-meeting that convenes health technology developers, marketers, health providers, insurers, investors, patient advocates, and public sector representatives (who, sadly, had to depart for Washington, DC, much earlier than intended due to the government shutdown). The Unmentionables is the brainchild of Alexandra Drane and her brilliant team at the Eliza

By 2022, $1 in every $5 worth of spending in the U.S. will go to health care in some way, amounting to nearly $15,000 for each and every person in America. From biggest line item on down, health spending will go to payments to: Hospitals, representing about 32% of all spending Physicians and clinical costs, 20% of spending Prescription drugs, 9% of spending Nursing, continuing care, and home health care, together accounting for over 8% of health spending (added together for purposes of this analysis) Among other categories like personal care, durable medical equipment, and the cost of health insurance.

In game-scoring unit terms, 52 is the number of hours an average American spends seeking health information online each year. The 1 (hour) is roughly equivalent to the approximate total time a patient spends with a physician (an average of 3 visits, with an average time per vision of 20 minutes). Thus, 52:1. This means that the average U.S. health consumer spends much more time DIYing her health using digital information resources than speaking face-to-face with their physician in the doctor’s office. Still, the physician continues to be a go-to source for health information, according to Makovsky, a health communications

Women are the Chief Health Officers of their families and in their communities. But stress is on the rise for women. Taking an inventory on several health risks for American women in 2013 paints a picture of pain: of overdosing, caregiver burnout, health disparities, financial stress, and over-drinking. Overdosing on opioids. Opioids are strong drugs prescribed for pain management such as hydrocodone, morphine, and oxycodone. The number of opioid prescriptions grew in the U.S. by over 300% between 1999 and 2010. Deaths from prescription painkiller overdoses among women have increased more than 400% since 1999, compared to 265% among men.

  Most Americans are concerned about their ability to for medical bills, even when they have health insurance. As a result, most are comfortable asking their doctor about how much their medical treatment will cost. People are becoming savvier health care shoppers largely because they have to: 37% of people in the U.S. have an annual health insurance deductible over $2,000, according to the Spring/Summer 2013 Altarum Institute Survey of Consumer Health Care Opinion, published on 11th July 2013. Many of the media stories coming out of the Altarum survey since its publication have been about people and their trust in

3 in 4 Americans say that out-of-pocket costs are the main reason they decide whether or not to seek preventive care, in A Call for Change: How Adopting a Preventive Lifestyle Can Ensure a Healthy Future for More Americans from TeleVox, the communications company, published in June 2013. TeleVox surveyed over 1,015 U.S. adults 18 and over. That’s the snapshot on seeking care externally: but U.S. health consumers aren’t that self-motivated to undertake preventive self-care separate from the health system, either, based on TeleVox’s finding that 49% of people say they routinely exercise, and 52% say they’ve attempted to improve eating habits.

The notion of consumers’ greater skin in the game of U.S. health care — and the underlying theory of rational economic men and women that would drive people to greater self-care — permeated the agenda of the 2nd annual Consumer Health & Wellness Innovation Summit, chaired by Lisa Suennen of Psilos Ventures. Lisa kicked off the meeting providing a wellness market landscape, describing the opportunity that is the ‘real’ consumer-driven health care: people getting and staying well, and increasing participation in self-management of chronic conditions. The U.S. health system is transforming, she explained, with payors beginning to look like computer

Nearly 100% of employers are likely to continue to provide health insurance benefits to workers in 2014, moving beyond a “wait and see” approach to the Affordable Care Act (ACA). As firms strategize tactics for a post-ACA world, nearly 40% will increase emphasis on high-deductible health plans with a health savings account, 43% will increase participants’ share of premium costs, and 33% will increase in-network deductibles for plan members. Two-thirds of U.S. companies have analyzed the ACA’s cost impact on their businesses but need to know more, according to the 2013 survey from the International Foundation of Employee Benefit Plans (IFEBP).

While the blockbuster erectile dysfunction (ED) drug has been shipped directly to consumer’s homes for years via pharmacy benefits management companies and specialty pharmacy retailers catering to the ED segment, Pfizer wants in on the transaction and has decided to get into the Direct-to-Consumer (DTC) distribution business for a prescription drug. Call this market development Direct-to-Home, or DTH. This is a kind of sentinel event signaling a pharmaceutical manufacturer cutting out the middle-man (read: retail pharmacy), and in this case getting up-close-and-personal with users of a drug that represents quality of life. Another motivation for Pfizer is trying to stem

Food is inextricably bound up with health whether we are well or not. Several key area of the Food=Health ecosystem made the news this week which, together, will impact public and personal health. On the employer health benefits front, more media are covering the story on CVS strongly incentivizing employees to drop body mass index (BMI) through behavioral economics-inspired health plan design of a $50 peer month penalty. Michelin, whose bulky advertising icon Bibendum has more than one “spare tire,” introduced a program to combat health issues, including but not limited to BMI and high blood pressure, according to the

  Patient satisfaction survey scores have begun to directly impact Medicare payment for health providers. Health plan members are morphing into health consumers spending “real money” in high-deductible health plans. Newly-diagnosed patients with chronic conditions look online for information to sort out whether a generic drug is equivalent to a branded Rx that costs five-times the out-of-pocket cost of the cheaper substitute. While health care report cards have been around for many years, consumers’ need to get their arms around relevant and accessible information on quality and value is driving a new market for a Yelp, Travelocity, or Zagat in

Digital health is attracting the likes of Bill Clinton, Lupe Fiasco, Deepak Chopra, Dr. Sanjay Gupta, Arianna Huffington, and numerous famous athletes who rep a growing array of activity trackers, wearable sensors, and mobile health apps. Will this diverse cadre of popular celebs drive consumer adoption of mobile health? Can a “cool factor” motivate people to try out mobile health tools that, over time, help people sustain healthy behaviors? Mobile and digital health is a fast-growing, good-news segment in the U.S. macroeconomy. The industry attracted more venture capital in 2012 than other health sectors, based on Rock Health’s analysis of the year-in-review. Digital health

Americans have a clear message for the 113th Congress: I want my MTV, but I want my Medicare, Medicaid, Social Security,   health insurance subsidies, and public schools. These budget-saving priorities are detailed in The Public’s Health Care Agenda for the 113th Congress, conducted by the Kaiser Family Foundation, Robert Wood Johnson Foundation, and the Harvard School of Public Health, published in January 2013. The poll found that a majority of Americans placed creating health insurance exchanges/marketplaces at top priority, compared with other health priorities at the state level. More people support rather than oppose Medicaid expansion, heavily weighted toward 75%