View Research by Author - Baoping Shang

Publications

Fewer than one-third of eligible Medicare beneficiaries enroll in Medicare savings programs, which pay premiums and, in some cases, eliminate out-of-pocket cost sharing for poor and near-poor enrollees. Many beneficiaries don't participate in savings programs because they must complete a cumbersome application process, including a burdensome asset test. We demonstrate that a streamlined alternative to the asset test—letting seniors avoid the asset test by showing a lack of investment income-would let 78 percent of currently eligible seniors bypass the asset test. Eligibility would increase by 30 percent, compared to 104 percent if the asset test were eliminated.

Low-income Medicare beneficiaries are eligible for subsidies to help them pay premiums and cost sharing. However, these subsidies fall short of those contained in the Patient Protection and Affordable Care Act (ACA) that help low-income families afford adequate health coverage. In this report we consider policy options to reform Medicare's low-income subsidies to better align with ACA provisions. We estimate that a significant simplification in low-income protection and cost-sharing rules could greatly reduce burdens on the poorest and sickest beneficiaries. Depending on how they are implemented, these reforms could either reduce or only modestly increase total public spending.

This is a Methodological Appendix to a paper that explores options for reforming Medicare cost sharing. Using data from the Health and Retirement Study and the Medicare Current Beneficiary Survey, we consider how unified deductibles, alternative coinsurance rates, and a limit on out-of-pocket spending would alter program spending, beneficiary cost sharing, and premiums for supplemental coverage. We show that cost sharing reforms could provide better safeguards to beneficiaries with high costs than the current Medicare benefit structure and that policies could be structured in a way that would add little to overall program costs.

This paper explores options for reforming Medicare cost sharing to provide better financial protection for those beneficiaries with the greatest health care needs. Using data from the Health and Retirement Study and the Medicare Current Beneficiary Survey, we consider how unified deductibles, alternative coinsurance rates, and a limit on out-of-pocket spending would alter program spending, beneficiary cost sharing, and premiums for supplemental coverage. We show that cost sharing reforms could provide better safeguards to beneficiaries with high costs than the current Medicare benefit structure and that policies could be structured in a way that would add little to overall program costs.

Under contract to the State of New York, researchers conducted in-depth micro-simulation analyses of four types of health care reforms being considered for state implementation: a single payer public health insurance option, Assembly Member Gottfried's New York Health Plus proposal that provides an option for all New Yorkers to enroll in Family Health plus, public-private hybrid options that simplify and expand existing public programs and reform private health insurance, and a market-based option that relies on regulatory flexibility and tax credits. The cost and coverage implications of state reform options falling into these four categories are presented in this report.

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