Senior Research Associate
Health Policy Center
Lisa Clemans-Cope, PhD, is a Senior Research Associate at the Urban Institute in Washington, D.C. with five years of research experience. Dr. Clemans-Cope's current research examines geographic variation in the medical spending of "dual" Medicare/Medicaid beneficiaries and how Medicaid beneficiaries' spending and health care use compares to that of the low-income privately insured and the uninsured. Dr. Clemans-Cope assisted in the development of the Health Insurance Policy Simulation Model (HIPSM), which has the capability to simulate state and national health insurance and tax reform policies. Her previous modeling work includes simulation and evaluation of state and national reform policies involving: individual and employer coverage mandates, tax credits and premium subsidies for the purchase of health insurance, expansions of public health insurance programs, publicly-funded reinsurance, guaranteed issue purchasing pools, and high deductible health plans. Clemans-Cope has also assisted in research investigating how public policies affect vulnerable populations in terms of their access to health care, use of services, and enrollment in health insurance.
Limiting the Tax Exclusion of Employer-Sponsored Health Insurance Premiums: Revenue Potential and Distributional Consequences (Policy Briefs/Timely Analysis of Health Policy Issues)
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The exclusion of employer-sponsored health insurance premiums and medical benefits reduced federal tax revenues by $268 billion in 2011 alone-by far the largest federal tax expenditure. Moreover, the exclusion disproportionately subsidizes those with higher incomes. In this brief, we provide estimates of the revenue potential and distributional consequences of limiting the exclusion from income and payroll taxes at the 75th percentile of 2013 premiums, indexing by GDP. The policy would produce $264.0 billion in new tax revenues over the coming decade while preserving 93 percent of the tax subsidies available under the current policy.
Enrollment-Driven Expenditure Growth: Medicaid Spending during the Economic Downturn, FY 2007-2011 (Research Report)
|Posted to Web: May 08, 2013||Publication Date: May 08, 2013|
This report presents data on changes in Medicaid's enrollment and spending between federal fiscal year 2007 and federal fiscal year 2011, a period which includes the worst economic downturn in the United States since the Great Depression of the 1930s. The paper also examines what factors drove Medicaid spending over the period, and concludes that overall spending growth from 2007 to 2011 was driven largely by the enrollment growth that resulted from many people losing jobs and income during the recession. However, on a per enrollee basis, Medicaid spending has grown more slowly than other sectors of the health system.
Reconciling the Massachusetts and Federal Individual Mandates for Health Insurance: A Comparison of Policy Options (Research Report)
|Posted to Web: April 24, 2013||Publication Date: April 24, 2013|
The 2006 Massachusetts health reform law increased insurance coverage and improved access to care for residents, in part due to the law’s individual mandate. An individual mandate is also a component of the federal Patient Protection and Affordable Care Act (ACA), though its design differs from Massachusetts' mandate in many ways. The implementation of the federal mandate in 2014 raises complex questions about the interaction of the two requirements. We analyze three basic policy options available to the state, assessing their implications for residents and each policy option's ability to satisfy core policy objectives.
Protecting High-Risk, High-Cost Patients: "Essential Health Benefits," "Actuarial Value," and Other Tools in the Affordable Care Act (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: December 10, 2012||Publication Date: December 10, 2012|
The Affordable Care Act (ACA) will dramatically improve the nongroup and small group health insurance markets for everyone in them, including the high-risk population.
But insurance reforms, guided by requirements for minimum or "essential health benefits," insurance plan actuarial value and other tools provided by the ACA, are and will remain a work in progress. This analysis suggests the way these tools-working together and reevaluated over time-can most effectively ensure that ACA implementation progresses toward the goals of adequate and affordable insurance protection, especially for the highest-need, highest cost patients.
Enrollment-Driven Expenditure Growth: Medicaid Spending during the Economic Downturn, FFY2007-2010 (Research Report)
|Posted to Web: June 14, 2012||Publication Date: June 14, 2012|
This report presents data on changes in Medicaid's enrollment and spending between federal fiscal year 2007 and federal fiscal year 2010, a period which includes the worst economic downturn in the United States since the Great Depression of the 1930s. The paper also examines what factors drove Medicaid spending over the period, and concludes that overall spending growth from 2007 to 2010 was driven largely by the enrollment growth that resulted from many people losing jobs and income during the recession. However, on a per enrollee basis, Medicaid spending has grown more slowly than other sectors of the health system.
Health Reform Could Greatly Reduce Racial and Ethnic Differentials in Insurance Coverage (Research Report)
|Posted to Web: May 14, 2012||Publication Date: May 11, 2012|
Racial and ethnic differentials in uninsurance rates could be greatly reduced under the Affordable Care Act, potentially cutting the black-white differential by more than half and the Hispanic-white differential by just under one-quarter. Improving coverage for these populations will depend on states adopting policies that promote high enrollment in Medicaid/CHIP and new insurance exchanges. Coverage gains among Hispanics will depend on policies in California and Texas (where almost half of Hispanics live). If the projected coverage gains are realized, long-standing racial and ethnic differentials in access to care and health status could shrink considerably. This research was funded in part by the Annie E. Casey Foundation.
Refocusing Responsibility For Dual Eligibles: Why Medicare Should Take The Lead (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: May 07, 2012||Publication Date: May 07, 2012|
At 40 percent of Medicare's and of Medicaid's costs, the 9 million dual eligibles who receive benefits from both programs, are a focus of efforts to slow growth in entitlement spending. But, given the two programs' responsibilities, policy-makers are relying far too heavily on states to find the solution. Dollars spent on dual eligibles are overwhelmingly federal; potential savings come from better management of Medicare-financed acute care services; and enhanced state, rather than federal, responsibility for overall spending increases the risk of cost-shifting to Medicare and may undermine quality of care for vulnerable beneficiaries.
Improving Care for Dual Eligibles through Innovations in Financing (Commentary)
|Posted to Web: October 04, 2011||Publication Date: October 04, 2011|
Health care for over 9 million elderly and disabled people enrolled in both Medicare and Medicaid ("dual eligibles") is complicated by an inefficient and fragmented system. In each program, dual eligibles account for about one sixth of enrollment but almost 40% of spending. Despite health-care costs exceeding $315 billion in 2011, of which Medicare pays about 55%, both Medicaid and Medicare have shown a striking lack of leadership in coordinating care for dual eligibles. We suggest ways in which the CMS's recently proposed models could be modified to improve both the quality and cost-effectiveness of care for this population.
Medicaid Spending Growth over the Last Decade and the Great Recession, 2000-2009 (Research Report)
|Posted to Web: August 31, 2011||Publication Date: August 31, 2011|
This report examines Medicaid spending growth nationally during the last decade, with a focus on growth during the recession of 2007 to 2009. The recession-driven enrollment growth in recent years drove program spending to increase faster than national health spending overall, but on a per enrollee basis the growth in Medicaid spending has remained lower than the rise in private insurance premiums and overall national health expenditures. The recession-driven increase in Medicaid enrollment has been the primary cause of the increase in overall Medicaid spending.
Health Insurance in Nonstandard Jobs and Small Firms: Differences for Parents by Race and Ethnicity (Series/Perspectives on Low-Income Working Families)
|Posted to Web: April 06, 2011||Publication Date: February 01, 2011|
This brief provides new insights about health insurance coverage gaps among racial and ethnic minority groups, focusing on parents with employment in small firms or nonstandard employment. Compared with white parents, a disproportionate share of Latino and black parents have nonstandard employment, and Latino parents are more likely to have employment in small firms. These work arrangements increase the risk of being uninsured since they are less likely to come with an offer of health insurance compared to regular large firm employment. Few uninsured Latino parents could obtain coverage under existing Medicaid programs. Potential impacts of health reform are discussed.
|Posted to Web: May 14, 2010||Publication Date: April 15, 2010|
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