View Research by Author - Lisa Clemans-Cope

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.

Publications

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Return to list of authors