Cristina Boccuti, director of health policy at the West Health Policy Center, was a member of the year-long Medicare Eligibility Study Panel, which issued its extensive report, Examining Approaches to Expand Medicare Eligibility: Key Design Options and Implications. Boccuti also moderated a breakout session on “Reinforcing Current Programs: Incremental Changes to Medicare, Medicaid, and the Affordable Care Act” at the Academy’s 2020 policy conference on Healthcare Coverage and Costs: Assessing Medicare-Based Approaches, which centered on findings from the report. In this interview, she shares her experience working on the Study Panel, as well as her work at West Health, where she focuses on opportunities to lower healthcare spending and Medicare payment policy.


Q: For the Study Panel, you were the lead for the Working Group on Lowering the Medicare Eligibility Age. What was that process like for your working group, within the context of the larger study?

The goal of the whole project was to examine three specific policy options that use Medicare as a platform for expanding health insurance coverage. These three approaches were:

  • lowering the age of Medicare eligibility to somewhere between 62-50;
  • extending Medicare coverage to all ages, akin to a public option; and
  • creating a Medicare buy-in for people or employers.

All groups were instructed to look beyond the big headline proposals and provide analysis of the real, and sometimes quite technical, issues that policymakers who sincerely want to implement change need to consider.

Our working group set out to tackle the first and relatively more straightforward option. I learned a great deal from my colleagues. We talked through the implications and decision points that policymakers would need to consider when lowering the age of Medicare eligibility, including what the eligibility criteria would be, how benefits for individuals might change when they become eligible, what effects the policy would have on potential premium structures and provider payments, among other design details. In considering the goal of improving coverage for people who are uninsured or underinsured, the panel also considered effects on costs to the U.S. health care system – state costs, federal costs, employer costs, and personal costs.

Q: Sounds like changes to health care coverage could have a significant effect on the economy.

Yes, in various ways. Health care spending represents about 18 percent of our nation’s GDP, which in some respects is an economic sector that provides jobs and innovative products and services. However, there was general agreement across the members of the Study Panel that the rising cost of health care is putting enormous financial pressure on individuals and families, employers, and federal and state governments. The major reforms to expand coverage examined by the other two working groups– public option and buy-in approaches – have the potential to increase government spending, while at the same time lower overall revenue and profits to health care providers and other organizations if Medicare payment levels were used to contain costs. This tradeoff was a major discussion point among the study panelists, which included economists, actuaries, researchers, advocates, and other experts.  

Q: What are your hopes for the report once it has been published?

I hope that the comprehensive report will be a useful resource for policymakers who are looking for ways to expand health care coverage while also constraining spending. It digs into many of the design questions and considerations that would need to be addressed when changing Medicare eligibility for some or all of the U.S. population.

Q: At the conference on March 5, you moderated a breakout session on potential incremental changes to Medicare, Medicaid and the Affordable Care Act. What policy options did panelists (Sheila Burke, Tara O’Neill Hayes, Fred Riccardi, and Sara Rosenbaum) highlight?

Panelists reviewed a broad range of policy issues, including the need to stabilize premiums in the individual health insurance marketplaces, increase coverage in non-expansion states, lower health care costs in non-competitive markets, establish out-of-pocket limits in Medicare for prescription drugs and health care, streamline Medicare enrollment, ease access to low-income assistance programs for Medicare beneficiaries, and ways to coordinate Medicare and Medicaid. The panel also discussed the current proposals in Congress to lower prescription drug prices.

Q: What motivates you to undertake projects with fellow Academy Members?

In my work at West Health, policy change is not an abstract concept. We understand that real people are suffering because of the high cost of health care. In fact, our surveys and those from other organizations find that Americans are borrowing billions of dollars, skipping treatments, and significantly cutting back on household spending to pay for basic healthcare. Many people say they fear getting a medical bill for a serious illness more than they fear getting the diagnosis. 

At West Health, we are analyzing policy options that can lower health care costs, not only for households, but for employers and governments as well. West Health also has a focus on improving care for seniors, most of whom rely on Medicare, a major program of interest to the Academy. We are actively engaged in policies and programs to enhance geriatric-specific care in emergency departments to improve health outcomes and reduce overall costs. We are also examining ways to expand the Program of All-Inclusive Care for the Elderly (PACE) across the country to help frail seniors stay in their homes and communities as long as possible. Our policy work is uniquely informed by first-hand experiences with seniors, providers, and family caregivers in these programs through our affiliations with partner organizations and the West Health Institute.

More about Cristina Boccuti

Cristina Boccuti is a director of health policy at the West Health Policy Center, which is solely funded by the Gary and Mary West Foundation with the mission to lower healthcare spending to enable seniors to successfully age in place with access to high-quality, affordable health and support services that preserve and protect their dignity, quality of life, and independence.

Before joining the West Health Policy Center, Boccuti was an associate director at the Kaiser Family Foundation, where she analyzed Medicare reform proposals as part of a major initiative on the future of Medicare. Prior to her work at the Foundation, Boccuti held senior positions at the Medicare Payment Advisory Commission (MedPAC) and the Health Resources and Services Administration. She earned her MPP from Georgetown University, and her bachelor’s degree from Cornell University. Before her career in public policy, she was a speech-language pathologist in hospitals in Washington, DC and Chicago. She has been a Member of the Academy since 2014.

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