Health Care Hall of Fame - 2019

Karen Davis pushed for broader coverage under Medicare and Medicaid since their inception more than 50 years ago, and she is not about to slow down. 

The former leader of the Commonwealth Fund and deputy secretary at HHS has made economics a key part of her career and has had a lasting influence in how economic tools are applied to healthcare. As a professor emerita at the Johns Hopkins Bloomberg School of Public Health, Davis continues to explore ways to improve the two entitlement programs in order to impact patient health outcomes. 

“She helped found the discipline of healthcare economics, and worked in and alongside government to formulate path-breaking national healthcare proposals for universal healthcare, including the Affordable Care Act,” said Dr. David Blumenthal, who succeeded Davis as Commonwealth Fund president in 2012 and formerly served as the national coordinator of health information technology.

Davis first became interested in healthcare while working on a doctorate degree in economics at Rice University. “When I was looking for a dissertation topic in economics at Rice, it was the late ’60s and there was a lot of interest on the war on poverty, and Medicare and Medicaid were enacted,” she said. “It just seemed like a very exciting field to apply economic tools to.”

She had a short stint in academia after college before moving to Washington, D.C., to serve as a health policy fellow with the Brookings Institution. Then, from 1977 to 1980, she served as the deputy assistant secretary for planning and evaluation at HHS during the Carter administration and worked on the administration’s universal healthcare plan. In 1980, she became the first woman to lead a U.S. public health services agency within HHS when she took over as head of the Health Resources Administration.

“The attraction of government for me was just what a huge impact that you could have, affecting millions of people,” she said. “I got particularly interested in coverage and access to care and expanding Medicaid to cover low-income, initially pregnant women and children.”

During her time in the Carter administration, she advocated for expanding Medicaid to all pregnant women and children. It didn’t happen during her time at HHS, but Davis wasn’t about to give up the fight. She worked with former Rep. Henry Waxman (D-Calif.) to “keep pushing for incremental Medicaid expansions.” That laid the groundwork for landmark legislation.

“I wrote an article in the (Journal of the American Medical Association) after the demise of Clinton’s (health plan) that we could at least start with children,” said Davis, who by this time was at the Commonwealth Fund. “I remember the congressional health staff got interested.” The Children’s Health Insurance Program was enacted in 1997. 

Throughout her tenure at Commonwealth Fund—first as executive vice president and then, in 1995, president—Davis made it a priority to generate bipartisan action on healthcare policy, including setting up annual retreats with Republicans and Democrats. “For years she did something that is impossible to contemplate in today’s environment,” said Dr. Risa Lavizzo-Mourey, former longtime CEO of the Robert Wood Johnson Foundation.

So when Congress started to craft the Affordable Care Act in 2009, Democrats turned to her for vital insights. “She was frequently called upon by congressional staff to provide technical assistance in the drafting of that legislation,” Blumenthal said. “Karen was the rare economist who was comfortable dealing not only with numbers, but with legislative language and policy trade-offs as well.”

Davis left the Commonwealth Fund in 2012 to become director of the Roger C. Lipitz Center for Integrated Health Care at the Johns Hopkins Bloomberg School of Public Health; she left that post in 2017, and is now part-time at Hopkins as a professor emerita. She is still searching for ways to improve and expand Medicare and Medicaid and has set her sights on the benefits package for Medicare beneficiaries specifically. She also has ideas for the biggest debates occurring right now in healthcare policy: Medicare for All.

Although Democratic lawmakers and 2020 presidential hopefuls are flocking to the concept, Davis said more context and details are needed. “It can mean anything from abolishing private insurance and all cost-sharing and everyone covered under public program and the other end of the spectrum is making (an) option available to people under 65, maybe in the marketplaces offering Medicare and Medicare Advantage,” she said.

In the early 1990s, Davis wrote an article in JAMA suggesting a Medicare for All option, but creating an opt-out for employer coverage. “If you had employer coverage you could keep that and if you wanted to cover workers you could do that,” she said.

 A mixed public and private system has “always struck me as more feasible, including maintaining Medicare Advantage within Medicare as opposed to eliminating private insurance and replacing it with a tax-financed public program,” she added.

Davis hasn’t gotten tired of exploring how to improve Medicare or Medicaid or reduce the number of uninsured.

“I once had a board member at the Commonwealth Fund ask me how long we are going to work on the problem of the uninsured, and I said until there are no more uninsured,” she said.