Income, Material Hardship, and the Use of Public Programs among the Elderly

I use data from the 2006 Health and Retirement Study to analyze the determinants of material hardship among individuals ages 65 and older. Ten percent of the elderly report hardship – defined here as cutting back on food or medications because of cost – in 2006. Although hardship is more likely for poorer individuals and, to some extent, for recipients of public transfer programs (Medicaid, Food Stamps, and/or Supplemental Security Income), the majority of those experiencing hardship are not poor and do not participate in these programs. In multivariate models, I find that self-reported health and activity limitations are significant predictors of hardship.

Employer-Sponsored Disability Insurance: Where are the Gaps in Coverage?

I use data from the Current Population Surveys and Employee Benefits Surveys to analyze employer-sponsored disability insurance coverage. There does not appear to be a systematic trend from 1980 to 2000 in the fraction of workers with coverage. Disability insurance coverage rates are lower than health insurance coverage rates; low-skill, low-wage, low-tenure, part-time and small establishment workers are all less likely to have either of these fringe benefits. Public policy debates about workers without health insurance fail to consider an important economic risk these workers face in the event of an illness or injury: the risk of lost wages.

Saving among Low-Income Women: Motivation and Obstacles

How do low-income households think about saving? What motivations do they identify for saving, and what obstacles to meeting their goals? We use data from qualitative interviews with 51 households in Detroit to shed light on these questions. We find that they wish they could save - primarily for protection against the unexpected or to put children through college - but that most of them cannot. Friends and family surface as a major obstacle to saving, since those who have liquid assets are asked for help. When savings is feasible in this population, it occurs largely through relatively inaccessible vehicles such as pensions and 401Ks.

Gender, Occupation Choice and the Risk of Death at Work

Women and men tend to work in different occupations. Although a great deal of research has been devoted to the measurement of trends in occupation segregation by gender, very little work has focused on the underlying job choice process that generates this segregation. What makes men and women choose the jobs they do? Using employment data from the 1995 - 1998 Current Population Surveys and data on occupational injuries and deaths from the Bureau of Labor Statistics, we estimate conditional logit models of occupation choice as a function of the risk of work-related death and other job characteristics. Our results suggest that women choose safer jobs than men. Within gender, we find that single moms or dads are most averse to fatal risk, presumably because they have the most to lose. The effect of parenthood on married women is larger than its effect on married men, which is consistent with the idea that men's contributions to raising children are more fully insured than women's. Overall, men and women's different preferences for risk can explain about one-quarter of the fact that men and women choose different occupations.

Employer Health Insurance Mandates and the Risk of Unemployment

Employer health insurance mandates form the basis of many health care reform proposals. Proponents make the case that they will increase insurance, while opponents raise the concern that low-wage workers will see offsetting reductions in their wages and that in the presence of minimum wage laws some of the lowest wage workers will become unemployed. We construct an estimate of the number of workers whose wages are so close to the minimum wage that they cannot be lowered to absorb the cost of health insurance, using detailed data on wages, health insurance, and demographics from the Current Population Survey. We find that 33 percent of uninsured workers earn within $3 of the minimum wage, putting them at risk of unemployment if their employers were required to offer insurance. Assuming an elasticity of employment with respect to minimum wage increase of -0.10, we estimate that 0.2 percent of all full-time workers and 1.4 percent of uninsured full-time workers would lose their jobs because of a health insurance mandate. Workers who would lose their jobs are disproportionately likely to be high school dropouts, minority, and female. This risk of unemployment should be a crucial component in the evaluation of both the effectiveness and distributional implications of these policies relative to alternatives such as tax credits, Medicaid expansions, and individual mandates, and their broader effects on the well-being of low-wage workers.

What Do People Buy When They Don't Buy Health Insurance And What Does that Say about Why They are Uninsured?

Using data from the 1994 through 1998 Consumer Expenditure Surveys, we compare household spending on 16 different goods (food at home, food away from home, housing, transportation, alcohol and tobacco, interest, furniture and appliances, home maintenance, clothing, utilities, medical care, health insurance, entertainment, personal care, education, and other) for insured versus uninsured households, controlling for total expenditures and demographic characteristics. The analysis shows that the uninsured in the lowest quartile of the distribution of total expenditures spend more on housing, food at home, alcohol and tobacco, and education than do the insured. In contrast, households in the top quartile of the distribution of total expenditures spend more on transportation and furniture and appliances than do comparable insured households. These results are consistent with the idea that poor uninsured households face higher housing prices than do poor insured households. Further research is necessary to determine whether high housing prices can help explain why some households do not have insurance.

Recent Trends in Employer-Sponsored Health Insurance Coverage: Are Bad Jobs Getting Worse?

employer-sponsored health insurance

Health Insurance Patterns Nearing Retirement

Gaps in health insurance coverage among the near-elderly are of particular policy concern both because older individuals are more likely to have health shocks and also because they are more likely to have a retirement nest egg to protect. This working paper compares health insurance coverage of the Baby Boomers with coverage for two earlier cohorts using data from the Current Population and the Health and Retirement Survey (HRS). I also analyze the experiences of the original HRS respondents as they age into Medicare coverage. My main finding is that while exposure to risk is relatively high, the realization of risk is unlikely, and not that much wealth is at stake. Almost one-quarter of the original HRS cohort was uninsured at some point in the six-year window before Medicare eligibility, but only two percent had an uninsured hospitalization and the amount at stake for the median uninsured person is relatively low: between $10,000 and$20,000 in total net non-housing, non-pension wealth. Lack of assets may be a larger problem for these households than lack of health insurance coverage, and policies aimed at preventing poverty may be more important for their well-being than policies to expand insurance coverage

Unhappiness after Hurricane Katrina

In August, September and October of 2005, the Monthly Surveys of Consumers fielded by the University of Michigan included questions about the happiness of a nationally representative sample of U.S. adults. The date of each interview is known. Looking at the data week by week, reported happiness dipped significantly in the first week of September, after the seriousness of the damage done by Katrina became clear. The impulse response of happiness is especially strong in the South Central region, closest to the devastation of Katrina. The dip in happiness lasted two or three weeks in the South Central region; in the rest of the country, reported happiness returned to normal after one or two weeks. In addition to the reaction to Katrina, happiness dipped significantly after the October 2005 earthquake in Pakistan. These results illustrate the potential of high-frequency happiness data to yield information about preferences over regional, national and international conditions by indicating the magnitude of the good or bad news conveyed by events.

Child Health and Access to Medical Care

This article reviews studies that explore the relationship between access to medical care and children's health. The authors find that, on the whole, policies to improve access indeed improve children's health, with the caveat that context plays a big role. Focusing on studies that can plausibly show a causal effect between policies to increase access and better health for children, and starting from an economic framework, they consider both the demand for and supply of health care. On the demand side, they examine what happens when the government expands public insurance programs (such as Medicaid), or when parents are offered financial incentives to take their children to preventive appointments. On the supply side, they look at what happens when public insurance programs increase the payments they offer to health care providers, or when health care providers are placed directly in schools where children spend their days. They also examine how the Affordable Care Act is likely to affect children's access to medical care