How Race/Ethnicity, Immigration Status, and Language Affect Health Insurance Coverage, Access to and Quality of Care Among the Low-Income Population

Uses data from the 1999 National Survey of America's Families to examine the roles of race/ethnicity, citizenship status, and language on insurance coverage, access to care, and quality of care, particularly focusing on the low-income Latino population

Estimating the Health Effects of Retirements

We estimate the magnitude of any direct effect of retirement on health. Since retirement is endogenous to heath, it is not possible to estimate this effect by comparing the health of individuals before and after they retire. As an alternative we use institutional features of the pension system in the United Kingdom that are exogenous to the individual to isolate exogenous variation in retirement behavior. Data used will include both vital statistics and survey data that include both "objective" physical measurements and respondent self-reports. We find no evidence of negative health effects of retirement and some evidence that there may be a positive effect, at least for men.

The Social Security Early Retirement Benefit as Safety Net

In this paper we used the Health and Retirement Study to examine the health and economic status of those who collect Social Security retirement benefits prior to the full retirement age. We used a propensity score reweighting method to estimate the fraction of early retirees who use early retirement benefits as a safety net against deteriorating health and who might be induced to apply for disability benefits (SSDI) or retire without income replacement if the generosity or availability of early retirement benefits were reduced. We find that while the majority of early retirees would likely not qualify for disability benefits, approximately one in five have health characteristics similar to SSDI beneficiaries, and thus might not be able to replace losses in benefit income with labor income.

Policy Options to Improve the Performance of Low Income Subsidy Programs for Medicare Beneficiaries

Outlines options for establishing a unified annual Medicare deductible, uniform coinsurance, and limits on out-of-pocket spending and providing better protection to low-income beneficiaries and beneficiaries with the greatest health care needs

Race and Education Differences in Disability Status and Labor Force Attachment

The labor force participation rates of older, working-aged black men and men with lower levels of education have historically been significantly lower than those of white men and men with more education, respectively. This paper uses data from the alpha release of the new Health and Retirement Survey (HRS) to examine the extent to which variation in health and job characteristics can account for these differences. Our analysis suggests that race and education differences in health status of middle-aged men can explain a substantial fraction of black/white differences in labor force attachment and essentially all of the gap between men with different levels of education.

Reconciling Findings on the Employment Effect of Disability Insurance

Over the last 25 years the Social Security Disability Insurance Program (DI) has grown dramatically. During the same period of time employment rates for men with work limitations showed substantial declines in both absolute and relative terms. While the timing of these trends suggests that the expansion of DI was a major contributor to employment decline and raises questions about the targeting of disability benefits, studies using denied applicants suggest a more modest role for DI expansion. In order to reconcile these findings, we decompose total employment changes into population and employment changes for three categories: DI beneficiaries, denied applicants and non-applicants. Our results show that during the early 1990s, the growth in DI can fully explain the employment decline for men only under an extreme assumption about the employment potential of beneficiaries. For the period after the mid-1990s, we find little role for the DI program in explaining the continuing employment decline for men with work limitations.

What Directions for Public Health Under the Affordable Care Act?

Outlines opportunities for public health efforts under the 2010 healthcare reform law, such as building prevention into insurance expansion and boosting innovation in population health, as well as challenges, such as budget constraints

Health, Economic Resources and the Work Decisions of Older Men

In this paper, we specify a dynamic programming model that addresses the interplay among health, financial resources, and the labor market behavior of men in the later part of their working lives. Unlike previous work which has typically used self reported health or disability status as a proxy for health status, we model health as a latent variable, using self reported disability status as an indicator of this latent construct. Our model is explicitly designed to account for the possibility that the reporting of disability may be endogenous to the labor market behavior we are studying. The model is estimated using data from the Health and Retirement Study. We compare results based on our model to results based on models that treat health in the typical way, and find large differences in the estimated effect of health on behavior. While estimates based on our model suggest that health has a large impact on behavior, the estimates suggest a substantially smaller role for health than we find when using standard techniques. We use our model to simulate the impact on behavior of raising the normal retirement age, eliminating early retirement altogether and eliminating the Social Security Disability Insurance program.

The Illusion of Failure: Trends in the Self-Reported Health of the U.S. Elderly

Data from the National Health Interview Survey and elsewhere showed a trend toward worsening self-reported health among American men and women in middle age and older during the 1970s. This evidence - combined with the significant declines in age-specific mortality observed since the 1960s - led some researchers to suggest that, on average, the health of the older population is declining. We examine recent trends in self-reported health and find that the health declines observed during the 1970s generally reversed during the 1980s. This shift would appear to belie the notion that lower adult mortality necessarily implies worse health. We argue further that the reversals observed during the 1980s also call into question whether trends in self-reported health during the 1970s reflected actual health declines. We suggest that changes in the social and economic forces influencing the options available for responding to health problems, combined with earlier diagnosis of pre-existing conditions, provide a more plausible explanation for these trends - an explanation that is consistent with data from both the 1970s and 1980s.

Financial Burden of Medical Spending by State and the Implications of the 2014 Medicaid Expansions

This study is the first to offer a detailed look at medical spending burden levels, defined as total family medical out-of-pocket spending as a proportion of income, for each state. It further investigates which states have greater shares of individuals with high burden levels and no Medicaid coverage, but would be Medicaid eligible under the 2014 rules of the Affordable Care Act should their state choose to participate in the expansion. This work suggests which states have the largest populations likely to benefit, in terms of lowering medical spending burden, from participating in the 2014 adult Medicaid expansions