Do Health Insurance Premium Restrictions Improve Older Workers Labor Market Outcomes by Socioeconomic Status?

Delaying retirement improves retirement preparedness, but older workers cannot work longer if employers do not hire or retain them.  This study examines one way in which public policy potentially makes older workers more attractive to employers: state regulatory restrictions on how much employer premiums are permitted to increase at small firms with older, unhealthier workforces.  The study uses data from the Current Population Survey from 1989-2013 to compare older individuals' overall employment, small-firm employment, and earnings in states with varying degrees of premium regulation, and among workers of different educational backgrounds.  The analysis shows mixed results.  Stronger premium regulations were not effective in increasing employment: employment at small firms, which are most sensitive to premium increases, saw no statistically significant increase, and overall employment for older workers at both large and small firms increased only slightly.  The earnings gap between large and small firms is also smaller in states with tighter restrictions, but older workers were not helped appreciably more than younger workers.  These results suggest that indirect efforts to lower the price of hiring an older worker are not likely to be effective in improving their job prospects

Are Retirees Falling Short? Reconciling the Conflicting Evidence

A fundamental question in the retirement area is whether people will have adequate retirement income to maintain their pre-retirement standard of living. Existing studies offer conflicting assessments; some indicate a serious problem while others present an optimistic view. This chapter attempts to explain why the assessments differ. We find that the optimistic views of retirement preparedness depend crucially on behavioral assumptions that may not reflect real world activity or on consumption levels that are unsustainable in the long run. Thus, our best assessment is that retirees are falling short and will fall increasingly short over time

Three Essays in Health Insurance Coverage.

Obtaining health insurance through an employer pools risk, but may lead to moral hazard, where employees with more coverage seek care valued below cost, and adverse selection, where the unhealthy choose more generous plans, driving up premiums. In the first essay, I model the decision to choose the more generous employer plan, which suggests testable empirical predictions. Using MEPS data from 1996-2001, I find that enrollees in non-HMO plans, but not HMO plans, spend more on medical care the more generous their plan, indicating moral hazard. Within HMO or non-HMO options, the more generous plan does not enroll the unhealthier employees, but adverse selection may lead to healthier employees choosing an HMO over a non-HMO. The second essay, written with Catherine McLaughlin, examines the growing disparity between Hispanics and non-Hispanic Whites in health insurance coverage. While the percentage of non-Hispanic Whites without health insurance has fallen slightly since 1983, the uninsured rate has risen dramatically among Hispanics. Using 25 years of SIPP data, we find that differences in citizenship and education explain some of the divergence, but more than half of the increase in the gap, or more than one million extra uninsured Hispanics, remains unexplained by differences in any observable characteristic. While observable differences account for most of the divergence in public and employer coverage rates, much of the decline in family coverage remains unexplained. In the final essay, I examine the decision to select a health insurance plan from the options offered by one's employer, considering not only the level of the plan's financial generosity, but also the variability of out-of-pocket spending under the plan. I also consider other elements that may differ between plans, including access to providers and supplemental coverage. I find that employees demand a plan with lower expected out-of-pocket costs, but that the variance of a plan's out-of-pocket spending has no effect on plan choice. Employees are only weakly responsive to their share of the premium, but do tend to choose the most popular plan at a firm, suggesting the importance of unobserved plan quality differences and/or the employees opting for the default plan.Ph.D.EconomicsUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/77916/1/rutledma_1.pd

Do Tax Incentives Increase 401(K) Retirement Saving? Evidence from the Adoption of Catch-Up Contributions

Retirement Research Consortium. The opinions and conclusions expressed are solely those of the authors and do not represent the opinions or policy of SSA, any agency of the federal government, or Boston College. Neither the United States Government nor any agency thereof, nor any of their employees, makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of the contents of this report. Reference herein to any specific commercial product, process or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement, recommendation or favoring by the United States Government or any agency thereof. The authors are indebted to the indispensable data analysis of Qi Guan, and would also like to thank Robin Jensen for excellent research assistance. The authors are grateful to Kelly Trageser, Gary Benedetto, and Martha Stinson for helping us access the SIPP synthetic data and re-running our code on the actual data

Maintenance of activity and eating change after a clinical trial of tailored newsletters with older rural women.

BACKGROUND: In the Wellness for Women Project, a randomized-by-site 1-year controlled clinical trial, the efficacy of generic newsletters and newsletters tailored on Health Promotion Model behavior-specific cognitions, eating behavior, and activity behavior were compared among 225 women aged 50 to 69 years. OBJECTIVES: The purpose of this study was to compare the maintenance of change in healthy eating and physical activity over the 12 months following the tailored versus generic mailed newsletter intervention. METHODS: Outcomes at 18 and 24 months included behavioral markers and biomarkers of physical activity and eating. Data were analyzed using the multivariate approach to repeated measures analysis of variance and generalized estimating equations (alpha \u3c.05). RESULTS: At 18 months, the tailored group maintained levels of all eating and activity behaviors, whereas the generic group maintained levels of fruit and vegetable servings, a moderate or greater activity, stretching exercise, lower body strength and flexibility but increased saturated fat intake and declined in weekly strength exercise and cardiorespiratory fitness. At 24 months, both groups maintained or returned to 12-month levels of all eating behaviors,moderate or greater activity, stretching exercise, and flexibility but declined in cardiorespiratory fitness; the tailored group maintained levels of strength exercise and lower body strength, whereas the generic group decreased in both. A greater proportion of women who received tailored newsletters continued to achieve most Healthy People 2010 criteria for eating and activity. DISCUSSION: Mailed tailored print newsletters were more efficacious than generic newsletters in facilitating maintenance of change in eating and activity for 6 months postintervention. Both tailored and generic newsletters facilitated the maintenance of change in eating behaviors and in moderate or greater physical activity and stretching exercise, whereas tailored newsletters were more efficacious in maintaining change in strength exercise for 12 months postintervention

Evaluation of an emergency department lean process improvement program to reduce length of stay

Study objective In recent years, lean principles have been applied to improve wait times in the emergency department (ED). In 2009, an ED process improvement program based on lean methods was introduced in Ontario as part of a broad strategy to reduce ED length of stay and improve patient flow. This study seeks to determine the effect of this program on ED wait times and quality of care. Methods We conducted a retrospective cohort study of all ED visits at program and control sites during 3 program waves from April 1, 2007, to June 30, 2011, in Ontario, Canada. Time series analyses of outcomes before and after the program and difference-in-differences analyses comparing changes in program sites with control sites were conducted. Results In before-after models among program sites alone, 90th percentile ED length of stay did not change in wave 1 (–14 minutes [95% confidence interval {CI} –47 to 20]) but decreased after wave 2 (–87 [95% CI –108 to –66]) and wave 3 (–33 [95% CI –50 to –17]); median ED length of stay decreased after wave 1 (–18 [95% CI –24 to –12]), wave 2 (–23 [95% CI –27 to –19]), and wave 3 (–15 [95% CI –18 to –12]). In all waves, decreases were observed in time to physician assessment, left-without-being-seen rates, and 72-hour ED revisit rates. In the difference-in-difference models, in which changes in program sites were compared with controls, the program was associated with no change in 90th percentile ED length of stay in wave 2 (17 [95% CI –0.2 to 33]) and increases in wave 1 (23 [95% CI 0.9 to 45]) and wave 3 (31 [95% CI 10 to 51]), modest reductions in median ED length of stay in waves 2 and 3 alone, and a decrease in time to physician assessment in wave 3 alone. Conclusion Although the program reduced ED waiting times, it appeared that its benefits were diminished or disappeared when compared with that of control sites, which were exposed to system-wide initiatives such as public reporting and pay for performance. This study suggests that further evaluation of the effectiveness of lean methods in the ED is warranted before widespread implementation

Eskers associated with buried glaciers in Mars' mid latitudes: recent advances and future directions

Until recently, the influence of basal liquid water on the evolution of buried glaciers in Mars’ mid latitudes was assumed to be negligible because the latter stages of Mars’ Amazonian period (3 Ga to present) have long been thought to have been similarly cold and dry to today. Recent identifications of several landforms interpreted as eskers associated with these young (100s Ma) glaciers calls this assumption into doubt. They indicate basal melting (at least locally and transiently) of their parent glaciers. Although rare, they demonstrate a more complex mid-to-late Amazonian environment than was previously understood. Here, we discuss several open questions posed by the existence of glacier-linked eskers on Mars, including on their global-scale abundance and distribution, the drivers and dynamics of melting and drainage, and the fate of meltwater upon reaching the ice margin. Such questions provide rich opportunities for collaboration between the Mars and Earth cryosphere research communities