Retirement and Older Americans

Although Medicare covers nearly all Americans age 65 and older, premiums, cost shares, and holes in the benefit package raise concerns about seniors' ability to pay for their health care. This brief, based on newly released data, shows that Medicare Part D, introduced in 2006 to cover prescription drugs, helped reduce out-of-pocket costs. The majority of older adults devoted less than one-eighth of their incomes to health care in 2006. However, nearly half of low-income seniors spent more than 20 percent of their 2006 incomes on health care. Medical costs for seniors should figure into the health-reform debate.

About two-thirds of those over 65 will need some long-term care before they die. Howard Gleckman looks at a key question at the heart of the debate over long-term care insurance: how much will premiums cost?

I argue that Social Security benefits for long-term, low-wage workers are modest and need to be increased. There are many ways to bolster benefits for low-income retirees, each with strengths and weaknesses, so technical details of each proposal will determine its effectiveness. Any Social Security reform package will include multiple provisions that interact with one another. Certain provisions to help low-earners may be more or less desirable depending on a package's other components. Finally, some low-income older and disabled Americans are beyond Social Security's reach. To help them, Congress should consider expanding the Supplemental Security Income program.

Urban Institute projections suggest the stock market collapse will have small effects on most Americans' retirement incomes. It's estimated that 37 percent of Americans born between 1941 and 1965 owned no stocks when the market crashed in 2008 and that income from assets will account for a small share of retirement income, even for those with stocks. For most retirees, Social Security provides the majority of income. Had Social Security been invested in private accounts with equities, the impact of the crash would have been much larger—positive or negative, depending on one's birth cohort and on future market performance.

As one of the fastest growing segments of the older population, Hispanics could become an important target for employers trying to attract and retain older workers. Older Hispanics participate in the labor force at relatively high rates and generally appear to be at least as healthy as non-Hispanic whites and healthier than blacks. Many, however, face substantial challenges in the workplace. They earn low wages and few benefits, and tend to work in physically demanding jobs that are often difficult to maintain into later life. Various policy reforms could boost older Hispanics' employment and earnings. Published by AARP (see link below.)

As many as 10 million older Americans and younger adults with disabilities require long-term care, either at home or in nursing facilities. The United States spends more than $200 billion annually for such care. However, our system for financing this assistance-principally Medicaid and family assets, with a small share funded through private insurance—may be untenable as baby boomers age. TPC's Howard Gleckman looks at the way we deliver and pay for these services in a new book, Caring for Our Parents: Inspiring Stories of Families Seeking New Solutions to America's Most Urgent Health Crisis. He and a panel of top policy experts will discuss how—or whether—long-term care should be included in health reform legislation.

Relatively little is know about the implications for Medicare spending of downward trends in old age disability in the United States between the mid-1980s and the end of the century. This is in part because uncertainty persists about the extent to which the aggregate disability declines reflect improvements in health versus improvements in the technology, service, and physical environment. This study examines Medicare spending and utilization that occurred over the period of declining disability between 1984 and 1999 and how it differed from what might have been expected had disability not changed and discusses implications for the relationship between disability, Medicare spending, and health. Projections are developed under various assumptions about how disability and spending are likely to change over the over the next several years.

One of the most intriguing aspects of recent declines in old age disability is the concurrent increases in use of assistive devices among older persons with disability, and in particularly in use of devices for all disabilities without human assistance. This study updates information on trends in assistive device use and characteristics of device users; examines differences in the hours of care received by persons who do not use devices and those who use devices with and without help; and discusses implications for multivariate modeling of the relationship between device use and hours of help and other outcomes. Data are from the 1984 through 1999 rounds of the National Long Term Care Survey (NLTCS), which has been the key source of earlier information on trends in equipment use.

More than 250 million Americans-more than 80 percent of us- have health coverage, usually through employers or Medicare, Howard Gleckman points out in a USA Today commentary. By contrast, just 7 million have long-term care insurance. That, it seems, is the real crisis of the uninsured.

Career change is common at older ages. This report shows that 27 percent of workers employed full time at age 51 to 55 change occupations by age 65 to 69. More than one-third of older job leavers separate because of job layoffs or health problems, including nearly half of those who did not complete high school. Workers who change careers typically move into jobs that pay less than their previous jobs and are less likely to offer pension and health benefits. However, new careers tend to offer more flexible employment arrangements, less stressful working conditions, and fewer managerial responsibilities.