Research by Author & Topic

Publications by Richard W. Johnson on Health and Health Care

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.

High out-of-pocket health care costs may have serious repercussions for older people and their families. This paper examines the impact of health problems at older ages on out-of-pocket health care spending and other types of expenditures. The results show that medical conditions increase health spending, particularly for households ages 51 to 64, but do not generally reduce nonhealth spending. Health conditions do, however, reduce nonhealth spending for low-income households ages 51 to 64, suggesting that holes in the health safety net before the Medicare eligibility age force some low-income people to lower their living standards to cover medical expenses.

As the nation grows older, it's time to find a better way to care for those who need help as they age. The financial, emotional, and physical costs of providing long-term care often overwhelm families. Unpaid family members supply most of it, struggling to balance these duties with work and other responsibilities. A year's stay in a nursing home averaged $78,000 in 2007, and public assistance is not generally available until residents have exhausted almost all of their financial resources. Policymakers should encourage Americans to prepare for their own long-term care needs or create a larger role for government financing

Older men who expect high health care costs for themselves or their spouses after age 65 retire about 13 months later than those who expect low costs. The difference for women is 12 months. For those receiving health insurance from their employers, continued work reduces the risk of high out-of-pocket health care costs. Working longer also increases retirement incomes, making health care costs more affordable.

Rising health care costs threaten financial security at older ages and lead many older Americans to delay retirement. Continued work reduces the risk of high out-of-pocket health care costs for workers receiving health benefits from their employers. Working longer also increases retirement incomes, making health care costs more affordable. This report shows that men with very high expected health care costs after age 65 retire 11 months later than those with very low health care costs. For women, the difference is 12 months.

This paper proposes to expand Medicare to cover comprehensive long-term care services, including home care and custodial nursing home care. These services would be financed by a surcharge on federal income taxes. Unlike the regressive payroll tax that finances Medicare’s hospitalization coverage, the proposed surcharge would not increase tax burdens for low-income people. Beneficiaries would share costs through deductibles and copayments, but the program would include stop loss coverage and special protections for low-income adults. By providing long-term care insurance that protects the assets of older adults, our proposal would eliminate the savings disincentives inherent in the means-tested Medicaid system.

Working without pay and often putting in long hours over many months or years, family caregivers improve the lives of many frail older Americans. The help they provide saves the public billions of dollars a year in nursing home and paid home care costs. Yet care responsibilities often create serious burdens for caregivers, especially those balancing elder care duties with paid employment and childcare. More public funds are needed to support their work.

The demand for long-term care services will surge in coming decades when the baby boomers reach their 80s. Declining family sizes, increasing childlessness, and rising divorce rates will limit the number of family caregivers. Rising female employment rates may further reduce the availability of family care, increasing the future need for paid home care. This study projects to 2040 the number of people ages 65 and older with disabilities and their use of long-term care services. The simulations show that even under the most optimistic scenario long-term care burdens on families and institutions will increase substantially.

Because most workers receive health benefits from their employers, retirement often disrupts health insurance coverage. This brief examines the availability and cost of health insurance at ages 55 to 64 and changes in coverage after retirement. Today most workers with employer health benefits retain their coverage when they retire early, although their required premium contributions have increased sharply over the past 10 years. In the future, however, steady declines in the share of younger workers with access to retiree health benefits may jeopardize income security for the next generation of retirees.

Adult daughters have traditionally served as primary caregivers for frail unmarried adults, but the levels of care they provided in the past may interfere with their growing work responsibilities. This paper examines the impact of time transfers to elderly parents on labor supply at midlife. Using a sample of women ages 55 to 67 in the Health and Retirement Study, we estimate panel data models of annual hours of paid work controlling for the endogeneity of time assistance to parents. The results indicate that time help to parents strongly reduces female labor supply at midlife. (Inquiry 43(3): 195-210, 2006.)