Most agree that something must be done to restrain future Social Security costs or raise additional revenues, but few agree on what should be done or when. Our research shows how well Social Security serves today's retirees, and how different reforms might affect future retirees.

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Rising Health Care Costs Lead Workers to Delay Retirement (Series/Older Americans' Economic Security)
Author(s): Richard W. Johnson, Rudolph G. Penner, Desmond Toohey

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.

Posted: May 14, 2008

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Can Faster Economic Growth Bail Out Our Retirement Programs? (Research Report)
Author(s): Rudolph G. Penner

Government analysts portray a bleak fiscal future as the retirement of baby boomers and soaring health costs push up expenditures on Social Security, Medicare and Medicaid much faster than projected tax revenues. Some argue that the analysts' economic growth projections are too pessimistic. This analysis argues that official growth projections are quite reasonable, but even if they are too pessimistic, faster growth will accelerate Social Security costs because of the program's structure and health costs are also likely to grow more rapidly. Faster growth will, however, ease the pain associated with necessary reforms.

Posted: March 19, 2008

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Do Out-of-Pocket Health Care Costs Delay Retirement? (Series/The Retirement Project Discussion Papers)
Author(s): Richard W. Johnson, Rudolph G. Penner, Desmond Toohey

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.

Posted: March 14, 2008

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Options for Improving Medicare Payment for Skilled Nursing Facilities (Research Report)
Author(s): Korbin Liu, Bowen Garrett, Douglas A. Wissoker, Stephanie Maxwell, Andrew Kramer, Theresa Eilertsen, Anne Epstein, Yu-Chu Shen, Sung-Joon Min, Sharon K. Long, Robert Schlenker, Brant Fries, Joan Buchanan

Medicare has paid skilled nursing facilities (SNFs) using a prospective payment system (PPS) since 1998. This report offers policy options to refine Medicare’s payment of SNF services by developing alternative patient classification models. Three models classify patients according to expected non-therapy ancillary (NTA) costs: two models use data from the SNF to model NTA costs; a third adds data from prior hospital stays. A fourth model predicts rehabilitation therapy costs using patient characteristics. The fifth uses Diagnostic Related Groups to predict total SNF care costs. The report also simulates options for outlier payments for exceptionally high-cost cases.

Posted: August 22, 2007

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A Proposal to Finance Long-Term Care Services through Medicare with an Income Tax Surcharge (Research Report)
Author(s): Richard W. Johnson, Leonard E. Burman

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.

Posted: June 22, 2007

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