Use of Medicare Subsidy Low in Some States

A major government program helps poor and low-income retirees and adults with disabilities defray what can be substantial healthcare expenses that aren’t covered by Medicare. But enrollment is unusually low in some states because of more stringent eligibility standards.

The Medicare Savings Programs, which are administered by the states and funded by the federal government, subsidize Medicare’s Part A and Part B premiums and cost-sharing obligations for more than 10 million Medicare beneficiaries.

But participation varies widely from state to state, according to a new report by the Kaiser Family Foundation, due to a combination of differences in need and varying eligibility standards.


No more than 10 percent of the retirees in Nebraska, New Hampshire, North Dakota, Utah, and Wyoming are enrolled in their state programs. The enrollment rates are double or even triple that – from 20 percent to 26 percent – in Alabama, California, Connecticut, the District of Columbia, Louisiana, Maine, Massachusetts, and Mississippi.

A major reason for the disparities in enrollment is the difference in the dollar value of assets retirees in each state are permitted to have and still qualify. The federal government set the dollar values on the stocks, bonds, and other assets of Medicare beneficiaries at $8,400 for single and widowed retirees and $12,600 for couples in 2022. The house and one car do not count.

But several states have chosen to make it easier to qualify by setting asset limits that exceed these federal minimums. In fact, eight of the nine states and the District of Columbia that have the highest shares of retirees in their programs either set asset limits above the federal standard or don’t have an asset test at all.

These states still restrict participation to disadvantaged people by placing income caps on eligibility, which range from about $13,000 to $26,000 per year in all but one state. But in several states that only match the low federal minimums for assets, disadvantaged retirees aren’t getting the financial assistance they need to access medical care.

Meredith Freed, a senior Medicare policy analyst for Kaiser, said that between a third to half of retirees with incomes below 135 percent of the federal poverty limit nationwide are not enrolled.

Medicare beneficiaries spend an average $6,000 per year out of their own pockets for medical care. “Having help with premium and cost-sharing is incredibly important,” Freed said. …Learn More

Woman in a dark place

Opioids Make it Harder, Not Easier to Work

The twin goals of prescribing opioids to workers with a bad back or arthritis are to alleviate their pain and keep them employed.

But the use and abuse of opioids can cause poor memory, extreme drowsiness, and an inability to engage in normal social interactions – all of which limit workers’ ability to function. Opioids also have serious physical effects outside of the dependence itself.

The resulting detachment from the labor market, revealed in a new research study, calls into question any benefits the medications have.

Between 2012 and 2018, average employment declined by nearly 2 percent for every 10 additional opioid prescriptions per 100 adults in a county-sized area, the researchers found. Wages also dropped by 6 percent, indicating that the opioid users who do remain employed are less productive.

The painkillers had more permanent consequences, too, when workers, unable to cope, left the labor market for good. The rate of applications for federal disability benefits increased sharply in the areas with higher prescribing rates, according to the study funded by the U. S. Social Security Administration, which runs the disability program. …Learn More

retired couple on a boat

Health and Wealth Drive Retirees’ Spending

Previous research has shown that spending drops immediately at the moment the paychecks stop, and a few studies have found that households, once retired, reduce their consumption over time.

But a new study that also takes the long view suggests that the spending decline is not what retirees want to do but what is necessitated by their financial and health constraints.

The analysis, which used data from two national consumption surveys, divided retired households into groups to get a sense of what goes into their spending decisions. The researchers compared the consumption patterns of retirees at three different wealth levels over a 20-year period and then compared consumption for three states of health.

The evidence that financial resources drive behavior is that the wealthier households’ consumption was relatively constant, declining just one-third of 1 percent a year.

While these retirees have the financial wherewithal to largely maintain their spending, retirees in the bottom wealth tier saw bigger drops of 1 percent a year. When accumulated over 20 years, the declines produced much lower spending levels than when they first retired.

Health is a second factor in retirees’ decisions. Again, the extremes tell the story. Spending in the top tier – very good or excellent health – held fairly flat, while the retirees in fair or poor health saw relatively large declines. Even if they can afford to travel or eat out frequently, health problems may be preventing them from enjoying their money. …Learn More

Workers Stress about Inflation Spike

Emotional toll figureRegular working folks can always find something about their finances to be stressed about. But today’s stress is coming from a new place: a level of inflation this country hasn’t seen in four decades.

A large majority of workers – 76 percent – identified rising prices as having a negative impact on their finances. And among households earning under $55,000, 84 percent are feeling stretched, according to the financial services website Salaryfinance.com.

Nearly half of the 3,000 workers the firm surveyed in February specifically said that inflation is stressing them out, causing anxiety, depression, or both. They said the inflation makes it tough to afford basic necessities or save money.

Gas signThe stress is understandable. The consumer price index has risen 8.5 percent over the past year, and the increase isn’t just at the grocery store or the gas pump. A narrower measure of inflation that excludes food and energy is also up sharply – 6.5 percent for the year. Housing, another necessity, is driving up living costs too.

Workers got some protection from price hikes in 2021, because their wages were outpacing prices, according to the Wharton School. But those gains could disappear this year if inflation continues to accelerate.

Consumers are getting some relief from falling gas prices, which have declined for the fourth straight week, according to Gas Buddy. …Learn More

Mental Health Crisis is an Inequality Problem

The connection between Americans’ socioeconomic status (SES) and their health was established long ago and the evidence keeps piling up.

"Healing: Our Path from Mental Illness to Mental Health" book coverLess-educated, lower-income workers suffer more medical conditions ranging from arthritis to obesity and diabetes. And the increase in life expectancy for less-educated 50-year-olds was, in most cases, roughly 40 percent of the gains for people with higher socioeconomic status between 2006 and 2018.

More recently researchers have connected SES and mental health. The foundations are laid in childhood. In one study, the children and teenagers of parents with more financial stresses – job losses, large debts, divorce, or serious illness – have worse mental health. And COVID has only aggravated the nation’s mental health crisis.

In a new book, Dr. Thomas Insel, former director of the National Institute of Mental Health, is concerned about the impact of inequality.

Mental health in disadvantaged communities “is worse because of the world outside of health care. It’s our housing crisis, our poverty crisis, our racial crisis, our increasing social disparities that weigh heaviest on those in need,” he writes in “Healing: Our Path from Mental Illness to Mental Health.” …Learn More

UI Benefits Can Get Caregivers Back to Work

Elderly coupleWhen older workers are laid off, the timing of the career disruption could not be worse – when they should keep working and saving for retirement. Their situation is even more precarious if a parent or spouse is in need of care.

A new study shows that people who become unemployed mid-to-late career are more vulnerable to being pulled into the demands of caregiving, which can derail their efforts to find another job.

Intensive caregiving spells usually kick in about four months after a job loss and can continue for up to 12 months – and possibly longer – according to the research, which was based on U.S. Census surveys of the unemployed prior to the pandemic.

“Family caregiving needs have the potential to turn short-term employment shocks into longer-run decreases in labor force participation, impacting the economic security” of future retirees, concluded Yulya Truskinovsky at Wayne State University.

But she also uncovered another factor in workers’ calculations: the generosity of unemployment benefits, which vary dramatically from state to state. The federal and state governments share the cost of the benefits, but states set the minimum and maximum benefit levels. During the pandemic, for example, the weekly maximum in Massachusetts was 3 1/2 times more than Mississippi’s, far exceeding the difference in the two states’ cost of living.

More generous unemployment benefits could cut one of two ways. They might give the worker enough income to support being a caregiver rather than returning to the labor force right away. The downside of taking so much time off is that it could be harder to eventually find a new job.

But the researcher finds that the opposite occurs: more generous benefits sharply reduce the likelihood that someone takes on caregiving duties after losing a job. Benefits that replace more of a worker’s earnings may make it easier to hire a professional caregiver or continue paying an existing one so the worker can focus on a job search. …Learn More

Her Home Purchase Builds Children’s Wealth

Robin Valentine with son, Alexander, and daughter Alanna.Robin Valentine with son, Alexander, and daughter Alanna.

There is joy in owning one’s first home. But homeownership has a deeper meaning for Robin Valentine.

Unlike her late mother, who was unable to leave any money to her children, Valentine will one day pass on the house that she purchased last September to her three children.

“I told my children, ‘If anything happens to me, and you don’t want to stay here, that’s fine. Take the money [from selling the house] and put it towards your home,’ ” she said. “It’s more than just me buying this house and living in it. It’s for me to leave a legacy.”

Valentine, who is 52, is accomplishing something that historically has proved difficult for African-Americans like herself: building intergenerational wealth.

For most workers, a house is their largest source of wealth. But the homeownership rate in the Black community is dramatically lower than for whites for reasons ranging from mortgage discrimination to insufficient income. When Black people do own houses, their properties hold significantly less wealth. The typical Black homeowner had $4,400 in home equity in 2020, compared with $67,800 for white homeowners.

With sheer determination, Valentine, an administrative assistant in academic services at the University of Massachusetts-Boston, overcame numerous obstacles to buying a house.

She attended college but had to drop out because she couldn’t afford it. It took about eight years to pay off $20,000 in student loans and credit card bills after a divorce from an abusive marriage. For seven years after that, she saved for a down payment by resisting any purchase that wasn’t essential. Once a year, she would ask the bank for a mortgage preapproval to see if she could afford a house yet.

“I just kept saving every little penny I could save,” she said.

Last July, Valentine paid $275,480 for a three-story townhouse in Boston’s Dorchester neighborhood. Her mortgage payment is $1,635 – not much more than she paid to rent a subsidized apartment under the federal Section 8 program.

She got big assists from two government programs and a non-profit. One program is overseen by the U.S. Department of Housing and Urban Development (HUD). Under HUD’s Family Self-Sufficiency Program (FSS), the non-profit Compass Working Capital partners with local housing authorities to help tenants like Valentine get a foothold in the housing market. …Learn More