May 12, 2022

The following statistic will sound familiar since I use it regularly: about half of U.S. workers are not saving enough and may see their standard of living drop when they retire.

A major culprit in this poor state of preparedness is that millions of Americans at any given moment don’t have a traditional pension or 401(k) savings plan at work.

A new study takes a close look at who these people are and shows stark differences along racial lines. A large majority of Hispanic workers in the private sector – two out of every three – do not have access to a pension or 401(k)-style plan, and more than half of Black workers do not have access. Although the numbers are lower for Asians (45 percent) and whites (42 percent), they are still substantial.

Other estimates of private sector coverage, also from this study by John Sabelhaus of the Brookings Institution, show big gaps between high- and low-paid workers and workers with and without college degrees, and at large and small employers.

Coverage also varies from state to state: In Pennsylvania, 41 percent lack access to a retirement plan, but in Florida, 59 percent do not have coverage.

Sabelhaus is certainly not the first to document disparities in retirement plan access for different demographic groups. But his methodology advanced the ball, resulting in more reliable estimates. By using three data sources, he could compensate for their shortcomings while taking advantage of the unique information in each one. He combined recent data from the U.S. Census Bureau, the IRS, and the Federal Reserve Board. …Learn More

April 21, 2022

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

Less-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

February 22, 2022

The pandemic has dramatized the grim consequences of Black and Latino Americans having less access to healthcare than whites: disproportionately high death rates from COVID-19.

But there has been some progress toward racial equity in an unlikely place: Medicare Advantage plans sold by insurance companies. Enrollment in the plans has increased unabated for years, and minority enrollment more than doubled between 2013 and 2019.

During that time, Advantage plans increased from about a third of the various Medicare options purchased by Black, Latino, Asian and other minority retirees to nearly half, according to the non-profit Better Medicare Alliance.

Dr. Elena Rios, president of the National Hispanic Medical Association, and Martin Hamlette, executive director of the National Medical Association representing Black physicians, said Advantage plans provide retirees with access to preventive services like mammograms and cholesterol checks that keep them healthy.

Advantage plans are “a needed tool in the work of building a more just health care system,” they wrote in a recent Health Affairs article.

The appeal is upfront affordability. The monthly premiums are significantly lower than Medigap premiums, and many Advantage plans charge no premium. They frequently include prescription drug coverage, eliminating the need to pay for a separate Part D drug plan.

The reason Advantage plans are especially popular with minorities is that they tend to have lower incomes than whites and less room in their monthly budgets for medical care. Three out of four minority retirees in Advantage plans have incomes below 200 percent of the federal poverty level, compared with half of the whites in the plans.

Like all insurance, however, Advantage policies are a mixed bag. Medicare beneficiaries in poor health may face higher costs down the road if they experience a major medical crisis. In one study, the sickest retirees with Advantage plans had more risk of inordinately large annual out-of-pocket expenses for copayments and deductibles than retirees with Medigap plans. …Learn More

Research

January 6, 2022

Opioids fueled a record of nearly 100,000 drug overdose deaths in the United States last year.

The biggest cause of overdose deaths was dangerous synthetic opioids, such as fentanyl. But the epidemic involving illegal chemicals grew out of the abuse of highly addictive prescription opioids. A spate of new research reveals that the use and abuse of these prescription drugs have plagued people with disabilities, who often start taking them to treat painful musculoskeletal conditions such as arthritis or a bad back.

A 2017 analysis featured in this blog provided the first estimate of opioid use among people who have disabilities that limit their ability to work. The researchers found that about one in four people applying for federal disability benefits used the medications – a much higher rate than in the U.S. population overall.

Painkillers often do more harm than good because they can increase society’s dependence on disability benefits by impairing lung function, aggravating existing conditions like rheumatoid arthritis, or causing addiction. According to 2021 research by RAND that followed older workers over several years, the opioid users in the study were much more likely to wind up on disability than their counterparts who did not take them.

“Although the pain relief is an important health goal,” the researchers concluded, “the consequences to workers and social programs of powerful prescription painkillers are substantial and long-lasting.”

The isolation and stresses caused by the pandemic are believed to have fueled the dramatic rise in overdose deaths last year. But a long-running cause, prior to COVID, was the decline in U.S. manufacturing employment. Research reported in this blog directly tied the movement of robots onto factory floors to the rise in deaths of despair – from drug addiction, alcoholism, and suicide – among men between ages 30 and 54. The study found that automation accounts for nearly one in five overdose deaths in manufacturing counties, which are concentrated in the heavily industrialized Midwest. The researchers said the rate of applications for disability benefits is also higher in these counties.

Opioid abuse in the disability community is happening for the same reason it is pervasive in society: an ample supply of the addictive drugs. …Learn More

August 26, 2021

Retirement experts encourage baby boomers to hang on to their jobs as long as possible to boost their monthly Social Security checks and add to their retirement savings. If they can delay retirement to age 70, they have good odds of maintaining their standard of living.

That isn’t always possible, however, for the baby boomers confronting disabling physical impairments or health problems. Add to that the generally declining health of the older population over the past 20 years.

But a new study has revealed a deep socioeconomic divide. More-educated older workers are actually able to work longer than they did 15 years ago, while less-educated older workers – and Black men in particular – are mostly losing ground.

To estimate the changes in working life expectancy for various groups of older workers, Laura Quinby and Gal Wettstein at the Center for Retirement Research considered three factors: life expectancy overall, how long the workers can expect to remain free of a disability, and the rates of institutionalization in prisons and long-term care facilities. The incarceration rate is relevant, because the young adult men who received the longer prison sentences that started being imposed a couple of decades ago are now in their 50s and 60s.

Between 2006 and 2018, working life expectancy increased by about one year for older Black and white workers in the top half of the educational ranking. This makes sense because more educated people tend to be healthier and have seen stronger gains in their longevity.

But working life expectancy declined in the bottom half of the educational ranking for Black men and for white men and women. The exception is less-educated Black women – they have seen a small increase in working life expectancy, along with a more substantial increase in longevity.

The researchers also estimated the share of each group who, at age 62, could feasibly work until age 67, which would lock in their full retirement age benefit every month from Social Security, and until 70, which would provide them with their maximum monthly benefit.

A comparison of two extremes – more-educated white men and less-educated Black men – dramatizes the divide. …Learn More

August 24, 2021

Last year, millions of older Americans went into hiding to protect themselves from the ravages of COVID-19.

Did the isolation take a psychological toll? How did they respond to infrequent contact with friends and family? Researchers in a recent webinar tried to understand the unique phenomenon of loneliness in a modern pandemic.

What we know from the National Poll on Healthy Aging in the early months of the pandemic is that more than half of older workers and retirees between 50 and 80 said they “felt isolated from others” – twice the levels seen in 2018.

In a different survey conducted every two months for most of last year, loneliness was “common and it was incredibly persistent during the first six months of the pandemic,” said Lindsay Kobayashi, a University of Michigan epidemiologist involved in the COVID-19 Coping Study, a survey of adults over age 55.

Two groups in particular suffered rates of loneliness that were twice as high as their peers: older people who live alone and residents of senior communities and nursing homes, where staff often separated the residents or confined them to their rooms in an attempt to protect their health.

A larger share of Black Americans also expressed feelings of loneliness than whites and Hispanics, and women were generally more lonely than men. “I’m very afraid that we are going to get so used to being alone, on our own, by ourselves that we won’t reconnect the way we need to,” a 76-year-old woman told the Coping Study researchers last fall.

But the news isn’t all bad. Feelings of loneliness, especially among the oldest retirees, had subsided a bit as early as November as news reports emerged that the vaccines were effective. Older people also found ways to cope with their isolation, and some even felt the pandemic gave them a renewed sense of purpose, according to a pair of studies in The Gerontologist. …Learn More

Behavior

August 5, 2021

For baby boomers who have abused drugs or alcohol for years or decades, the negative health consequences of addiction are particularly damaging.

But information about older Americans’ success in substance abuse programs is sparse, even though people between 55 and 75 now make up 22 percent of all U.S. overdose deaths, up from 9 percent in the late 1990s. And virtually no racial breakdown of treatment outcomes is available for this age group.

A new study by Jevay Grooms at Howard University and Alberto Ortega at Indiana University fills this gap. The researchers find that the number of older Black, white and Hispanic Americans admitted to treatment facilities and programs is steadily increasing.

The biggest growth in Black admissions was in cocaine and heroin treatment, while the rise for whites was concentrated in prescription opioids and alcohol treatment. The largest increase for Hispanics was for heroin addiction.

Amid rising admissions, however, the share of people 50 and older who completed treatment has generally trended down for each group during the period of this analysis, 2006 through 2017, though the rates bounce around quite a bit from year to year.

To gauge how each group fared over the period, the analysis controlled for various factors that determine success or failure, including education levels, employment status, and past attempts at treatment.

Older Blacks – and, to a lesser extent, Hispanics – are not as likely as older whites to successfully finish a substance abuse program. One reason is that minorities are more likely to be terminated by a treatment facility or program. Just as worrisome, however, are the widening disparities in the rates of treatment completion between each older minority group and their white counterparts – even as the disparities were closing for Blacks and Hispanics under 50.

The researchers did not dissect the reasons for treatments being terminated but noted that “lack of insurance, social stigma, distrust, lack of diversity and cultural incompetence among providers” are likely contributing factors in the racial differences. …Learn More