February 9, 2023

About one out of every five Latinx workers in this country lacks health insurance. The uninsured ratio rises to one in four in the states that have chosen not to expand their Medicaid programs to more low-income workers under the Affordable Care Act.

The motivation for Josefina Flores Morales’ new research is that there’s more to health insurance than just medical care. It is also critical to individuals’ financial health, she argues, and broader insurance coverage in the Latinx community is an underappreciated way that the vast wealth gap between them and non-Latinx White workers could be reduced.

Having insurance keeps people healthy so they can continue to work and is important for other financial reasons. Insurance reduces the size of medical bills through caps on out-of-pocket costs and limits on how much doctors and hospitals can charge for their services.

In cases of severe illness, insurance can prevent a cascade of financial problems resulting in bankruptcy, a car repossession, or home foreclosure.

Flores Morales, a postdoctoral scholar at Stanford University’s School of Medicine, attempts to put a dollar value on the health insurance disparity by measuring the gap between Latinx and non-Latinx White household wealth – and then estimating whether broadening coverage under the 2014 Medicaid expansion reduced that gap. Her analysis takes advantage of the key difference – each group’s uninsured rates in each state – after Congress expanded the joint federal-state Medicaid program as part of the Affordable Care Act.

In the states that agreed to expand their programs, the Affordable Care Act began covering millions more low-income workers by increasing the income limit for people who qualify.

Based on the known impact that broader insurance coverage and the Medicaid expansion have had so far on the wealth gap between Latinx and White households, the researcher found that if both groups had the same, lower uninsured rate, the gap would shrink by about 8 percent. Flores Morales limited her analysis to the households that have positive net worth, meaning their assets exceeded their debts. …Learn More

On the Web

June 30, 2022

Retirement inequality is a thread running through several articles that have appeared here this year.

One blog that was particularly popular with our readers distinguishes retirees who have enough wealth to maintain the same spending levels throughout retirement from those who will, over time, have to cut back and reduce their standard of living.

The research behind the article – “Health and Wealth Drive Retirees’ Spending” – makes clear that wealth is just one component of a satisfying lifestyle. Even retirees who can afford to maintain their living standard may not be healthy enough to enjoy their money to the fullest. The retirees who have both – health and wealth – are best equipped to maintain their pre-retirement lifestyle.

Homeownership also marks a dividing line between the haves and have-nots. A home is one of retirees’ largest sources of wealth. Although most are hesitant to withdraw home equity, the ones who have equity and tap it to pay medical bills see large, positive health benefits, according to “Using Home Equity Improves Retirees’ Health.”

Pensions are another dividing line. “Retirees with Pensions Slower to Spend 401(k)s” shows the value of having guaranteed income from defined benefit pensions, which are all but extinct outside the public sector. …Learn More

April 14, 2022

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

March 31, 2022

Retirees spend $1,500 more per year, on average, for medical care after a diagnosis of a serious condition like lung disease or diabetes.

Often, the solution for individuals who can’t afford such big bills is to scrimp on care or avoid the doctor altogether. But older homeowners can get access to extra cash if they withdraw some of the home equity they’ve built up over the years.

While the money clearly provides financial relief for retirees, a new study out of Ohio State University finds that it is also good for their health. Every $10,000 that Medicare beneficiaries extracted from their homes greatly improved their success in controlling a chronic or serious disease.

Among the retirees who had hypertension or heart disease, for example, one standard used to determine whether the condition was under control was whether blood pressure levels stayed below 140/90, which the medical profession deems an acceptable level. The people who tapped their home equity were more likely to stay below these levels than those who did not.

This is one of several studies in recent years to tie financial security to home equity, a resource many retirees are reluctant to tap. A study in 2020 found that older homeowners were less likely to skip medications due to cost after they had extracted equity through a refinancing, home equity loan, or reverse mortgage.

But this new research is the first attempt to connect the strategy to retirees’ actual health. The analysis followed the health of more than 4,000 homeowners for up to 15 years after they were diagnosed with one of four conditions – lung disease, diabetes, heart conditions, or cancer. …Learn More

Research

February 17, 2022

Paying off the mortgage frees up a lot of money for other things. The homeowners in one study splurged on big-ticket items.

Older homeowners, however, are adding another priority: medications.

After a mortgage payoff, workers and retirees ages 50 to 64 spent 50 percent more on prescription drugs in a comparison with households who had no major changes in their monthly housing costs, according to a new study by Harvard’s Joint Center for Housing Studies and funded by the U.S Social Security Administration.

The mortgage is typically a homeowner’s largest monthly expense. If medication spending rises when this big bill is eliminated, it supports the argument that some aging homeowners who are still carrying a mortgage may be choosing housing over necessary medical care.

This research is particularly relevant at a time older Americans are entering retirement with more debt. In 2016, four in 10 retirees had a mortgage – double the share in the late 1980s.

Not surprisingly, the researchers found some indication that lower-income workers and early retirees benefited more from eliminating their monthly payments. They have difficulty paying even for essential expenses, and the increase in their prescription purchases after paying off the home loan appeared to be larger than for higher-income groups with fewer constraints.

The researchers split the homeowners into two age groups – under and over 65. While homeowners under 65 sharply increased their drug spending after the mortgage payments ended, the Medicare beneficiaries did not.

The level spending after Medicare eligibility indicates that the program relieves some of the pressure on the family budget, the researchers said. Medicare also provides an average $5,000 annually to subsidize low-income retirees’ medications under the Low Income Subsidy program.

But for older homeowners who are too young to get Medicare but are still paying a mortgage, the study “raises serious concerns for health care quality and the costs to treat poorly managed conditions,” the researchers said.

To read this study, authored by Christopher Herbert, Jennifer Molinsky, Samara Scheckler, and Kacie Dragan, see “Older Adult Out-of-Pocket Pharmaceutical Spending after Home Mortgage Payoff.”

A blog post last year featured a similar study – this one about the older Americans’ adherence to medications after …Learn More

On the Web

July 15, 2021

Many older Americans could benefit from using home equity for some much-needed income in retirement. But they have found many reasons not to.

Some want to preserve that housing wealth for their kids. Others don’t like the idea of cashing in on the equity if it means relocating to a smaller house or apartment or a less expensive neighborhood. They also have plenty of concerns about federally insured reverse mortgages, which are a way to extract equity but are complicated to understand.

These doubts, expressed in readers’ comments on recent articles, are persistent. But economists see things differently: home equity has great potential to ease retirees’ financial problems – after all, roughly $8 trillion of wealth is locked up in older people’s houses.

K. Friesen is a rare reader who agrees. She said a couple women in her family are proof of the benefits of deploying home equity. Thanks to a reverse mortgage, her aunt had “a roof over her head until she died at age 97,” Friesen wrote in a comment posted to “Tapping Home Equity – Retirees’ Relief Valve.” The article described a study demonstrating that using home equity is effective in reducing financial hardship.

Now Friesen’s mother has a reverse mortgage. “If she can squeeze every dime out of the little she has to have a better quality of life, I’m all for it.”

The advantage of reverse mortgages is that they don’t have to be paid back before the homeowner dies – the catch is that the borrower must continue to live in the house. A potential downside, as a reader noted, is that if a retiree has to sell the house and pay the loan back, the balance and accrued interest will have depleted equity.

But in fact, selling in retirement is an unlikely scenario. Nearly three out of four older workers either don’t move out of their current home or, when they retire, they sell their house, buy a new one, and stay put, according to research featured in “Most Older Americans Age in their Homes.”

Granted, these homeowners tend to be healthier than the older people who move around more. But Paul Brustowicz said even retirees who have health issues want the same thing as everyone else: to age in their own homes. …Learn More

Research

May 25, 2021

Every year, older homeowners leave billions of dollars worth of the wealth locked up in their houses to their adult children.

This is a paradox if one considers that home equity is one of retirees’ primary assets and could be a crucial source of income for people who are “house rich and income poor.” Retirement experts searching for an explanation have long wondered whether the deceased had intended to leave the house to family or simply died before they were able to cash in on the equity and spend it.

A new study has an answer: retirees have every intention of letting family members inherit their homes. The people in the study who expressed a stronger desire to leave an inheritance of at least $10,000 were much less likely to sell their homes before they died – with the intention that the house would be part, if not all, of that inheritance.

The foundation for this study is a precise estimate of the housing decisions being made in the final two years of life from a survey of older Americans. The researchers counted as many people as possible, including the deceased – their final living status came from interviews with next of kin – as well as people who continued to be homeowners after going into hospice or a nursing home.

The homeownership rate in the older population peaks around age 70 and starts falling precipitously after 80. But when the elderly in the study died, about half of them still owned their homes, while the other half had sold them and moved into rental housing.

At younger ages, the retirees had been asked to estimate the probability, from 0 (no chance) to 100 (definitely), that they would leave a financial inheritance. Based on this information, the researchers found that those who had said they had a high probability of leaving an inheritance remained in their homes.

There is also a financial advantage to the owner of not selling the house to avoid the capital gains tax, especially if the price appreciated dramatically during their lifetimes. The researchers didn’t account for this incentive in their analysis.

But they did find that the desire to leave a bequest is so compelling that parents held on to their homes even after predicting they might need to pay for nursing home care within a few years. …Learn More