Dignity for All: Ensuring Economic Security as America Ages. A Senior Poverty Forum

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Randall Joshua Goodman
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1 Dignity for All: Ensuring Economic Security as America Ages A Senior Poverty Forum November 15, 2016

2 Panel 1:Understanding Low-Income Older Adults through Research and Data Moderator: Emily Allen, AARP Foundation

Ensuring Economic Security as America Ages Tricia Neuman, Sc.

3 Retirement Security for Older Americans Why Health Coverage Matters November 15, 2016 Justice in Aging Dignity for All: Ensuring Economic Security as America Ages Tricia Neuman, Sc. D. Director, Program on Medicare Policy Kaiser Family Foundation

4 Figure 6 More than 4 in 10 seniors live below twice the poverty level based on the SPM which takes health costs into account Poverty rates are higher under the Supplemental Poverty Measure (SPM) Official Poverty Measure (OPM) Supplemental Poverty Measure (SPM) 2015 Poverty Level $11,367/individual $14,342/couple 43% with incomes below 200% of the poverty threshold 25% with incomes below 200% of the poverty threshold 16% 29% 9% 14% Official Measure 100%-199% FPL Under 100% FPL Supplemental Measure SOURCE: Kaiser Family Foundation analysis of Current Population Survey 2015 Annual Social Economic Supplement.

5 Figure 7 Under the SPM, at least 35% of people ages 65 and older lived below 200% of poverty in every state and DC ( ) People Ages 65+ Below 200% of Poverty (SPM) = 45% Nationwide 43% 40% 40% 44% 40% 36% 50% 54% 42% 42% 45% 44% 54% 44% 38% 42% 51% 36% 42% 40% 44% 43% 41% 43% 44%44% 42% 42% 38% 39% 48% 52% 47% 38% 48% 46% 48% 44% 44% 51% 47% 52% 40% 46% 50% 49% 47% 46% 42% 47% DC 57% Less than 35% 35% < 50% 50% or higher 0 states 42 states 8 states + DC NOTE: SPM is supplemental poverty measure. Estimates are based on pooling three years of data. SOURCE: Kaiser Family Foundation analysis of Current Population Survey, 2012, 2013, and 2014 Annual Social and Economic Supplement.

6 Figure 8 Poverty rates rise with age, are higher for older women than men, and much higher for Black and Hispanic than White seniors Share of people ages 65+ with incomes below 200% of poverty, 2014: 57% 50% 45% 39% 41% 36% 60% 68% Men Women White Black Hispanic Age Gender Race/ethnicity SOURCE: Kaiser Family Foundation analysis of Current Population Survey 2014 Annual Social Economic Supplement.

Figure 9 Median income and savings are significantly lower for Black and Hispanic than White Medicare beneficiaries Median income per capita= $24,150 Median savings per

7 Figure 9 Median income and savings are significantly lower for Black and Hispanic than White Medicare beneficiaries Median income per capita= $24,150 Median savings per capita= $63,350 $91,950 $27,450 $16,150 $12,800 $12,350 $9,800 White Black Hispanic White Black Hispanic SOURCE: Urban Institute / Kaiser Family Foundation analysis of DYNASIM, 2014.

8 Figure 10 Health problems are more common among seniors with low incomes (below $15,000) Share of seniors age 65+ with health concern, by income Total <$15,000 >$15,000 47% 20% 32% 34% 29% 29% 39% 24% 14% Fair/poor health Functional impairment Cognitive/mental impairment NOTE: Income is calculated in a per person basis. For married couples, income is divided equally. SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey Cost and Use File, 2012.

9 Figure 11 Even with Medicare, medical costs consume a significant portion of seniors' budgets Medicare Household Spending Non-Medicare Household Spending Housing $12,468 35% Other $7,593 21% Transportation $5,277 15% Food $5,400 15% Health Care $5,342 15% Housing $17,855 33% Other $15,316 28% Transportation $9,479 Health 17% Care $3,511 7% Food $8,070 15% Average Household Spending = $36,080 Average Household Spending = $54,232 SOURCE: Kaiser Family Foundation analysis of the Bureau of Labor Statistics Consumer Expenditure Survey, 2014.

10 Figure 12 Premiums + Deductibles + Cost-Sharing + Gaps in Medicare benefits lead to affordability challenges Gaps in Coverage: No dental care, or dentures No hearing aids, eye glasses Part D donut hole until 2020; no hard cap on out-of-pocket drug costs No long-term care benefit (limited SNF and home health Other Expenses: MIND THE GAP Medicare premiums; deductibles and cost-sharing (with no outof-pocket limit) Premiums for supplemental insurance

11 Figure 13 Medicare premiums and cost-sharing are projected to continue to rise as a share of Social Security benefits 33% 24% 7% 14% Source: Social Security Trustees Report, 2015 Note: Includes Medicare SMI premiums and cost-sharing. Does not include other out-of-pocket health spending

12 Figure 14 About half of all Medicare beneficiaries ages 65+ with incomes below 200% FPL do not get low-income assistance with Medicare premiums/cost-sharing (Medicaid) 200% Poverty Threshold (2011): $22,968 (individual) $29,314 (couple) 49.5% Received low-income assistance (9.8 million) 50.5% Did not receive low-income assistance (10 million) Total Medicare Beneficiaries < 200% FPL, 2011 = 19.8 million in 2011 NOTE: Premium/cost sharing assistance refers to assistance under Medicaid/Medicare Savings Programs, but not Part D LIS. SOURCE: Kaiser Family Foundation analysis of CMS CCW, standard 5 percent sample of Medicare beneficiaries 2011, Urban Institute analysis of DYNASIM income and assets Census poverty thresholds from

13 Figure 15 Looking Forward: Key Issues How would ACA repeal affect low-income seniors and younger adults with disabilities on Medicare? What would a Medicaid block grant mean for lowincome beneficiaries dually eligible for Medicare and Medicaid?

14 Figure 16 Additional Resources on kff.org Old and Poor: America s Forgotten An Overview of Medicare Poverty Among Seniors: An Updated Analysis of National and State Level Poverty Under the Official and Supplemental Poverty Measures Income and Assets of Medicare Beneficiaries, Key Issues in Understanding the Economic and Health Security of Current and Future Generations of Seniors Comparing Poverty Rates under the Official Census Poverty Measure and the Supplemental Poverty Measure For more information, visit kff.org/medicare

15 Who Are Low-income Older Adults? Hidden Poor The Officially Poor and Hidden Poor Steven P. Wallace, PhD UCLA Fielding School of Public Health UCLA Center for Health Policy Research November 15, 2016

16 Acknowledgements Funding The California Wellness Foundation & others Partners Insight Center for Community Economic Development, Wider Opportunities for Women, University of Mass-Boston Gerontology Center Researchers D. Imelda Padilla-Frausto & others

17 Key points The federal poverty line (FPL) is inadequate Many older adults are economically insecure, with incomes above poverty but not enough for basic needs (the hidden poor) The health status of the hidden poor worsens the mismatch between resources and needs

18 FPL vs. Elder Economic Security Standard Index FPL 50 year old standard of living (CPI adjusted) Single national amount Based on consumption of average family Same amount whether renter or owner of home Elder Index Current standard of living County level Uses costs of basic goods and services needed by average older adult (e.g. higher health care costs) Varies by type of housing

19 Any problem poverty = $11,880 in 2016 everywhere?

20 Housing Costs Vary Geographically HUD Fair Market Rents, br apartment San Francisco, CA $1,814 New York, NY $1,357 Los Angeles, CA $1,154 Chicago, IL $1,001 Atlanta, GA $ 820 Houston, TX $ 773 Des Moines, IA $ 682 See:

Rent 42.4% 42.9% 24.9% Own, paying mortgage 23.1 22.

21 Housing type varies, U.S., age 65+, <200% FPL Latino African American white Rent 42.4% 42.9% 24.9% Own, paying mortgage Own w/o mortgage Source: American Community Survey,

22 Distribution of household expenditures, and over Other Food Housing Transportation Healthcare Personal insurance and pensions Source: 2015 Consumer Expenditure Survey

23 Alternative to FPL: Elder Economic Security Standard Index (Elder Index) Health care costs Housing (3-types) Food (at home) costs Transportation, local Misc. (phone, clothing, home repair, etc.)

24 Elder Standard Index 2013 LA City & Humboldt County Los Angeles City Humboldt County Monthly Expenses Owner w/o Mortgage Renter, One Bedroom Owner w/o Mortgage Renter, One Bedroom Housing $544 $1,171 $372 $715 Food Transportation Health Care=Good Miscellaneous Elder Index Per Month $1,448 $2,075 $1,461 $1,804 Elder Index Per Year $17,376 $24,900 $17,532 $21,648 Note: Numbers may not add up to total due to rounding.

25 Gap in Measuring Economic Need, Elder Index vs. FPL, California average 2013 $34,560 $23,112-11,622 $17,976 $11,490 EI, Owners w mortgage EI, Renters EI, Owner wo mortgage FPL

Who is overlooked by FPL? http://healthpolicy.ucla.

26 Who is overlooked by FPL?

27 Elder Index by Race/Ethnicity, Families Headed by Ages 65+, California, % 52.4% 51.0% 70.3% 36.2% 31.3% 28.9% 19.5% 16.3% 20.1% 21.8% 7.8% Latino African-American* Asian* White* < 100% FPL 100 FPL-Elder Index (Hidden Poor) Above Elder Index * NonLatino

28 Health Issues of Hidden Poor

29 50. 0% 45. 0% 40. 0% 35. 0% 30. 0% 25. 0% 20. 0% 15. 0% 10. 0% 5.0 % 0.0 % Fair & Poor Health by Elder Index, Singles & Couples, Ages 65+, California, % 33.9% 17.5% < 100% FPL 100% FPL-Elder Index (Hidden Poor) Axis Title Source: California Health Interview Survey Above Elder Index

30 12. 0% 10. 0% 8.0 % 6.0 % 4.0 % 2.0 % 0.0 % Depression* by Elder Index, Singles & Couples, Ages 65+, California, *Self reports feeling depressed some, most, or all of the time in past month 10.2% 10.6% 3.4% < 100% FPL 100% FPL-Elder Index (Hidden Poor) Axis Title Source: California Health Interview Survey Above Elder Index

31 30. 0% 25. 0% 20. 0% 15. 0% 10. 0% 5.0 % 0.0 % Difficulty Obtaining Timely Medical Care by Elder Index, Singles & Couples Ages 65+, California, % 22.2% 11.9% < 100% FPL 100% FPL-Elder Index (Hidden Poor) Axis Title Source: California Health Interview Survey Above Elder Index

32 30. 0% 25. 0% 20. 0% 15. 0% 10. 0% 5.0 % 0.0 % Diagnosed with Diabetes by Income, Singles & Couples Ages 65+, California, % 27.0% 14.9% < 100% FPL 100% FPL-Elder Index (Hidden Poor) Source: California Health Interview Survey Axis Title Above Elder Index

33 80. 0% 70. 0% 60. 0% 50. 0% 40. 0% 30. 0% 20. 0% 10. 0% 0.0 % Diabetics Reporting Management Plan by Income, Singles & Couples Ages 65+, California, % 66.7% 81.2% < 100% FPL 100% FPL-Elder Index (Hidden Poor) Source: California Health Interview Survey Axis Title Above Elder Index

34 71. 0% 69. 0% 67. 0% 65. 0% 63. 0% 61. 0% 59. 0% Flu Shot last year by Income, Singles & Couples Ages 65+, California, % 63.5% 65.9% < 100% FPL 100% FPL-Elder Index (Hidden Poor) Source: California Health Interview Survey Axis Title Above Elder Index

35 Policy Solutions Improve incomes of low-income older adults Improve access to affordable housing Improve access to food, health care, transportation

We must accurately identify those who are economically insecure (Elder Index) 3.

36 Conclusions We can not ignore economic insecurity among older adults 1. Economic insecurity is common in among older adults 2. We must accurately identify those who are economically insecure (Elder Index) 3. The health care needs of the hidden poor are high & services don t match need 4. We should provide the supports needed to live a minimal decent life after all that our seniors have contributed during their lifetimes

37 Thank You!!

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