Health Insurance for Americans Approaching Age Sixty-five: An Analysis of Options for Incremental Reform

Abstract

This article provides a systematic evaluation of the options for incremental health insurance reforms aimed at older Americans nearing age sixty-five. It presents three basic arguments for giving special consideration to this age group: (1) early retirement and its effect on access to employer insurance; (2) changes in health and health care expenses associated with increasing age; (3) the vulnerability to unexpected economic or health "shocks" that will affect people throughout their retirement. The analysis of policy options begins by specifying criteria for evaluating alternative approaches to reform. The proposed criteria emphasize that reforms for this age group should be designed to fit with other financial plans and decisions made during such a transitional stage of life. Policy options should be judged according to fundamental goals such as equity and efficiency, not simply ranked according to the number of uninsured who will gain coverage. After offering a comprehensive catalog and evaluation of available options, the analysis identifies and discusses a preferred approach-which preserves choices while offering universal and subsidized access to Medicare before age sixty-five.

Health Insurance Coverage and the Risk of Decline in Overall Health and Death Among the Near Elderly, 1992–2002

“…20,[45][46][47] The situation appears to be one of "Pay me now or pay me later": pay for expanded coverage of the near elderly or pay higher costs later when people enter Medicaid or Medicare coverage in worse health than they would have been. Hadley and Waidmann 44 estimated that Medicare and Medicaid would spend approximately $19 billion less on care for newly enrolled aged beneficiaries over their first 5 years of coverage if they were continuously insured over the 8 years prior to entering Medicare, even after accounting for the fact that more of the uninsured would live to reach Medicare.…”

Changes in health for the uninsured after reaching age-eligibility for medicare

“…27 One proposed option is to allow uninsured individuals to buy-in to Medicaid or Medicare with the help of government subsidies for the poor and near-poor. 28 Hadley and Waidman 7 estimated that Medicare and Medicaid would spend approximately $19 billion less on care for newly enrolled aged beneficiaries over their first 5 years of coverage if they were continuously insured over the 8 years before entering Medicare. This estimate of the benefits of expanded coverage only includes direct medical costs, whereas the indirect benefits of improved health are likely to be far larger.…”

A meta‐analysis of the relationships of age and tenure with innovation‐related behaviour

“…To date, researchers have examined whether or not older workers contribute as much to organizational productivity as younger workers do (Ng & Feldman, ), the influence of age discrimination on older workers in recruitment and selection (Avolio & Barrett, ; Perry, Kulik, & Bourhis, ), the prevalence of negative age stereotypes in older workers' performance evaluation and career development experiences (Maurer, ; Schwab & Heneman, ), and other issues related to retirement decisions (Feldman & Beehr, ), health care benefits and pension funds (Short, Shea, & Powell, ), and bridge employment (Gobeki & Beehr, ). In addition, as older workers are less likely to change organizations over time and thereby accumulate more years of work experience with one employer, researchers have paid increasing attention to the effects of long organizational tenure on job performance, too (Ng & Feldman, ; Sturman, ).…”