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Every non-profit or academic institution focused on aging in America (e.g. AARP, Older Women’s League, American Society on Aging, etc.) supports the American Care Act. It’s great news that the Supreme Court ruled the law was constitutional. With this ruling, insurance companies will no longer be able to deny coverage, or charge more because of a pre-existing condition, or force women to pay higher premiums than men. Preventive care will continue to be covered at no cost, and seniors will continue to save money on prescription drugs (5.3 million Medicare Part D beneficiaries have already saved $3.7 billion on prescriptions since the law was enacted).

The ACA is a major step toward ensuring affordable and quality health coverage for millions of working families, elders, and children. Therefore, it is surprising to me that many Americans don’t believe the ACA will help them. A Kaiser Family Foundation report found that people believe young adults and children are likely to benefit from the new law, but not themselves or their families. Thirty-seven percent of respondents felt the law will make no difference in their lives, thirty-one percent felt they will be worse off.

Where are these answers coming from? Is it that a case being brought to the Supreme Court is enough to reduced people’s opinions of the law? Who are the individuals against the ACA…do they understand the implications for American’s health system and the American people’s well-being?

The ACA is in no way perfect, but many of the laws are designed specifically to help older people acquire and pay for comprehensive health care. An AARP article lists the number of ways the law supports older adults:

  • Insurance companies cannot drop you if you become sick or disabled
  • They cannot have lifetime dollar limits on your coverage
  • Medicare recipients receive annual wellness visits, preventive services, and immunizations at no additional cost
  • As mentioned, people with Medicare Part D now receive discounts on prescription drugs while in the doughnut hole. The Part D discounts will gradually increase until 2020, when the doughnut hole will close
  • In 2014, insurers can no longer deny coverage if you have a preexisting condition
  • In 2014, insurance “exchanges” will provide better access and options to self-employed people, small businesses and others who are unable to find affordable coverage

The Supreme Court’s decision is a significant move in the right direction. It will help the United States build a health care plan for our future that is on par with what other developed nations provide already: Affordable health care coverage as a right, not a privilege.

The Older Women’s League has come out with their 2012 Mother’s Day report. Their reports are always thorough, up-to-date, and readable. This year the topic is on women in the U.S. workforce and highlights what women are faced with as they grow older. As OWL’s president mentions in her message to readers, this is a timely report since mid-life and older women are the fastest growing segment of our workforce and the economic downturn presents new challenges in their ability to find work, keep their jobs, and build their retirement wealth.

Women and the Workforce: Challenges and Opportunities Facing Women as They Age

MDR2012

From the OWL National Website: “This year’s report looks at how factors such as unemployment and underemployment, pay inequality, caregiving, age and gender discrimination, and education, training, and technology are impacting women age 40 and older. The report highlights existing programs that produce real results and offer innovative solutions and policy-driven recommendations to expand economic diversity and accelerate our nation’s productivity.”

Last week I was asked to present high school students with information on women in the workforce and saving for retirement. One of my major goals was to instill the value of starting early. But I had the sense, maybe because I’m not too far from high school age myself, that my slides about compound interest and Roth IRAs would be particularly boring.

Rather than watch their eyes glaze over I added a new slide: A personal story about my mother, her life course, marital history and saving behavior. I wasn’t saying anything novel but by explaining compound interest this way I kept everyone’s attention. So, I encourage you to share this with the young people in your life and reflect on what it really means to save early and save often.

(For simplicity, the interest rate at all time points is 5%. In actuality, she gained more during her earlier life and has lost a lot during the recent recession).

This figure tells us two stories. Let’s begin with the story in blue, which is what really happened. At age 21, my mom got married and started working a new job. She was so excited to finally have her own money and be able to buy all the clothes she wanted and decorate their new house. My dad, however, didn’t think this was a good plan and told her, “Save your money! We both should be saving now for our future.” Reluctantly she saved, putting $2,000 away each year for her retirement. By the time her first child was born (me!) she had saved up $20,000.

In her 30’s she had another baby and raised my sister and me. She was not working or saving at this time but her $20,000 continued to grow. By 42 her marriage was on the rocks and she became divorced. Now, all that planning for her future had to be done alone. She spent a couple years searching for a new job and struggling with the change. Even so, the savings from her 20’s continued to grow. By 45 she found a new job and started her career over. She was getting nervous about her retirement savings and started putting away $5,000 a year. The savings from her new job were added the nice nest egg she had accumulated while she wasn’t working. The final blue bar shows an optimistic future where she continues to save each year, the economy improves and hopefully she reaches over $300,000 by retirement.

What is the reality of saving? Well, you can’t always save when you want to or need to and it’s hard to predict the future. For example, my mom couldn’t predict that we’d be in an economic recession right at the time most people her age start saving for retirement. The green bars show us what this path would look like for her. Nothing in her life has changed except that she didn’t save in her 20’s. Instead she chose to ignore my dad’s suggestion and spend her money on clothes, new furniture and all the other things she wanted. The message is clear: Saving early, even if it’s just a little, makes a huge difference for your future.

I can tell you honestly that most of my mom’s friends are extremely worried about their futures. They are in their 50’s, starting to save now and having a difficult time. She knows, though she hates to admit it, my dad was right.

The 2011 OWL Mother’s Day report  starts with a very strong statement: “Health care for all is a women’s issue…” Why would this be? Men also need and use our health system. Yet, the case is made for how women’s lives are affected by health care coverage or a lack there of. Women play a large role in managing care for sick family members, most often providing this care themselves. Widows can often be left impoverished if their husbands’ chronic illnesses dwindled savings accounts and assets. In late life, women find themselves 60% more likely to need help with basic daily activities (i.e. eating, dressing, bathing) compared to men. This paints a picture in our minds: Grandma spent her 60’s and 70’s caring for grandpa. He had heart problems and diabetes but she made sure he took his medications, got to his appointments, and was cared for till the end. Now in her 80’s, grandma finds herself sick, poor and alone in a big, empty house. Since women’s life expectancy continues to exceed that of men’s, this story is all too familiar.

“After a lifetime of caring for others, older women often need affordable care but find that the costs are high and their options are severely limited.” I’ve described to you a common late-life situation for women. Let’s keep this image in our minds as we discuss how the Affordable Care Act (ACA) aims to support Americans as they age. People, like grandma, find themselves skipping preventative services because Medicare requires them to pay a 20% co-payment. This cost is found to be a disincentive for approximately half of Medicare beneficiaries who do not use preventative services available to them.  Grandma lives on a fixed income of $1,000/month from Social Security (the average benefit is $1,177) and this means that paying a $30 co-pay to see her doctor gives her $30 less for grocery shopping that month. She isn’t feeling sick, so she prefers to spend the money on food. This begs the question: Should she have to make that choice?

 
The good news is changes to our health care system are happening over the next few years and should support people in old age. Below I’ve highlighted some of the changes but please read the full report or see this great summary of the Health Reform Law from the Kaiser Family Foundation for more details.

Health Insurance Reforms

  • Medicaid will be expanded to cover 16 million Americans (all legal residents up to 133% of the federal poverty level will be eligible)
  • Retroactive cancelling of insurance because of accidents or sickness, denying coverage because of pre-existing conditions, and basing premiums on health status, gender and genetics will all be prohibited
  • Insurance companies must devote at least 80 – 85% of premium dollars received to medical benefits and quality improvement and they must provide justifications for any excessive rate increases, making this information available to consumers

Medicare

  • People who reach the “donut hole” on prescription drug coverage will get a large discount on drugs and biologics and this discount will grow each subsequent year.  The hole will be closed in 2020
  • Beneficiaries will receive a free annual exam, free flu and pneumonia shots, and any covered service that is given a grade A or B by the U.S. Preventive Services Task Force must be provided at no cost
  • Medicare payments will be reduced for hospitals that have high HAC rates (hospital-acquired conditions) and incentives will be provided to hospitals that improve their transitional care and partner with community services to reduce readmission rates

Long-Term Care 

  • The Community Living Assistance Services and Support (CLASS) Act will provide a voluntary long-term care insurance program available to all working Americans. When an individual becomes eligible and needs long-term care services an average cash benefit of $50/day will be given to help them pay. Beneficiaries have control over their own care, so this includes paying family or friends who provide help at home.
  • Home and Community Based Services (HCBS) aim to provide a network of services within state and local areas to meet the needs of elders aging in place. A new protection called under HCBS will attempt to prevent “spousal improverishment” by only counting the ill spouse’s income when determining eligibility.
  • Nursing home care will be improved as the ACA aims to make the system, procedures, staffing and care more transparent and regulated. The Elder Justice Act is a part of this, in an attempt to identify and prevent elder abuse.

In the United States everyday people are providing 85% of needed long-term care for their family members and friends. These roles are generally unpaid and at the expense of their own careers, health, and well-being.  Rather than creating a health system that works, we have created a system that to a large extent depends on informal caregivers yet still costs us 17% of GDP.  The ACA is not a perfect system and will not be fully up and running for a few years. Still, it is a step in the right direction and will expand coverage to 95% of the population and support those who care for the people they love.

If you find yourself bombarded with mixed messages or feeling confused about the new health care changes, I encourage you to at minimum read the OWL Mother’s Day report’s appendix. Here the authors address a number of major myths about the Affordable Care Act and answer some common questions about the policies and coverage.

2010 saw the passing of the Elder Justice Act (EJA), the most comprehensive federal elder abuse law in U.S. history. We know from earlier studies that roughly 11 to15% of people ages 60 and older face some form of elder abuse each year. Experts agree this number is under-reporting and the scope of the problem is larger than we realize. According to a 2008 study by the Metlife Mature Market Institute et al., the perpetrators of elder financial abuse are typically not strangers. They are often businesses, service providers, family and friends who have gained the trust of the older adult. Here are some interesting findings:

  • The victims of elder financial abuse are losing a combined total of $2.9 billion dollars annually.
  • Women are twice as likely to be victims of financial abuse as men. Most of these women are age 80-89, living alone, and requiring some help in the home or with their health care.
  • Nearly 60% of the perpetrator were men, mostly aged 30-59.
  • The amount of money stolen by family or friends increased during the holidays.

Recently the researchers at MetLife updated these numbers, discovering that elder financial abuse cases have risen 12% since 2008. Though instances are increasing, data suggests that only one out of 43.9 financial exploitation cases are reported. Unfortunately the newly passed EJA can do nothing without the support of Congress and the President. Currently the Act only provides Congress with the authority to spend up to $777 million over the next four years on elder abuse. To actually see the money used, however, a separate bill must be passed by Congress and signed by the President.

Until this can get sorted out, and the EJA can strengthen existing adult protective services (APS), here are ways the report says you can watch out for yourself:

  • Stay Alert – Don’t leave valuable items, cash, or checkbooks out in the open. Don’t be left out of decisions about your finances. Don’t sign anything without reading first and having someone you trust review it. If you are a concerned family member, be sure to ask periodically about the elder’s financial situation and keep an eye out for changes in their behavior (i.e. sudden worry about money) and any other sudden financial changes or unusual expenses.
  • Stay Organized – Keep track of possessions, mail, and checking and savings account balances. Know who is calling and use an answering machine or caller ID to screen calls. Know who is asking for personal information and why (never provide this over the phone!)
  • Stay Informed – Know where to go if you suspect abuse (your local APS, the police, or get help from bank employees). Talk to an attorney and keep track of your will, future caregiving arrangements and power of attorney.
  • Report Abuse – Anyone (e.g. elder, family member, physician, bank teller, etc.) suspecting elder abuse should be reporting it to the local APS. Reports can be made confidentially and reporters are protected from civil and criminal liability. It is always better to err on the side of caution.

The Elder Justice Act comes almost 40 years after the passage of the Child Abuse and Neglect Prevention Act. Congress, and the general public, see the value in protecting vulnerable children from abuse and today we spend upward of $7 billion to help this effort. Surely vulnerable older adults deserve the same protection.

Employment over one’s life time is rarely with a single company. Individuals often change jobs or employers over their working years. People leave to have children, to go back to school, or to try their hand at running a business.  All these changes in employment could confuse retirees trying to determine what pensions they are entitled to. And let’s be honest, who couldn’t use an extra $100 a month.

For New England residents there is a free resource that I’d love to share with you. The Pension Action Center was launched in 1999 and is based out of the University of Massachusetts Boston. Its primary program, the New England Pension Assistance Project, brings together pension experts, pension lawyers and a group of dedicated, knowledgeable volunteers to help you understand or obtain your pension benefits.

As their website states, the goals of the Center are to:

• offer individual counseling and assistance
• help you negotiate layers of bureaucracy
• help locate pension funds
• explain the benefits and rights under your pension plan
• supply referrals to attorneys if needed
• supply a listing of financial advisers if needed

The Pension Action Center complied this informative booklet in 2009 to help retirees answer a few burning pension questions. Am I entitled to a pension from my former employer or my spouse’s former employer? Where do I start looking? What documents will I need to understand my situation? What resources are available in my state? I think I have a lost pension, now what?

Employers are not required to provide a pension, so everyone’s results will be different. But now more than ever it is important to make sure you are getting all the benefits you are entitled to from your years of hard work. Check out the booklet to read more or contact the Center if you’d like to talk to someone directly. No one should be missing out on their much needed and well deserved retirement income.

The New England Pension Assistance Project
Phone: (617) 287-7307 or toll free (888) 425-6067
Fax: (617) 287-7080
E-mail: npln@umb.edu

While I was reading an article for class on international comparisons of long-term care I noticed little was mentioned on women specifically. We are aware that women live longer and utilize more long-term care services then men, in addition to being more likely to be the provider of care regardless of whether it is formal or informal. I found a few short articles looking at this topic. One is an issue brief by the Kaiser Family Foundation looking at Medicaid’s Role for Women and examining long term care as well. The second is an AARP Fact Sheet specifically focusing on Women and Long-Term Care.

The Kaiser Issue Brief sets the stage for our discussion. It discusses how most people with disabilities receive Supplemental Security Income (SSI) and therefore qualify for Medicaid since they are already deemed to have a severe disability. The other way to qualify is to “spend down” assets to meet the state’s income threshold and obtain Medicaid coverage. This is essentially making people spend away all income and assets, pushing themselves into poverty before the government will give assistance. Lastly, in some states if medical expenses are very high they may meet the state’s “medically needy” income standard and be eligible for Medicaid. The issue brief tells us that over 4 million low-income elderly women have Medicaid paying for their long-term care services. This is no surprise as women comprise the majority of seniors on Medicaid (70%), they live longer than men, and are disproportionately poorer. Women live longer then have a higher rate of chronic illnesses and disability than men, obviously translating to some required long-term care. The article tells us that nearly 75% of nursing home residents and 66% of people receiving home health care are women. This costly expense may be devastating for these older women on fixed incomes. It is common for the husband to go through a costly illness and pass first, leaving the widow behind with what is left of their assets. She cared for him during his illness and saw to his long-term care needs, utilizing their funds as necessary. However, she is now left with little funding and no one lives with her to provide care if she starts to lose daily functioning. It is a blessing for those few women who have family or friends who can act as caregivers.

The AARP fact sheet goes into more detail about the major challenges women face as they get older, but this article also addresses the fact that women are also the primary providers of long-term care in both the formal and informal settings. Almost 66% of formal and informal caregivers are women. AARP addresses the issue of payment and that a major factor affecting income is marital status. We know, partly because men do not live as long, that almost 70% of women over age 75 are divorced, widowed, or never married. Only about 30% of men over 75 are in this category. This difference in marital status greatly affects the number of women who live alone. Statistics also show that these women living alone are on average more likely to have a lower income than men living alone or couples.

An interesting thing to mull over is the treatment of these women care providers. Currently there is no payment, pensions, or tax break for these women. Therefore it is perpetuating the long-term care system. More than 60% of women caregivers who were employed made sacrifices at work that ranged from cutting hours, refusing promotions, losing benefits, taking a leave of absence, working late or unusual hours, or choosing an early retirement. All of these resulted in one major change in the woman’s life; lower income. Not only are they unable to accumulate as much income as they could have had they no caregiving responsibilities, but they are also loosing Social Security income, and benefits like health insurance coverage if they choose early retirement or cut hours below a 40 work week (where many jobs do not provide benefits for part-timers). All of these sacrifices also lead to less possible savings for the future. They will most likely not have the income for a CCRC or home care, so when they are in need of long term care they too will need the help of a family member. Most likely another woman who is taking time off work to help. Moreover, we cannot forget the formal caregivers which are made up of almost 90% women, who are getting low pay, uneven hours, and often few benefits. Many employers even hire these caregivers on on-call schedules making it difficult for the provider to plan for her future.

I honestly don’t know what to do about this gender-based issue, but it is clear from my readings in class that no one is really talking about the long-term care crisis’ impact on this sex and the vicious cycle this system has them in. At least can we have some discussion on the subject?

The retirement income system affects women differently and often negatively. The three-legged stool is often used to describe the sources of income one can expect to receive in retirement. The three aspects of the stool model, government benefits, employer-based pensions, and personal savings, make up this retirement system. Women, unfortunately, have a disadvantage in these three elements of retirement income.

When it comes to government benefits, Social Security was established when women were scarce in the workplace. Therefore, a woman did not receive her own benefits in old age. Instead, her income was based on her husbands, receiving 50 percent of his PIA if she is married to him or divorced, as long as the marriage lasted 10 years. If the woman worked, she must decide between receiving her own benefit or the 50 percent of her husbands, not both. Technically speaking, the spouse receives their own benefits and then if this is less than the benefit they would be receiving from the spousal benefit, the difference is awarded. If the widow is at full retirement age they will receive full benefits of the insured worker. The issue here is that before the death of the loved one, 150 percent of benefits were coming in daily. Now the widow is reduced to 100 percent which may or may not allow them to keep to the old budget. Also, the woman has a much greater risk of lost benefits following a divorce in a one-earner family. In addition, the average woman who does work, more often than the average man, will take time off to raise children. As we know from the way Social Security benefits are calculated, this will hurt the woman’s eventual benefit because of fewer years on the job, lower earnings, and more frequent job changes.

Additionally, the dual-entitlement rules of the system often impose a sort of penalty on wives and widows of a two-earner couple. Two-earner couples receive less in total benefits than the one-earner couple because each can only claim their own PIA or a spouse benefit based on their partner’s. The two-earner couple may pay the same in taxes as the single worker and the one-earner couple, but will receive more benefits than the single worker and less than the one-earner couple. And when a death occurs the disparity is greater for the widow. As mentioned before the one-earner couple received 150 percent while both are living, and the survivor receives 100 percent which is 2/3 of the benefit. In a two-earner couple, the survivor receives the benefit based on the higher PIA paid to the two workers, thus receiving only ½ of the benefit. Clearly this needs to be changed because the survivor is often a woman who is living off of only half the benefit received prior to the spouse’s death, since nowadays most couples are two-earner. Many women go into poverty in old age and some have pointed to this policy issue as part of the cause.

When looking at the other legs of our retirement stool, women on average have lower savings and fewer pensions. Some of the same reasons listed above that result in women having lower Social Security benefits also influence their pension benefits. Women, on average, have pensions that are much lower than men’s and this is probably due to fewer or scattered years on the job, too many job changes, and making less money. As one can surmise, these influence savings rates as well. Another difference for women is related to annuities. Private insurance annuities generally charge women as a class more money because historically women live longer than men. Holding all other factors constant, women can expect to receive more lifetime benefit than men. Therefore, even though this is a supposed gender-neutral system, it is not really fair because the average woman gets a net transfer at the expense of the average man. Policies must be created to try and erase the disparities women face in the three-legged retirement stool.

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