@article {11479, title = {The Hidden Role of Racial Wealth Disparities in Older Adults{\textquoteright} Vulnerability to COVID-19}, journal = {Research Square}, year = {Forthcoming}, abstract = {Background: To examine racial and ethnic differences in wealth and other economic, exposure and baseline health-related risks of COVID-19 among older adults in the U.S. Methods: Using rich data on wealth and long-term care use among older Americans unique to the 2016 Health and Retirement Study, we quantify differences in COVID-19 vulnerability among non-Hispanic white, non-Hispanic Black and Hispanic respondents aged 50+. We measure wealth, other economic (insurance, income); exposure (long-term care, employment, telework, household size); and health (chronic conditions, smoking) risk stratified by age (50-64, 65+). Results: Blacks and Hispanics face dramatically greater financial risk that potentially increases exposure to COVID-19, relative to whites; Blacks and Hispanics are four to five times more likely to have no financial wealth. Blacks are also more likely than whites to use long-term care. Blacks and Hispanics also are less likely to have health insurance and face greater risk of exposure to COVID-19 because they are less likely to telework, and Hispanic older adults reside in larger households. Black and Hispanic older adults are also more likely to have a chronic condition associated with worse COVID-19 outcomes. Conclusions: Our results suggest that wealth differences may play a substantial role in contributing to the very large racial and ethnic disparities in the health burden of COVID-19. Racial disparities in long-term care, where COVID-19 risks are higher, contribute to make older Black Americans even more vulnerable to COVID-19.}, keywords = {COVID-19, Racial wealth disparities}, isbn = {2693-5015}, doi = {10.21203/rs.3.rs-271452/v1}, author = {Ruth Winecoff and Padmaja Ayyagari and Melissa McInerney and Kosali I. Simon and M Kate Bundorf} } @article {10978, title = {ACA Medicaid Expansion Associated With Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence From the Health and Retirement Study}, journal = {Inquiry : a journal of medical care organization, provision and financing}, volume = {57}, year = {2020}, abstract = {The Affordable Care Act (ACA) dramatically expanded health insurance, but questions remain regarding its effects on health. We focus on older adults for whom health insurance has greater potential to improve health and well-being because of their greater health care needs relative to younger adults. We further focus on low-income adults who were the target of the Medicaid expansion. We believe our study provides the first evidence of the health-related effects of ACA Medicaid expansion using the Health and Retirement Study (HRS). Using geo-coded data from 2010 to 2016, we estimate difference-in-differences models, comparing changes in outcomes before and after the Medicaid expansion in treatment and control states among a sample of over 3,000 unique adults aged 50 to 64 with income below 100\% of the federal poverty level. The HRS allows us to examine morbidity outcomes not available in administrative data, providing evidence of the mechanisms underlying emerging evidence of mortality reductions due to expanded insurance coverage among the near-elderly. We find that the Medicaid expansion was associated with a 15 percentage point increase in Medicaid coverage which was largely offset by declines in other types of insurance. We find improvements in several measures of health including a 12\% reduction in metabolic syndrome; a 32\% reduction in complications from metabolic syndrome; an 18\% reduction in the likelihood of gross motor skills difficulties; and a 34\% reduction in compromised activities of daily living (ADLs). Our results thus suggest that the Medicaid expansion led to improved physical health for low-income, older adults.}, keywords = {crowd-out, difference-in-differences, Health Status, Insurance Coverage, Medicaid, near-elderly adults, Patient Protection and Affordable Care Act}, isbn = {1945-72430046-9580}, doi = {10.1177/0046958020935229}, author = {Melissa McInerney and Ruth Winecoff and Padmaja Ayyagari and Kosali I. Simon and M Kate Bundorf} }