@article {https://doi.org/10.1002/aepp.13229, title = {The long-run prevalence of food insufficiency among older Americans}, journal = {Applied Economic Perspectives and Policy}, volume = {44}, year = {2022}, pages = {575-590}, abstract = {The prevalence of food insufficiency among seniors in any given year is well-documented, but the prevalence of this hardship over a longer time period in later life is unknown. Using panel data from the Health and Retirement Study, I find that about 8\% of seniors report food insufficiency over a 2-year recall window, while 22\% experience it at some point over the two decades of their 60s and 70s. Food insufficiency is not concentrated among a small group of persistently disadvantaged elderly, but is instead a surprisingly common feature of the later life course.}, keywords = {Aging, Food insecurity, food insufficiency, hardship}, doi = {https://doi.org/10.1002/aepp.13229}, author = {Helen G Levy} } @article {13507, title = {The Long-Run Prevalence of Food Insufficiency among Older Americans.}, journal = {Applied Economic Perspectives and Policy}, volume = {44}, year = {2022}, pages = {575-590}, abstract = {

The prevalence of food insufficiency among seniors in any given year is well-documented, but the prevalence of this hardship over a longer time period in later life is unknown. Using panel data from the Health and Retirement Study, I find that about 8\% of seniors report food insufficiency over a two-year recall window, while 22\% experience it at some point over the two decades of their sixties and seventies. Food insufficiency is not concentrated among a small group of persistently disadvantaged elderly, but is instead a surprisingly common feature of the later life course.

}, keywords = {Food insecurity, food insufficiency, hardship}, issn = {2040-5790}, doi = {10.1002/aepp.13229}, author = {Helen G Levy} } @article {11670, title = {Changes in Health Care Access and Utilization for Low-SES Adults Age 51-64 after Medicaid Expansion.}, journal = {The Journal of Gerontology: Series B}, volume = {76}, year = {2021}, pages = {1218-1230}, abstract = {

OBJECTIVES: Whether the Affordable Care Act (ACA) insurance expansions improved access to care and health for adults age 51-64 has not been closely examined. This study examined longitudinal changes in access, utilization, and health for low-socioeconomic status adults age 51-64 before and after the ACA Medicaid expansion.

METHODS: Longitudinal difference-in-differences (DID) study before (2010-2014) and after (2016) Medicaid expansion, including N=2,088 noninstitutionalized low-education adults age 51-64 (N=633 in Medicaid expansion states, N=1,455 in non-expansion states) from the nationally representative biennial Health and Retirement Study. Outcomes included coverage (any, Medicaid, private), access (usual source of care, difficulty finding doctor, foregone care, cost-related medication nonadherence, out-of-pocket costs), utilization (outpatient visit, hospitalization), and health status.

RESULTS: Low-education adults age 51-64 had increased rates of Medicaid coverage (+10.6 percentage points [pp] in expansion states, +3.2 pp in non-expansion states, DID +7.4 pp, p=0.001) and increased likelihood of hospitalizations (+9.2 pp in expansion states, -1.1 pp in non-expansion states, DID +10.4 pp, p=0.003) in Medicaid expansion compared with non-expansion states after 2014. Those in expansion states also had a smaller increase in limitations in paid work/housework over time, compared to those in non-expansion states (+3.6 pp in expansion states, +11.0 pp in non-expansion states, DID -7.5 pp, p=0.006). There were no other significant differences in access, utilization or health trends between expansion and non-expansion states.

DISCUSSION: After Medicaid expansion, low-education status adults age 51-64 were more likely to be hospitalized, suggesting poor baseline access to chronic disease management and pent-up demand for hospital services.

}, keywords = {Affordable Care Act, Hospitalization, Medicaid, Retirement}, issn = {1758-5368}, doi = {10.1093/geronb/gbaa123}, author = {Tipirneni, Renuka and Helen G Levy and Kenneth M. Langa and Ryan J McCammon and Zivin, Kara and Jamie E Luster and Karmakar, Monita and John Z. Ayanian} } @article {11344, title = {The Risk of High Out-of-Pocket Health Spending among Older Americans}, number = {MRDRC WP 2020-409}, year = {2020}, institution = {Michigan Retirement and Disability Research Center, University of Michigan}, address = {Ann Arbor, MI}, abstract = {Traditional Medicare imposes significant cost-sharing on beneficiaries. Most but not all beneficiaries obtain supplemental insurance through Medigap, Medicare Advantage, Medicaid, or employer-sponsored retiree coverage, which may vary in how well they protect against the risk of high spending. This paper uses data from the Health and Retirement Study for the years 2002 through 2016 to document how supplemental coverage for Medicare beneficiaries 65 and older has changed over time, and to estimate the distribution of out-of-pocket spending for enrollees with different coverage types. I find that the shares of beneficiaries with employersponsored supplemental coverage or Medigap declined between 2002 and 2016, whereas the shares with Medicare Advantage or no supplemental coverage for doctor and hospital bills have increased. The majority of those with no supplemental coverage for doctor and hospital bills have Medicare Part D, which covers prescription drug expenses. I find that all supplemental coverage types are associated with lower observed dispersion in out-of-pocket medical care spending, measuring dispersion as the ratio of the 90th to the 50th percentile or the standard deviation. All supplemental insurance types are associated with a lower probability that out-ofpocket medical care spending exceeds 10\% of household income, while all but Medicaid are associated with a significantly higher probability that total out-of-pocket health spending (that is, medical care plus health insurance premiums) exceeds this threshold. Thus, all supplemental insurance forms effectively function as insurance, translating uncertain medical costs into more predictable {\textemdash} although still potentially burdensome {\textemdash} premiums.}, keywords = {health care spending, Out-of-pocket medical expenses}, url = {https://mrdrc.isr.umich.edu/publications/papers/pdf/wp409.pdf}, author = {Helen G Levy} } @article {11898, title = {Use of Health Savings Accounts Among US Adults Enrolled in High-Deductible Health Plans.}, journal = {JAMA Network Open}, volume = {3}, year = {2020}, pages = {e2011014}, abstract = {

Importance: Health savings accounts (HSAs) can be used by enrollees in high-deductible health plans (HDHPs) to save for health care expenses before taxes. Expansion of and encouraging contributions to HSAs have been centerpieces of recent federal legislation. Little is known about how US residents who may be eligible for HSAs are using them to save for health care.

Objective: To determine which patients who may be eligible for an HSA do not have one and what decisions patients with HSAs make about contributing to them.

Design, Setting, and Participants: This cross-sectional national survey assessed an online survey panel representative of the US adult population. Adults aged 18 to 64 years and enrolled in an HDHP for at least 12 months were eligible to participate. Data were collected from August 26 to September 19, 2016, and analyzed from November 1, 2019, to April 30, 2020.

Main Outcomes and Measures: Prevalence of not having an HSA or not making HSA contributions in the last 12 months and reasons for not making the HSA contributions.

Results: Based on data from 1637 individuals (American Association of Public Opinion Research response rate 4, 54.8\%), half (50.6\% [95\% CI, 47.7\%-53.6\%]) of US adults in HDHPs were female, and most were aged 36 to 51 (35.7\% [95\% CI, 32.8\%-38.6\%]) or 52 to 64 (36.8\% [95\% CI, 34.1\%-39.5\%]) years. Approximately 1 in 3 (32.5\% [95\% CI, 29.8\%-35.3\%]) did not have an HSA. Those who obtained their health insurance through an exchange were more likely to lack an HSA (70.3\% [95\% CI, 61.9\%-78.6\%]) than those who worked for an employer that offered only 1 health insurance plan (36.5\% [95\% CI, 30.9\%-42.1\%]; P < .001). More than half of individuals with an HSA (55.0\% [95\% CI, 51.1\%-58.8\%]) had not contributed money into it in the last 12 months. Among HDHP enrollees with an HSA, those with at least a master{\textquoteright}s degree (46.1\% [95\% CI, 38.3\%-53.9\%]; P = .02) or a high level of health insurance literacy (47.3\% [95\% CI, 40.7\%-54.0\%]; P = .03) were less likely to have made no HAS contributions. Common reasons for not contributing to an HSA included not considering it (36.8\% [95\% CI, 30.8\%-42.8\%]) and being unable to afford saving for health care (31.9\% [95\% CI, 26.2\%-37.6\%]).

Conclusions and Relevance: These findings suggest that many US adults enrolled in an HDHP lack an HSA, and few with an HSA saved for health care in the last year. Targeted interventions should be explored by employers, health plans, and health systems to encourage HSA uptake and contributions among individuals who could benefit from their use.

}, keywords = {Costs and Cost Analysis, Deductibles and Coinsurance, Female, health, Insurance, Male, Medical Savings Accounts}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2020.11014}, author = {Jeffrey T Kullgren and Cliff, Elizabeth Q and Krenz, Christopher and Brady T. West and Helen G Levy and A. Mark Fendrick and Angela Fagerlin} } @article {9719, title = {Determinants of Hearing Aid Use Among Older Americans With Hearing Loss}, journal = {The Gerontologist}, year = {2019}, abstract = {Background and Objectives Hearing loss (HL) is common among older adults and is associated with significant psychosocial, cognitive, and physical sequelae. Hearing aids (HA) can help, but not all individuals with HL use them. This study examines how social determinants may impact HA use. Research Design and Methods We conducted an explanatory sequential mixed methods study involving a secondary analysis of a nationally representative data set, the Health and Retirement Study (HRS; n = 35,572). This was followed up with 1:1 qualitative interviews (n = 21) with community participants to clarify our findings. Both samples included individuals aged 55 and older with a self-reported HL, with or without HA. The main outcome measure was the proportion of participants with a self-reported HL who use HA. Results and Discussion Analysis of HRS data indicated that younger, nonwhite, non-Hispanic, lower income, and less-educated individuals were significantly less likely to use HA than their referent groups (all p values < .001). Area of residence (e.g., urban) were not significantly associated with HA use. Qualitative findings revealed barriers to HA included cost, stigma, vanity, and a general low priority placed on addressing HL by health care providers. Facilitators to obtaining and using HA included family/friend support, knowledge, and adequate insurance coverage for HA. Implications Many socioeconomic factors hinder individuals{\textquoteright} ability to obtain and use HA, but these obstacles appeared to be mitigated in part when insurance plans provided adequate HA coverage, or when their family/friends provided encouragement to use HA.}, keywords = {Hearing aids, Hearing loss, Social Support, Stigma}, issn = {0016-9013}, doi = {10.1093/geront/gny051}, url = {https://academic.oup.com/gerontologist/advance-article/doi/10.1093/geront/gny051/5000029http://academic.oup.com/gerontologist/advance-article-pdf/doi/10.1093/geront/gny051/24836322/gny051.pdf}, author = {Michael M McKee and Choi, Hwajung and Wilson, Shelby and Melissa J DeJonckheere and Zazove, Philip and Helen G Levy} } @article {10030, title = {Does home equity affect decisions on long-term care insurance purchases? Evidence from the United States.}, journal = {Research on Aging}, volume = {41}, year = {2019}, month = {07/2019}, abstract = {The low uptake of private long-term care insurance (LTCI) by the elderly in the United States, despite visible risks, has left economists puzzled. Prior studies have hypothesized that home equity can be a substitute for LTCI and hence may partly explain the low uptake. We test this hypothesis empirically. We utilize exogenous variation in house prices at the level of the metropolitan statistical area (MSA) as an instrument for home equity for individuals residing in that MSA and data from the Health and Retirement Study. In the most robust specifications, we find no evidence that the elderly change their decision on LTCI based on variation in their home equity, and even specifications requiring stronger identification assumptions imply only small effect magnitudes. Home equity as a substitute for LTCI does not appear to be a major contributing factor to low LTCI take up.}, keywords = {Decision making, Homeownership, Long-term care insurance}, issn = {1552-7573}, doi = {10.1177/0164027519830078}, author = {Richard A Hirth and Acharya, Yubraj and Helen G Levy and Kenneth M. Langa} } @article {RePEc:mrr:papers:wp393, title = {Is the Affordable Care Act Affecting Retirement Yet?}, year = {2018}, institution = {University of Michigan}, abstract = {We analyze whether the Affordable Care Act (ACA) has affected labor supply of older Americans using data that span more than four years after the policy{\textquoteright}s implementation in 2014. We find no changes in labor supply of older Americans either in response to subsidized marketplace coverage, which became available nationally in 2014, or in response to the expansion of Medicaid eligibility in some states but not others. We analyze multiple dimensions of labor supply {\textemdash} labor force participation; employment; full-time work conditional on employment {\textemdash} as well as several measures of retirement including self-reported retirement and the receipt of retirement income. We fail to find labor supply effects even for subgroups with less than a high school education or those with fair or poor health, who might have been expected to have a greater labor supply response. The lack of a labor supply response stands in contrast to the large gains in coverage observed in 2014. These results suggest that for Americans approaching retirement the Affordable Care Act achieved its primary goal of increasing coverage without the unintended consequence of reducing labor supply.}, keywords = {Affordable Care Act, Insurance, Public Assistance, Retirement}, url = {https://ideas.repec.org/p/mrr/papers/wp393.html}, author = {Helen G Levy and Thomas Buchmueller and Sayeh Nikpay} } @article {9831, title = {Racial and Ethnic Disparities in the Lifetime Prevalence of Homelessness in the United States.}, journal = {Demography}, volume = {55}, year = {2018}, pages = {2119-2128}, abstract = {Homelessness in the United States is often examined using cross-sectional, point-in-time samples. Any experience of homelessness is a risk factor for adverse outcomes, so it is also useful to understand the incidence of homelessness over longer periods. We estimate the lifetime prevalence of homelessness among members of the Baby Boom cohort (n = 6,545) using the 2012 and 2014 waves of the Health and Retirement Study (HRS), a nationally representative survey of older Americans. Our analysis indicates that 6.2~\% of respondents had a period of homelessness at some point in their lives. We also identify dramatic disparities in lifetime incidence of homelessness by racial and ethnic subgroups. Rates of homelessness were higher for non-Hispanic blacks (16.8~\%) or Hispanics of any race (8.1~\%) than for non-Hispanic whites (4.8~\%; all differences significant with p < .05). The black-white gap, but not the Hispanic-white gap, remained significant after adjustment for covariates such as education, veteran status, and geographic region.<}, keywords = {Homelessness, Racial/ethnic differences}, issn = {1533-7790}, doi = {10.1007/s13524-018-0717-0}, author = {Vincent A Fusaro and Helen G Levy and H Luke Shaefer} } @article {8809, title = {Home and community-based service and other senior service use: Prevalence and characteristics in a national sample.}, journal = {Home Health Care Serv Q}, volume = {36}, year = {2017}, month = {2017 Jan-Mar}, pages = {16-28}, abstract = {

We report on the use of home and community-based services (HCBS) and other senior services and factors affecting utilization of both among Americans over age 60 in the Health and Retirement Study (HRS). Those using HCBS were more likely to be older, single, Black, lower income, receiving Medicaid, and in worse health. Past use of less traditional senior services, such as exercise classes and help with tax preparation, were found to be associated with current use of HCBS. These findings suggest use of less traditional senior services may serve as a "gateway" to HCBS that can help keep older adults living in the community.

}, keywords = {Aged, Aged, 80 and over, Community Health Services, Female, Home Care Services, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Prevalence, Senior Centers, United States}, issn = {1545-0856}, doi = {10.1080/01621424.2016.1268552}, url = {https://www.tandfonline.com/doi/full/10.1080/01621424.2016.1268552}, author = {Amanda Sonnega and Kristen N Robinson and Helen G Levy} } @article {9064, title = {User Guide to Health Insurance in the Health and Retirement Study, 2006-2014}, year = {2017}, institution = {Survey Research Center, Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, author = {Helen G Levy} } @article {8940, title = {Health Literacy and Access to Care.}, journal = {Journal of Health Communication}, volume = {21 Suppl 1}, year = {2016}, month = {2016}, pages = {43-50}, abstract = {

Despite well-documented links between low health literacy, low rates of health insurance coverage, and poor health outcomes, there has been almost no research on the relationship between low health literacy and self-reported access to care. This study analyzed a large, nationally representative sample of community-dwelling adults ages 50 and older to estimate the relationship between low health literacy and self-reported difficulty obtaining care. We found that individuals with low health literacy were significantly more likely than individuals with adequate health literacy to delay or forgo needed care or to report difficulty finding a provider, even after we controlled for other factors, including health insurance coverage, employment, race/ethnicity, poverty, and general cognitive function. They were also more likely to lack a usual source of care, although this result was only marginally significant after we controlled for other factors. The results show that in addition to any obstacles that low health literacy creates within the context of the clinical encounter, low health literacy also reduces the probability that people get in the door of the health care system in a timely way.

}, keywords = {Aging, Health Literacy, Healthcare, Older Adults}, issn = {1087-0415}, doi = {10.1080/10810730.2015.1131776}, author = {Helen G Levy and Alexander T Janke} } @article {8941, title = {Assessing the Need for a New Household Panel Study: Health Insurance and Health Care.}, journal = {Journal of Economic and Social Measurement}, volume = {40}, year = {2015}, month = {2015}, pages = {341-356}, abstract = {

This paper considers the availability of data for addressing questions related to health insurance and health care and the potential contribution of a new household panel study. The paper begins by outlining some of the major questions related to policy and concludes that survey data on health insurance, access to care, health spending, and overall economic well-being will likely be needed to answer them. The paper considers the strengths and weaknesses of existing sources of survey data for answering these questions. The paper concludes that either a new national panel study, an expansion in the age range of subjects in existing panel studies, or a set of smaller changes to existing panel and cross-sectional surveys, would significantly enhance our understanding of the dynamics of health insurance, access to health care, and economic well-being.

}, keywords = {Healthcare, Medicare/Medicaid/Health Insurance, Meta-analyses, Panel studies}, issn = {0747-9662}, doi = {10.3233/JEM-150408}, author = {Helen G Levy} } @article {8640, title = {The Effect of Health Reform on Retirement}, number = {WP 2015-329}, year = {2015}, pages = {1-26}, address = {Ann Arbor, MI}, abstract = {Many studies have shown that the availability of health insurance is an important determinant of the retirement decision. Beginning in January 2014, the Affordable Care Act (ACA) made affordable alternatives to employer-sponsored health insurance much more widely available than they had been previously through the establishment of health insurance exchanges and, in some states, the expansion of Medicaid eligibility to low-income, childless adults. We analyze whether these new health insurance options led to an increase in retirement or part-time work among individuals ages 55 through 64 during the first 18 months after the policy took effect. Using data from the basic monthly Current Population Survey from January 2005 through June 2015, we find that there was no increase in retirement in 2014 either overall or in Medicare expansion states relative to nonexpansion states. We also find no change in the fraction of older workers who are working part-time. }, keywords = {Health Conditions and Status, Health Shocks, Medicare/Medicaid/Health Insurance, Older Adults, Retirement Planning and Satisfaction}, url = {http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2697092$\#$$\#$}, author = {Helen G Levy and Thomas Buchmueller and Sayeh Nikpay} } @article {6472, title = {Health literacy and the digital divide among older Americans.}, journal = {J Gen Intern Med}, volume = {30}, year = {2015}, note = {Export Date: 20 January 2015 Article in Press}, month = {2015 Mar}, pages = {284-9}, chapter = {284}, abstract = {

BACKGROUND: Among the requirements for meaningful use of electronic medical records (EMRs) is that patients must be able to interact online with information from their records. However, many older Americans may be unprepared to do this, particularly those with low levels of health literacy.

OBJECTIVE: The purpose of the study was to quantify the relationship between health literacy and use of the Internet for obtaining health information among Americans aged 65 and older.

DESIGN: We performed retrospective analysis of 2009 and 2010 data from the Health and Retirement Study, a longitudinal survey of a nationally representative sample of older Americans.

PARTICIPANTS: Subjects were community-dwelling adults aged 65 years and older (824 individuals in the general population and 1,584 Internet users).

MAIN MEASURES: Our analysis included measures of regular use of the Internet for any purpose and use of the Internet to obtain health or medical information; health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R) and self-reported confidence filling out medical forms.

KEY RESULTS: Only 9.7\% of elderly individuals with low health literacy used the Internet to obtain health information, compared with 31.9\% of those with adequate health literacy. This gradient persisted after controlling for sociodemographic characteristics, health status, and general cognitive ability. The gradient arose both because individuals with low health literacy were less likely to use the Internet at all (OR = 0.36 [95\% CI 0.24 to 0.54]) and because, among those who did use the Internet, individuals with low health literacy were less likely to use it to get health or medical information (OR = 0.60 [95\% CI 0.47 to 0.77]).

CONCLUSION: Low health literacy is associated with significantly less use of the Internet for health information among Americans aged 65 and older. Web-based health interventions targeting older adults must address barriers to substantive use by individuals with low health literacy, or risk exacerbating the digital divide.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Cohort Studies, Digital Divide, Female, Health Literacy, Humans, Internet, Male, Prospective Studies, Retrospective Studies, Surveys and Questionnaires, United States}, issn = {1525-1497}, doi = {10.1007/s11606-014-3069-5}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84914171477andpartnerID=40andmd5=41b0823f4329aba89308dad7c476949a}, author = {Helen G Levy and Alexander T Janke and Kenneth M. Langa} } @article {8222, title = {Income, Poverty, and Material Hardship Among Older Americans.}, journal = {RSF}, volume = {1}, year = {2015}, month = {2015 Nov}, pages = {55-77}, publisher = {1}, abstract = {

Using data from the 2008 and 2010 waves of the Health and Retirement Study to analyze the determinants of material hardship among individuals ages sixty-five and older, I look at five self-reported hardships: food insecurity, skipped meals, medication cutbacks, difficulty paying bills, and dissatisfaction with one{\textquoteright}s financial situation. One-fifth of the elderly report one or more of these hardships. Although hardship is more likely for those with low incomes, most older Americans experiencing hardship are not poor. I analyze whether alternative measures of resources do a better job of predicting hardship than does income relative to the federal poverty threshold. I find that spending relative to the poverty threshold does a worse job predicting hardship than does income relative to poverty. Subtracting out-of-pocket medical spending from income yields a measure that is an even better predictor of hardship. In multivariate models, I find that self-reported health, activity limitations, and disability are significant predictors of hardship. Having reliable children (as assessed by the respondent) or an able-bodied spouse reduces the likelihood of hardship. Poor health increases hardship through three channels: by lowering income, by increasing out-of-pocket medical spending, and through its direct effect on hardship. The first two of these-lower income and higher medical spending-are much less quantitatively important than the third; in a nutshell, poor health makes it harder to get by with less.

}, issn = {2377-8253}, doi = {10.7758/RSF.2015.1.1.04}, author = {Helen G Levy} } @article {5851, title = {Racial Difference in the Use of VA Health Services}, year = {2015}, institution = {Ann Arbor, MI, Michigan Reirement Research Center, University of Michigan}, abstract = {We study the factors that affect the utilization of health care services administered by the Department of Veterans Affairs (VA) and its racial differences. Due to data limitation, previous research in this regard mostly only focuses on veterans who are VA users or at least eligible for VA services. We fill in the gap in literature with a random sample of veterans 51 and older from the Health and Retirement Study. We find that, among all veterans, those who are black and less healthy are more likely to use VA health services. These factors, nevertheless, are no longer statistically significant after the sample is restricted to veterans who are eligible for VA services. We also find that VA health services and services provided through other channels are at least partial substitutes: VA usage drops when a veteran becomes age eligible for Medicare or when a veteran has health insurance coverage through employment. This drop in usage holds not only among all veterans, but also among veterans eligible for VA services. Finally, perception about the quality of services delivered in VA versus non-VA facilities strongly predicts VA services usage. Those who have favorable views toward VA use VA services more, and the results from variance decomposition suggests a majority part of the racial difference in VA usage can be attributed to the racial difference in such perception.}, url = {http://www.mrrc.isr.umich.edu/publications/papers/pdf/wp334.pdf}, author = {Fang, Chichun and Kenneth M. Langa and Helen G Levy and David R Weir} } @article {8065, title = {Health numeracy: the importance of domain in assessing numeracy.}, journal = {Med Decis Making}, volume = {34}, year = {2014}, month = {2014 Jan}, pages = {107-15}, publisher = {34}, abstract = {

BACKGROUND AND OBJECTIVE: Existing research concludes that measures of general numeracy can be used to predict individuals{\textquoteright} ability to assess health risks. We posit that the domain in which questions are posed affects the ability to perform mathematical tasks, raising the possibility of a separate construct of "health numeracy" that is distinct from general numeracy. The objective was to determine whether older adults{\textquoteright} ability to perform simple math depends on domain.

METHODS: Community-based participants completed 4 math questions posed in 3 different domains: a health domain, a financial domain, and a pure math domain. Participants were 962 individuals aged 55 and older, representative of the community-dwelling US population over age 54.

RESULTS: We found that respondents performed significantly worse when questions were posed in the health domain (54\% correct) than in either the pure math domain (66\% correct) or the financial domain (63\% correct). Our experimental measure of numeracy consisted of only 4 questions, and it is possible that the apparent effect of domain is specific to the mathematical tasks that these questions require.

CONCLUSIONS: These results suggest that health numeracy is strongly related to general numeracy but that the 2 constructs may not be the same. Further research is needed into how different aspects of general numeracy and health numeracy translate into actual medical decisions.

}, keywords = {Aged, Humans, Mathematics, Middle Aged, Self Efficacy, Surveys and Questionnaires, Task Performance and Analysis}, issn = {1552-681X}, doi = {10.1177/0272989X13493144}, url = {http://mdm.sagepub.com/content/34/1/107.abstract}, author = {Helen G Levy and Peter A. Ubel and Amanda J. Dillard and David R Weir and Angela Fagerlin} } @article {5974, title = {Social Security Benefit Claiming and Medicare Utilization}, year = {2013}, institution = {Ann Arbor, MI, University of Michigan Retirement Research Center}, abstract = {Are early Social Security claimers too sick to work? We linked Health and Retirement Study data to Medicare claims to study health care utilization at ages 65 and 70. We find that Social Security Disability Insurance recipients use more health care on average than those who never received DI. At age 65, Medicare spending on SSDI recipients was 4,440 less than spending on retirees who claimed Social Security benefits prior to Full Retirement Age (FRA) and 4,727 less than those claiming at FRA. Differences in Medicare spending persist at all points of the spending distribution. They are robust to a variety of methodological approaches including general linear models, quantile regression, and reweighting, and in specifications limiting comparisons to beneficiaries claiming benefits at initial EEA. Our results suggest that poor health may contribute to EEA claiming decisions, though this group is considerably healthier than those who were too disabled to work and qualified for DI benefits.}, keywords = {Medicare/Medicaid/Health Insurance, Retirement Planning and Satisfaction, Social Security}, url = {http://www.mrrc.isr.umich.edu/publications/papers/pdf/wp281.pdf}, author = {John Bound and Helen G Levy and Lauren Hersch Nicholas} } @article {7495, title = {Take-up of Medicare Part D: results from the Health and Retirement Study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65}, year = {2010}, note = {Times Cited: 6}, month = {2010 Jul}, pages = {492-501}, publisher = {65}, abstract = {

OBJECTIVES: To estimate the impact of Medicare Part D on prescription drug coverage among elderly Medicare beneficiaries and to analyze the predictors of program enrollment ("take-up") among those with no prior drug coverage.

METHODS: Multivariate analyses of data from the 2002, 2004, and 2006 waves of the Health and Retirement Study.

RESULTS: Take-up of Part D among those without drug coverage in 2004 was high; about 50\%-60\% of this group had Part D coverage in 2006. Only 7\% of senior citizens lacked drug coverage in 2006 compared with 24\% in 2004. Demand for prescription drugs was the most important determinant of the decision to enroll in Part D among those with no prior coverage. Many of those who remained without coverage in 2006 reported that they do not use prescribed medicines, and the majority had relatively low out-of-pocket spending.

CONCLUSION: For the most part, Medicare beneficiaries seem to have been able to make economically rational decisions about Part D enrollment despite the complexity of the program.

}, keywords = {Aged, ethnicity, Humans, Longitudinal Studies, Medically Uninsured, Medicare Part D, Multivariate Analysis, Poverty, prescription drugs, Prescription Fees, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbp107}, author = {Helen G Levy and David R Weir} } @article {5781, title = {Documentation and Benchmarking of Health Insurance Measures in the Health and Retirement Study}, year = {2009}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {The Health and Retirement Study (HRS) has asked respondents about their health insurance coverage since the study began in 1992. The study has asked about public and private coverage, including detailed information on the source of coverage. These data can be used to paint a comprehensive picture of insurance coverage among the elderly and near-elderly from 1992 to the present. This documentation provides an overview of the health insurance measures in the HRS and benchmarks HRS estimates of health insurance for 1996 through 2006 to data from the Medical Expenditure Panel Study (MEPS). For selected outcomes, the data are also benchmarked to data from the National Health Interview Survey (NHIS) for 1997 through 2006.}, keywords = {Medicare/Medicaid/Health Insurance, Methodology}, author = {Helen G Levy and Italo Gutierrez} } @article {5739, title = {Take-Up of Medicare Part D and the SSA Subsidy: Early Results from the Health and Retirement Study}, year = {2009}, note = {http://www.nber.org/papers/w14692}, institution = {Cambridge, MA, National Bureau of Economic Research, Working Paper 14692}, abstract = {We analyze newly available data from the Health and Retirement Study on senior citizens take-up of Medicare Part D and the associated SSA Low-Income Subsidy. We find that economic factors specifically, demand for prescription drugs - drove the decision to enroll in Part D. For the most part, individuals with employer-sponsored coverage in 2004 kept that coverage, as they should have. Individuals with no prescription drug coverage in 2004 mostly enrolled in Part D or obtained other coverage; many of those who remained without coverage reported that they do not use prescribed medicines. Take-up of the SSA Extra Help subsidy seems to have been more problematic, with many Part D beneficiaries unaware of the subsidy program or unsure about their eligibility. There is apparent under-reporting in the HRS of participation in the subsidy program, suggesting that some who profess to be unaware of the program may actually be participating in it. In terms of respondents subjective experiences of decision-making, the majority report having had little or no difficulty with the Part D enrollment decision and being confident that they made the right decision. Thus, for the most part, despite the complexity of the program, Medicare beneficiaries seem to have been able to make economically rational decisions in which they had confidence, although additional intervention for low-income beneficiaries may be desirable.}, keywords = {Healthcare, Medicare/Medicaid/Health Insurance}, url = {http://www.nber.org/papers/w14692}, author = {Helen G Levy and David R Weir} } @inbook {5213, title = {Health Insurance Patterns Nearing Retirement}, booktitle = {Redefining Retirement: How Will Boomers Fare?}, year = {2007}, note = {ProCite field 6 : In ProCite field 8 : eds}, publisher = {Oxford University Press}, organization = {Oxford University Press}, address = {New York, NY}, keywords = {Medicare/Medicaid/Health Insurance, Retirement Planning and Satisfaction}, url = {https://pensionresearchcouncil.wharton.upenn.edu/publications/books/redefining-retirement-how-will-boomers-fare/}, author = {Helen G Levy} } @article {5490, title = {The Economic Consequences of Being Uninsured}, number = {12}, year = {2002}, institution = {University of Chicago}, abstract = {I estimate the impact of being diagnosed with a serious new health condition (cancer, diabetes, heart attack, chronic lung disease, or stroke) on household wealth, food consumption and total household income for households with and without health insurance at baseline, using data from the first four waves of the Health and Retirement Study. I find that health shocks do not have a significant effect on consumption; households are able to smooth the impact of these shocks. Whether they deplete wealth in order to do so is not entirely clear; the estimated effect of a health shock on wealth is large (about $28,000) for both insured and uninsured households, but is not statistically significant. The proportional effect on wealth is estimated to be larger for uninsured households (a drop of 20 percent) than for insured households (a drop of about 2 percent), but again, neither effect is significantly different from zero. Health shocks reduce household income by about $9,000 and reduce the probability of work by about ten percentage points; the labor supply response to a shock is about the same whether or not a household has insurance. There is no evidence that the uninsured face significantly higher economic risks than the insured in the event of a health shock. }, keywords = {Medicare/Medicaid/Health Insurance, Net Worth and Assets}, url = {http://rwjf-eriu.org/pdf/wp12.pdf}, author = {Helen G Levy} } @article {6710, title = {Data Watch: Research Data in Health Economics}, journal = {Journal of Economic Perspectives}, volume = {14}, year = {2000}, pages = {203-216}, publisher = {14}, abstract = {This paper describes what data are available, what questions can be addressed by, and how one can gain access to data sets of interest to economists. The HRS and AHEAD are written up under the {\textquoteright}Longitudinal and Household Surveys of Health Status and Health Care Use{\textquoteright} section of the paper. The paper summarizes both studies, explains their longitudinal nature, and describes the data used. The HRS and AHEAD represent an incredibly rich source of information on the health and economic behavior of individuals nearing retirement.}, keywords = {Methodology}, doi = {10.1257/jep.14.4.203}, author = {Evans, William N. and Helen G Levy and Kosali I. Simon} } @article {5410, title = {The Financial Impact of Health Insurance}, year = {2000}, institution = {University of California at Berkeley}, abstract = {What are the financial benefits of having health insurance? Although health insurance is ostensibly intended to help protect households from economic risks related to poor health, very little is known about the magnitude of this effect. Alternative mechanisms (such as informal health insurance or depleting assets) may be equally important in allowing households to smooth consumption in the event of a health shock. This paper analyzes the role of health insurance in buffering the impact of health shocks on household consumption and wealth. Using data from the Health and Retirement Study, I find very little evidence that household consumption or wealth is affected by the onset of a serious illness regardless of the household s insurance status. This suggests that on average, other insurance mechanisms may be at least as important as formal health insurance in protecting households from health-related economic risk.}, keywords = {Consumption and Savings, Medicare/Medicaid/Health Insurance}, author = {Helen G Levy} }