Public Policy & Aging E-Newsletter

Volume 5, Number 2, March 2011

This bimonthly e-newsletter highlights key developments and viewpoints in the field of aging policy from a wide variety of sources, including articles and reports circulating in the media, academy, think tanks, private sector, government and nonprofit organizations.

The goal of this email publication is to reach teachers, students, and citizens interested in aging-related issues, especially those who may not have sufficient access to policy information disseminated both in Washington and around the country.

Want the most up-to-date access to aging policy resources? Follow us on Twitter @Aging_Society!

I. WHAT’S HAPPENING IN WASHINGTON?

A. America’s Aging Population: Increases in the number of older Americans will have a profound impact on the age structure of the U.S. population. This Population Reference Bureau report provides detailed demographic information about the current and future U.S. population ages 65 and older, and considers the major social and economic consequences of the rapid changes in age structure. For a summary, click here.

B. 50+ African American Workers: A Status Report, Implications, and Recommendations: This AARP and National Urban League report examines the prospects for African-American older workers as the economy recovers. The report suggests that older African Americans could be well-positioned to take advantage of job opportunities likely to emerge in the rejuvenated economy, particularly in the health care and social service sectors. Currently, African Americans age 50+ total 2.6 million and compose 9.5 percent of the age 50+ labor force.

C. Poverty Among Older Americans, 2009: About one in three Americans age 65 or older lived in low-income families in 2009, including 8.9 percent in poverty. This Urban Institute data brief examines poverty and near-poverty rates among older Americans in 2009 by demographics, living arrangements, and health status. Findings show that poverty and near poverty rates declined between 2007 and 2009.

II. WHAT’S HAPPENING AROUND THE COUNTRY?

A. State Budgets Under Federal Health Reform: The Extent and Causes of Variations in Estimated Impacts: Given the continuing struggle of states with tight budgets in the wake of the recession, this Kaiser Family Foundation issue brief examines the potential costs and savings that the health reform law may generate for state budgets. It finds that there are many opportunities and new options to offset the state costs related to the expansion of Medicaid, such as reducing payments for uncompensated care costs as the number of uninsured individuals declines.

B. Behavioral Economics Perspectives on Public Sector Pension Plans: Unlike in the private sector, defined benefit (DB) pensions are still the norm in the public sector. This National Bureau of Economic Research (NBER) paper describes features of the pension plans offered to public sector employees in the states and the largest cities and counties in the U.S. Holding fixed a public employee’s work and salary history, the authors show that DB retirement income replacement ratios vary greatly across jurisdictions.

C. An Update on State Budget Cuts: At Least 46 States Have Imposed Cuts That Hurt Vulnerable Residents and the Economy: The cuts enacted in at least 46 states plus the District of Columbia since 2008 have occurred in all major areas of state services, including health care, services to the elderly and disabled, K-12 education, and higher education. This Center for Budget and Policy Priorities report explores the reasons for these cuts, and argues for the continuing and increasing need for these services.

III. THIS ISSUE'S MAJOR POLICY STORY: States Battle Over Long-Term Services and Community Supports

These are times that test the spirits of even naïve optimists. Our leaders in Washington, thus far seemingly unable to reach common ground about the future of entitlements, nibble away at items that will not be enough to get future budget deficits under control. It is inevitable that at both ends of Pennsylvania Avenue lawmakers will have to address Medicare, Medicaid, Social Security, and defense allocations, but it is not clear how (well) they will respond. We are watching a similarly distressing set of scripts being played out in state capitals. Legislatures slash education programs and social services. The governor of Texas has just announced that state contributions to all public-supported universities will be cut roughly 20%; fortunately, state allocations have over the past decade accounted for less and less of the funding of higher education, but few institutions have the reserves of Harvard or Stanford to sustain their commitments to prepare its youth for responsibilities in an aging society.

The pieces in the following section are timely—and encouraging in these bleak times. Here we can learn more and more about interactions between the recent Affordable Care Act and Medicaid. At a time when we can ill afford to depend on traditional methods of institutionalization, cost-effective and humane options for access to care and community support may be presenting themselves.

I learned a lot reading the pieces in this section. While I rely very much on the team at GSA’s aging-society project for conceptualizing and fleshing out this Public Policy & Aging e-Newsletter, Dani Kaiserman deserves our gratitude for her work.

--Andy Achenbaum

A. A Challenge for States: Assuring Timely Access to Optimal Long-Term Services and Supports in the Community: Medicaid programs play an important role in long-term services and supports (LTSS), accounting for 40 percent of total spending for LTSS. This Kaiser Family Foundation issue brief highlights two important aspects of operations in state Medicaid programs that affect access to LTSS in the community: efforts to provide accurate and timely information to consumers, and procedures to make Medicaid eligibility determinations quickly and efficiently.

B. Affordable Care Act Supports States in Strengthening Community Living: Health and Human Services Secretary Kathleen Sebelius announced that states will see significant new federal support in their efforts to help move Medicaid beneficiaries out of institutions and into their own homes or other community settings now and in the near future. The Affordable Care Act provided additional funding for two programs supporting that goal, the Money Follows the Person demonstration program and the Community First Choice Option program.

C. Medicaid Block Grant Would Shift Financial Risks and Costs to States: This Center for Budget and Policy Priorities report explains how federal financing would work under a block grant and why a block grant would provide inadequate federal funding. The report shows how a block grant would significantly deepen state budget holes in recessions, forcing still larger state budget cuts or tax increases in those periods, and thereby further slowing state economies and increasing job loss.

D. Helping Consumers Manage Long-Term Services and Supports in the Community: State Medicaid Program Activities: Case management services have been integral to Medicaid community-based LTSS programs since their inception, but as the programs have grown and evolved, particularly as options for care have increased and consumers have taken a more active role in directing services, the functions performed by case managers have changed. Drawing on the professional literature and interviews with state officials, this Kaiser Family Foundation brief describes current case management efforts in states and activities and policies that can enhance states’ efforts to help consumers manage the services and supports they need.

E. Dual Eligibles Across the States: This SCAN Foundation data brief examines the population of “dual eligibles,” low-income individuals who qualify for both Medicare and Medicaid. The brief explains the eligibility process and compares the proportion of dual eligibles across states. A related article from McKnight’s Long Term Care News also discusses dual eligibles and how the department of Health and Human Services is sending states teams of budget experts as a way to help states coordinate care for this population of beneficiaries.

IV. WORTH NOTING

A. GSA 65th Anniversary Journal Articles Available Online: In celebration of The Gerontological Society of America’s 65th anniversary and the 50th anniversary of their applied gerontology journal The Gerontologist, all specially commissioned anniversary articles can be viewed free of charge. Among the articles are David J. Ekerdt’s “Frontiers of Research on Work and Retirement,” Nancy Morrow-Howell’s “Volunteering in Later Life: Research Frontiers,” and Robert H. Binstock’s “From Compassionate Ageism to Intergenerational Conflict?”

B. Elder Justice: Stronger Federal Leadership Could Enhance National Response to Elder Abuse: This Government Accountability Office (GAO) report summarizes existing estimates of the extent of elder abuse, factors associated with elder abuse and its impact on victims, characteristics and challenges of state Adult Protective Services responsible for addressing elder abuse, and federal support and leadership in this area. Based on these findings, the GAO provides recommendations to Congress and Executive agencies. For a summary, click here.

C. Studying Aging, and Fearing Budget Cuts: This New York Times article highlights the work of Dr. Hodes, who has been director of the National Institute on Aging (NIA) at the National Institutes of Health for 17 years. As the nation’s prime source of grants for studies of aging, NIA currently operates at an annual budget of $1.1 billion. The article discusses potential changes to this amount under the President’s proposed budget, and the implications for aging research.

V. WHAT'S HAPPENING ABROAD?

A. World Population Aging: Clocks Illustrate Growth in Population Under Age 5 and Over Age 65: Very low birth rates in developed countries, coupled with birth rate declines in most developing countries, are projected to increase the population aged 65 and over to the point in 2050 when it will be 2.5 times that of the population ages 0 to 4. This Population Reference Bureau article uses animated graphics to show the trends in the growth of the two age groups for the world, including demographic differences between developed and less developed countries.

B. Latin America’s Fast Ageing Population Brings New Challenges: While older adults represented 6.5 percent of the Latin American population in 1975, today they account for 9 percent. CELADE, the population division of the Economic Commission for Latin America and the Caribbean, projects that this population will represent 14.8 percent by 2025 and 24.3 percent by 2050. This IPS article discusses concerns about the number of health care providers to serve an older population, and highlights opportunities to keep this group active through physical activity and technology classes.

C. The Future of Pensions and Healthcare in a Rapidly Ageing World: Scenarios to 2030: This World Economic Forum report identifies three global scenarios for 2030 and two sets of case studies from China and India. These scenarios are designed to challenge current thinking about the global aging population, facilitate debate between key decision-makers, and provide momentum for action. New forms of collaboration between key stakeholders – individuals, financial institutions, healthcare providers, employers and governments – will be critical to finance the ongoing well-being of current and future generations in a sustainable manner.

VI. PERSPECTIVES ON POLICY: ROB HUDSON, EDITOR, PP&AR

The most recent issue of Public Policy & Aging Report (Volume 20, Number 4) discusses empirical and normative issues surrounding ongoing biomedical research on morbidity and longevity. What social and ethical issues should shape and constrain the very goals of the biology of aging endeavor? And, has this arena of research gained the popular and political standing it should enjoy? Jay Olshansky provides a thorough and wide-ranging review of issues associated with extending life expectancy. Next, Steven Austad analyzes the likelihood that a single individual (not a population) might live to 150 years in the foreseeable future. Donald Ingram addresses a key measurement issue that is associated with so-called biomarkers whereby aging could be measured biologically rather than chronologically. Putting the biology of aging research in a political and policy context, Robert Binstock traces its “search for legitimacy” over several decades, with at least partial success realized through the creation of the National Institute on Aging in 1974, and, more recently, in receipt of the Nobel Prize by three researchers of the biology of aging. The final entry is a dialog between researchers and the public concerning their perceptions of how the public views basic research and how researchers understand the public mood.

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Newsletter Editors: Dani Kaiserman, Sarah F. Wilson, and Greg O'Neill, National Academy on an Aging Society; Andy Achenbaum, University of Houston.

The Public Policy and Aging E-Newsletter is supported in part by a grant from the AARP Office of Academic Affairs. The views expressed are those of the authors and not necessarily those of The Gerontological Society of America, the National Academy on an Aging Society, or the AARP Office of Academic Affairs.

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