Donna Spencer

Converging divergences in age, gender, health, and well-being: Strategic selection in the third age

Publisher Summary The deinstitutionalization of careers paths and retirement, along with evolving gender and age norms, are creating increasing flexibility in social roles for both men and women at all phases of the life course. This deinstitutionalization is producing a period of life with few shared norms and few possibilities, called a “third age,” around the time of cessation of ones career job but before the frailties of old age. The push for gender equality—along with a confluence of other experiences, options, and social forces,demographic, economic, and cultural—have transformed women and mens lives over the past several years and are producing a growing pool of healthy, educated, and skilled men and women in this third age at risk of being on the sideline of society. The third age represents a time of increased heterogeneity by age and gender—a time of converging divergences. Nevertheless, men and women in the third age are products of past age and gender-graded institutions and norms. People in, or moving toward, this emerging life stage bring with them existing disparities, and outmoded scripts about age and gender, producing asymmetries in power, resources, needs, and preferences.

Making Sense of a Mess: Phased Retirement Policies and Practices in the United States

SUMMARY Phased retirement programs represent one important and attractive way to increase flexibility for older workers, while simultaneously benefiting organizations that are worried about the loss of staff and expertise that will occur as the Baby Boom generation moves into retirement. Yet phased retirement advocates have often been baffled by the various intersecting employment laws adopted to protect older workers and their pensions. We describe the legal and regulatory barriers related to supplementing part-time wages with defined benefit pension benefits, as well as other legal concerns. Recent regulatory developments have clarified when phased retirement (with pension supplements) is permissible and what would constitute a compliant phased retirement program for the Internal Revenue Service. However, there are still some regulatory and practical questions that make it difficult to predict whether phased retirement will be widely adopted in the near future.

Coverage Gains After the Affordable Care Act Among the Uninsured in Minnesota

OBJECTIVES We determined whether and how Minnesotans who were uninsured in 2013 gained health insurance coverage in 2014, 1 year after the Affordable Care Act (ACA) expanded Medicaid coverage and enrollment. METHODS Insurance status and enrollment experiences came from the Minnesota Health Insurance Transitions Study (MH-HITS), a follow-up telephone survey of children and adults in Minnesota who had no health insurance in the fall of 2013. RESULTS ACA had a tempered success in Minnesota. Outreach and enrollment efforts were effective; one half of those previously uninsured gained coverage, although many reported difficulty signing up (nearly 62%). Of the previously uninsured who gained coverage, 44% obtained their coverage through MNsure, Minnesotas insurance marketplace. Most of those who remained uninsured heard of MNsure and went to the Web site. Many still struggled with the enrollment process or reported being deterred by the cost of coverage. CONCLUSIONS Targeting outreach, simplifying the enrollment process, focusing on affordability, and continuing funding for in-person assistance will be important in the future.

Converging Divergences in Age, Gender, Health, and Well-Being

Publisher Summary The deinstitutionalization of careers paths and retirement, along with evolving gender and age norms, are creating increasing flexibility in social roles for both men and women at all phases of the life course. This deinstitutionalization is producing a period of life with few shared norms and few possibilities, called a “third age,” around the time of cessation of ones career job but before the frailties of old age. The push for gender equality—along with a confluence of other experiences, options, and social forces,demographic, economic, and cultural—have transformed women and mens lives over the past several years and are producing a growing pool of healthy, educated, and skilled men and women in this third age at risk of being on the sideline of society. The third age represents a time of increased heterogeneity by age and gender—a time of converging divergences. Nevertheless, men and women in the third age are products of past age and gender-graded institutions and norms. People in, or moving toward, this emerging life stage bring with them existing disparities, and outmoded scripts about age and gender, producing asymmetries in power, resources, needs, and preferences.

Health Care Coverage and Access Among Children, Adolescents, and Young Adults, 2010–2016: Implications for Future Health Reforms

PURPOSE We examine changes to health insurance coverage and access to health care among children, adolescents, and young adults since the implementation of the Affordable Care Act. METHODS Using the National Health Interview Survey, bivariate and logistic regression analyses were conducted to compare coverage and access among children, young adolescents, older adolescents, and young adults between 2010 and 2016. RESULTS We show significant improvements in coverage among children, adolescents, and young adults since 2010. We also find some gains in access during this time, particularly reductions in delayed care due to cost. While we observe few age-group differences in overall trends in coverage and access, our analysis reveals an age-gradient pattern, with incrementally worse coverage and access rates for young adolescents, older adolescents, and young adults. CONCLUSIONS Prior analyses often group adolescents with younger children, masking important distinctions. Future reforms should consider the increased coverage and access risks of adolescents and young adults, recognizing that approximately 40% are low income, over a third live in the South, where many states have not expanded Medicaid, and over 15% have compromised health.

Minnesota Integrated Health Partnership Demonstration: Implementation of a Medicaid ACO Model

In recent years, accountable care organizations (ACOs) have become more prevalent in the United States. This study describes the origins, implementation, and early results of Minnesotas Medicaid ACO payment model, the Integrated Health Partnership (IHP) demonstration project. We describe the structure of the program and present preliminary evaluation results to document the states important work and to provide lessons for other states interested in implementing Medicaid ACOs. The IHP program has expanded in size over time, the state has reported significant savings, and evidence exists of capacity building among participating providers. We identify factors that may have contributed to the programs early success, but more work is needed to investigate the specific drivers of quality improvement and savings within Minnesotas ACO program and to compare the design and effects of the IHP with other Medicaid and Medicare ACO programs. We conclude with comments about the future of the states Medicaid ACO program and situate Minnesotas findings within the context of the broader ACO movement.

Changes to the Design of the National Health Interview Survey to Support Enhanced Monitoring of Health Reform Impacts at the State Level

Pursuant to passage of the Patient Protection and Affordable Care Act, the National Center for Health Statistics has enhanced the content of the National Health Interview Survey (NHIS)-the primary source of information for monitoring health and health care use of the US population at the national level-in several key areas and has positioned the NHIS as a source of population health information at the national and state levels. We review recent changes to the NHIS that support enhanced health reform monitoring, including new questions and response categories, sampling design changes to improve state-level analysis, and enhanced dissemination activities. We discuss the importance of the NHIS, the continued need for state-level analysis, and suggestions for future consideration.

Converging Divergences in Age, Gender, Health, and Well-Being: Strategic Selection in the Third Age11Supported by the Alfred P. Sloan Foundation, #2002-6-8 and NIH, U01 HD051256-01

Publisher Summary The deinstitutionalization of careers paths and retirement, along with evolving gender and age norms, are creating increasing flexibility in social roles for both men and women at all phases of the life course. This deinstitutionalization is producing a period of life with few shared norms and few possibilities, called a “third age,” around the time of cessation of ones career job but before the frailties of old age. The push for gender equality—along with a confluence of other experiences, options, and social forces,demographic, economic, and cultural—have transformed women and mens lives over the past several years and are producing a growing pool of healthy, educated, and skilled men and women in this third age at risk of being on the sideline of society. The third age represents a time of increased heterogeneity by age and gender—a time of converging divergences. Nevertheless, men and women in the third age are products of past age and gender-graded institutions and norms. People in, or moving toward, this emerging life stage bring with them existing disparities, and outmoded scripts about age and gender, producing asymmetries in power, resources, needs, and preferences.