The financing of long-term care services and supports (LTSS) relies heavily on self-insurance in the form of housing or financial wealth. Exploiting both local market variation in housing prices and individual-level variation in stock market wealth from 1996 to 2016, we show that exogenous wealth shocks significantly reduce the probability of LTCI coverage, without altering Medicaid eligibility among people with housing and financial assets. The effect of shocks to liquid wealth strongly dominates the effect of housing wealth changes. A $100 K increase in housing (financial) wealth reduces the likelihood of LTCI coverage by 1.24 (3.22) percentage points. 

We examine the impact of the Long-Term Care Insurance Partnership (LTCIP) program—a collaborative initiative between the state-level Medicaid programs and private health insurance companies designed to promote private long-term care insurance (LTCI)—on insurance ownership and Medicaid utilization. We draw on individual-level longitudinal data and employ a difference-in-differences (DD) design adjusted for the staggered implementation of the program between 2005 and 2018. Our results suggest that the rollout of the LTCIP program led to a 1.54 percentage point (pp) (14.7%) increase in LTCI ownership and a 0.82 pp (13.3%) reduction in Medicaid uptake. Our estimates suggest that these combined effects led to an approximate average cost saving of $74 per 65-year-old participant. These findings are explained by a certain degree of substitution between LTCIP and traditional LTCI contracts, ultimately postponing the use of Medicaid benefits. 

This chapter provides an overview of some key issues in the economics of healthy ageing, with particular focus on the varying healthcare needs across the life cycle, including the needs related to housing adaptation and ageing in place, caregiving and loss of independence, as well as quality of life deterioration as morbidy arises. It shows that the physical and mental health decline with age encompasses a health system reorganization and call for an enhance coordination and integration with long-term care, highlighting both challenges and opportunities. While there is a mismatch between individuals’ preferences for end-of-life care settings and the reality of hospital deaths, we show that decision regarding old-age health is determined by resource constraints (e.g., pension income and retirement) and employment trajectories across the life course which significantly impact health outcomes and access to care in later life, thereby exacerbating health inequities among older adults. The chapter summarizes broader discussions about the limits of human life and individuals’ perceptions of longevity, while also identifying the role of cognitive biases that hinder the capacity to benefit from healthy ageing, including the roles of insurance and housing adaptation. Finally, the chapter indentify some institutional barriers and behavioral constraints individuals face which influence the pursuit of healthy ageing, which it is argued warrant further research. 

Health insurance expansions can exert wellbeing effects on individuals who provide informal care to their loved ones, reducing their experience of depression. This study exploits evidence from the Affordable Care Act’s Medicaid expansion (ACA Medicaid) to examine the effects on the mental wellbeing of informal caregivers. Drawing on an event study and a Difference-in-Differences (DID) design we investigate the policy impact of ACA Medicaid using longitudinal evidence (from the Health and Retirement Study, HRS) for low-income individuals aged 64 or below. We find that ACA’s Medicaid reduced depressive symptoms among spousal caregivers, and specifically we estimate that exposure to ACA Medicaid gives rise to 8.2% points (on average, equivalent to 30% decrease) reduction in the feeling of depression and 8.7% points increase in the feeling of happiness (on average, 11% increase). The estimates are robust to various specifications, and we identify several potential driving mechanisms for the findings: reductions in out of -pocket expenses and labor supply and, as expected, increased after Medicaid uptake. The evidence from falsification tests confirms that the estimated effects are likely due to ACA’s Medicaid.

This paper introduces the R package edgar to download and analyze the Securities and Exchange Commission’s (SEC) mandatory public disclosures in the United States. Corporations in the U.S. submit their periodic reports, registration statements, and financial reports electronically to the SEC. The SEC makes these reports publicly accessible to everyone through the Electronic Data Gathering, Analysis, and Retrieval System (EDGAR). As financial reporting is one of the most crucial aspects of the financial system, efficient retrieval of EDGAR filings becomes imperative for analysts and researchers. We summarize the implementation of the edgar package that facilitates downloading, parsing, searching, and sentiment analysis of corporate reports.

Bequest motives and the desire to leave an inheritance play an important role in shaping intrafamily social contracts. This paper examines the impact of housing wealth shocks on the existence and intensity of family-level caregiving arrangements in the United States. In particular, we study whether increases in parental housing wealth affect adult children’s likelihood of providing care (“caring for”) and maintaining contact with their parents (“caring about”). Using restricted-access data from the Health and Retirement Study spanning 1996–2016, we estimate the causal effect of housing wealth on caregiving outcomes using an instrumental variables strategy. Our identification exploits exogenous local variation in house price indices to generate plausibly exogenous changes in housing wealth. We find that increases in housing wealth significantly raise both caring-for and caring-about measures of caregiving. A $100,000 increase in housing wealth increases the probability of ever receiving care from children by 0.74 percentage points and raises the number of children in contact by 0.34. We further show that these effects operate through stronger bequest motives and a reduction in intervivos transfers to children.

Does the uptake of long-term care insurance (LTCI – both public and private) alter economic activity in later life? I present evidence on how individuals adjust to their expectation of the need of long-term care at older age and how LTCI affects the labor participation of elderly population in the US. I take advantage of the variation that comes from the adoption of state level reforms, introduced for incentivizing the uptake of private-LTCI, to identify the effect of uptake of LTCI on labor outcomes and savings behavior. I use 12 waves of restricted data from Health and Retirement Study survey data from year 1996-2018. I find that the uptake of LTCI is associated with decrease in labor participation, both intensive and extensive margins. Most importantly, I observe that the uptake LTCI reduces weekly workhours by almost 8 hours and weeks per year by 0.25 weeks. In addition, I identify important mechanisms that drive the effect. These estimates are robust to various specification checks.