Preliminary analyses of the 2010 U.S. Census indicated that less than one in ten American seniors live in poverty. But a new and more nuanced “supplemental” poverty metric finds that number may actually be closer to one in seven seniors when accounting for their out-of-pocket medical bills.

The “original” poverty metric has been used since the 1960s. But some argue that it’s an archaic measuring stick, since health care costs and — consequently — out-of-pocket spending on medical services have exploded in the ensuing decades. That means that, despite access to relatively generous health coverage through Medicare (another 1960s-era program), seniors have been forced to pay an increasing share of their retirement income on hospital and drug bills over the last 50 years. And seniors who suffer from costly, chronic medical conditions such as cancer and Alzheimer’s are especially burdened by those escalating costs.

Since the new measure takes these contemporary expenses into account, it paints a more accurate picture of the American poverty landscape. And as a state-level analysis of the numbers by the Kaiser Family Foundation highlights, things don’t look very good:

The share of seniors living in poverty is higher in every state under the supplemental measure than under the official measure, and at least twice as high in 12 states: California, Colorado, Connecticut, Hawaii, Massachusetts, Maryland, Minnesota, New Hampshire, New Jersey, Nevada, Wisconsin, and Wyoming.

The share of seniors living in poverty under the supplemental measure is especially high in some areas. Based on the supplemental measure, about one in four seniors (26%) are living in poverty in DC and roughly one in five seniors are living in poverty in six states: California (20%); Hawaii, Louisiana, and Nevada (19%), and Georgia and New York (18%).

One possible reason that senior poverty rates in the aforementioned states are so high when taking medical expenses into account is that hospitals in those regions may charge more money for drugs and medical services — certainly a possibility considering that U.S. medical prices are essentially arbitrary. Another potential explanation is that these states have more seniors who are less likely to be eligible for Medicare due to immigration or citizenship status, and a higher number of poor seniors with chronic medical conditions.

But the key takeaway from the numbers is that, despite many seniors’ access to generous public health entitlements, they still can’t afford the associated costs of their medical care. And that means that efforts to reduce the federal deficit through cuts to health care programs amounts to putting more fiscal strain on a vulnerable population that can’t even afford treatments under the status quo.

Yet, the congressional GOP — and some Democrats — has vehemently encouraged such cuts. For instance, Republicans insisted on raising the Medicare eligibility age from 65 to 67 during budget negotiations in February, even though such a move would only net $5.7 billion in federal savings while shifting double that amount in costs onto seniors.

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A new study published in the Journal of the American Medical Association (JAMA) Internal Medicine raises a provocative question: can patients’ religious faith — and the spiritual support given to them by their caregivers — influence their decisions on end-of-life medical services and health care spending? The short answer, according to researchers’ findings, is yes — with some caveats.

Dr. Tracy Balboni of Dana-Farber Cancer Institute in Boston led the new study, which tracked 343 Americans with advanced cancers from its launch in 2002 up through their deaths. The results were striking. Compared to those who reported a lower level of spiritual support, the 43 percent of study participants who reported “high spiritual support” from religious communities were about a third as likely to receive end-of-life (EoL) hospice care, over two and half times more likely to to receive some form of aggressive — and expensive — EoL service (like being put on a ventilator or pursuing additional chemotherapy), and five times more likely to die in a hospital ICU in their last week of life.

Furthermore, patients who self-reported the highest levels of “religious coping” during their final days were 11 times as likely to receive aggressive EoL treatments and 22 times more likely to die in the ICU compared to those with lower levels of religious coping. Those numbers were also elevated for minority populations, particularly African Americans, who are among America’s most religious ethnic groups.

So what’s at the root of these notable trends — and what lessons do they hold for doctors who want to provide their patients with the best care while also reducing the number of unnecessary procedures they must undergo in their last days? Researchers speculate that the numbers may have something to do with religious Americans’ belief in a higher power and the prospect of God working through medical professionals. “One possibility is that religious people consider medicine to be a primary means of divine intervention,” wrote Balboni and her colleagues. They also mused that strong religious community support could foster the desire to “persevere” through “hope found within suffering” — in essence, the mettle to refuse to call it quits.

But as the study’s findings on these religious community-supported patients’ ICU death rates shows, channeling that faith-based will to live into aggressive medical care isn’t necessarily effective — and, to be blunt, it contributes to wasteful health care spending by Americans and public entitlement programs such as Medicare. EoL hospice care isn’t a huge proportion of total health care spending — but aggressive medical interventions for chronically ill elderly Americans on the cusp of death is, with the top five percent of such patients accounting for over $600 billion in health spending every year.

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According to a new study commissioned by Bank of America Corp’s Merrill Lynch, health problems and health care are the top concerns for the Americans who are approaching retirement. Even among wealthier Americans — defined in this survey as those who have more than $250,000 in investable assets — health care expenses represent the most pressing financial concern they anticipate having during their retired years.

When asked to rank their financial worries for retirement, respondents overwhelmingly selected health care expenses as their biggest concern. Over 50 percent of the Americans in the wealthier group, as well as nearly 40 percent of those who were defined as less wealthy, said they were most worried about struggling to afford their health costs:

Health problems, rather than financial success, were also ranked as the top reason that the retired respondents decided to stop working. That could point to the fact that many Americans aren’t saving up as much money as they would like to before retiring. That’s consistent with previous research that shows that the Great Recession has negatively impacted older Americans’ ability to retire. Almost two-thirds of working Americans now report they’re planning to delay their retirement, and most Americans say they’re putting off retiring so they can continue to access health benefits through their employer-sponsored insurance plans.

Medical costs have been soaring across the entire health care sector — and, since end-of-life care is typically expensive, that trend especially impacts retired seniors. The median cost of living in a nursing home is now more than twice as much as a private college tuition. High medical costs end up bankrupting one in four U.S. seniors, despite the coverage offered under Medicare.

On Tuesday, Rep. Renee Ellmers (R-NC) introduced H.R. 1416, The Cancer Patient Protection Act of 2013. According to a press release on Ellmers’ congressional webpage, the bill would reverse sequester cuts to Medicare funding for physician-administered chemotherapy drugs, which she calls “an unintended consequence of sequestration,” and reimburse doctors for any cuts that have affected them since the beginning of the month. The sequester’s two percent cut to Medicare Part B has been forcing community cancer clinics to turn away thousands of Medicare beneficiaries and deny them their treatments.

Although the congresswoman — a registered nurse — claims that the cuts to oncologists administering chemotherapy are simply an “unintended consequence,” they are anything but. The Budget Control Act, which included the sequester, specifically states that Medicare is subject to an across-the-board two percent cut. That’s about as intentional as you can get.

What Ellmers is really saying is that she didn’t realize exactly what those cuts would mean for the well-being of real Americans once they were actually implemented. She voted for the Budget Control Act back in 2011 and was still arguing the merits of sequestration earlier this year. “I do believe [the sequester] will start a very important process that will help our economy to start to grow. The debt that we have at the federal level is our biggest threat for our country,” she told the Washington Post in February.

That’s a shift from the recent rhetoric from Ellmers’ GOP colleagues. Republicans in Congress have been largely brushing off the sequester cuts, claiming their impact has been exaggerated and they aren’t actually a big deal. But now that the cuts are forcing schools, aviation centers, health care providers, and countless other organizations that receive federal funding to make tough decisions in the face of sequestration — decisions that affect Republican constituencies just as much as they affect Democratic ones — it’s becoming clear that abstract numbers on a balance sheet have tangible, real-world effects.

According to CNNMoney, the median cost of living in private nursing homes and assisted living facilities has ballooned by 24 percent and 23 percent, respectively, over the last five years. The median annual cost of private nursing home care is now $83,950 — almost two and half times the mean tuition at private not-for-profit colleges in 2010-2011.

Semi-private room costs in nursing homes have risen to $75,405 per year, and even a stay at an assisted living facility — where patients do not receive anywhere near the level of care that they would at a private nursing home — now tends to cost over $41,000 per year. As Bob Bua, vice president of long-term care provider Genworth, explained, employees at nursing homes “rarely get pay decreases, food rarely costs less, rent rarely goes down — it’s an ever-increasing cycle.”

The CNNMoney article points out that less costly alternatives include hiring home health care aides and other live-in assistance. The median price for those services have only risen at about one percent per year over the last half decade to about $44,000 annually. But considering health aide salary data released last month, even that comparatively low price is a figure that is greatly inflated by organizations providing assistance services to the elderly. Home health aid — the fastest-growing job in America — pays less than $10 per hour, meaning that a full-time worker makes only around $20,000 per year.

These new numbers underscore the financial and medical strain put on elderly Americans due to the ever-increasing cost of health care services. Despite generous coverage under Medicare, high out-of-pocket costs bankrupt one in four American seniors because medical services themselves cost so much money. And more than half of Americans will delay their retirement so as not to lose health benefits — a consequence of America’s entrenched system of employer-sponsored insurance.

On Tuesday, the Associated Press (AP) published an article recounting a Society of Actuaries (SOA) study that finds health insurance premiums “will jump an average 32 percent for Americans’ individual policies under President Obama’s overhaul.” That titillating claim formed the basis of multiple news agencies’ headlines Wednesday morning, including NBC News, Fox News, and U.S. News and World. But as several other analyses show — and the report’s own authors admit — these assertions are based on an extremely narrow interpretation of the health care law that assumes rising costs in perpetuity while ignoring its very real cost-cutting measures.

In essence, SOA argues that Obamacare provisions extending health coverage to all Americans regardless of their pre-existing medical conditions will dramatically raise costs in the individual insurance market — especially since sicker, older Americans will have guaranteed access to insurance and cannot be charged more than three times the premiums of younger people. The Society’s projections are quite dramatic, finding that premium rate increases by 2017 “would be 62 percent for California, about 80 percent for Ohio, more than 20 percent for Florida and 67 percent for Maryland.”

Corporate insurance giants have used many of these same arguments to dishonestly justify double-digit rate hikes on their customers, despite soaring profits. But these claims are founded on a baseline that assumes current health care cost trends to be set in stone, and ignore — even by the SOA’s own admission — almost all of Obamacare’s most important consumer protections and market regulations aimed at lowering overall costs. Rick Foster, a retired Medicare actuary, admitted that, although the study’s projections are consistent with certain health care trends, they don’t necessarily reflect the bigger picture:

“Having said that,” Foster added, “actuaries tend to be financially conservative, so the various assumptions might be more inclined to consider what might go wrong than to anticipate that everything will work beautifully.” Actuaries use statistics and economic theory to make long-range cost projections for insurance and pension programs sponsored by businesses and government. [...]

Kristi Bohn, an actuary who worked on the study, acknowledged it did not attempt to estimate the effect of subsidies, insurer competition and other factors that could mitigate cost increases. She said the goal was to look at the underlying cost of medical care.

In fact, more comprehensive studies of the health reform law that incorporate all of its provisions — rather than just the potentially negative ones — have found that “[m]ost young adults and families will be largely shielded from the full effects of the narrower age rating bands thanks to the ACA’s increased eligibility for Medicaid and tax credits offered through state health insurance exchanges or through access to employer-sponsored insurance,” and that Americans between the ages of 21 and 27 purchasing insurance through the individual market “will be protected by Medicaid/CHIP or exchange-based subsidies under reform.”
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As the health reform law approaches its third birthday, Obama Administration officials are noting that one of its provisions has already helped seniors on Medicare save $6.1 billion on their prescription drug costs.

Obamacare ensures that more prescription drugs are covered under Medicare by closing the “donut hole” coverage gap. Even as the cost of prescription drugs has continued to rise, the health law gives discounts to Medicare beneficiaries so seniors continue to be able to afford the medication they need — one of its most popular provisions. On Thursday, HHS Secretary Kathleen Sebelius announced that more than 6.3 million Americans in the Medicare program have saved more than $6 billion on prescription drugs.

Since the Affordable Care Act first began phasing in reforms to Medicare’s drug coverage in 2010, the recorded savings for seniors have been steadily growing. And according to new estimates from the Congressional Budget Office (CBO), it won’t cost as much to close the donut hole’s coverage gap as initial estimates predicted. Ultimately, making drugs more affordable means that people will take them more regularly, ensuring seniors stay healthy and their medical costs are lower. In fact, the estimated 90 million Americans who don’t take their medications as directed represent the biggest root of wasteful health spending in the United States.

A full 90 percent of seniors with Medicare plans are satisfied with the prescription drug coverage they can access through the program, largely because of the savings they’re now experiencing. And those savings are likely to increase. This year, Obamacare increases Medicare’s prescription drug discounts to about 52 percent of the cost of most brand name drugs and 21 percent of the cost of covered generic drugs.

With Obamacare on the pathway towards full implementation, critics have attempted to point out every perceived flaw in the health reform law to marshal public opinion against it. Recently, reform opponents have focused their sights on the rule that prevents insurers from charging seniors more than three times the premiums they charge younger Americans, claiming it will cause young people’s health premiums to skyrocket.

That provision is actually meant to protect seniors, who are costlier to cover, from excessive price gouging. But health reform critics point out that insurance companies may try to exploit the rule to raise prices for younger Americans, making these young people’s health coverage unaffordable. According to a new Urban Institute analysis, however, these allegations are rooted more in wishful thinking than policy reality.

According to the Urban Institute’s findings, the 3:1 premium ratio will have little effect on younger Americans, as “they will be eligible for either Medicaid or tax credits through state health insurance exchanges.” The study goes on to conclude that through a combination of elevated Medicaid/CHIP benefits, Obamacare’s provision allowing adults up to 26 years of age to stay on their parents’ insurance, and the health reform law’s private insurance subsidies for Americans living up to 400 percent of the federal poverty level (FPL), younger Americans will not experience the sort of “sticker shock” that the doomsayers have been foretelling:

Most young adults and families will be largely shielded from the full effects of the narrower age rating bands thanks to the ACA’s increased eligibility for Medicaid and tax credits offered through state health insurance exchanges or through access to employer-sponsored insurance. In fact, this is largely true across age groups. Eighty-five percent of policies sold through nongroup exchanges will be to those with incomes at or below 400 percent of federal poverty level (FPL), making them eligible for tax credits.

Looking specifically at young adults age 21–27 purchasing nongroup insurance today, two-thirds will be protected by Medicaid/CHIP or exchange-based subsidies under reform; two-thirds of the remainder are under age 26 and in homes where their parents have employer-based coverage for which they are eligible under the ACA’s dependent coverage provisions.

The study’s findings emphasize both the importance of states taking part in Obamacare’s optional Medicaid expansion and the tendency for Obamacare critics to portray the law as some sort of fiscal bogeyman. Even the media has been complicit in smearing the law, implicitly suggesting that some insurers’ plans to institute double-digit premium hikes are in anticipation of Obamacare’s expansive coverage requirements — they are not. The new Urban Institute analysis is yet further proof that there is a considerable gap between the rhetoric and the reality when it comes to Obamacare.

Tying health insurance benefits directly to employment is forcing most Americans to work longer than they would have otherwise, a new study from the Employee Benefits Research Institute finds.

According to the study’s results, nearly 20 percent of retired Americans ended up working longer than they initially planned because they didn’t want to lose access to their employer-based health benefits. And a majority of the Americans who are currently in the workforce are also planning to delay their retirement in order to keep the insurance plans they have through their employer:

This builds upon previous research that shows the Great Recession has seriously impacted older Americans’ ability to retire. An estimated 62 percent of working Americans now report they’re planning to put off their retirement — up from 42 percent in 2010 — largely due to job losses and financial insecurity. These issues go hand-in-hand particularly because, as health care costs continue to rise, Americans are increasingly worried about being able to afford their insurance coverage.

And the United States’ primarily employer-based health insurance system doesn’t just impact Americans’ retirement decisions. It has also contributed to the “job lock” phenomenon, which prevents Americans from switching jobs or changing career paths because they’re too worried about losing access to their health benefits. “Job lock” ultimately creates an inefficient labor market, since workers may not take better jobs because they’re concerned about having a gap in health coverage.

Fortunately, Obamacare will take steps to address these dynamics by making health care more affordable to low- and middle-income Americans, as well as preventing insurers from denying coverage to people with pre-existing conditions. The health reform law “completely changes the playing field,” one of the study’s authors told Wonkblog’s Sarah Kliff. “If everything goes as planned, you’ve got guaranteed issue next year. You don’t need the employer to fill the gap.”