NBER Working Papers by Louise Sheiner

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Working Papers

January 2014The Fiscal Stress Arising from State and Local Retiree Health Obligations
with Byron Lutz: w19779
A major factor weighing down the long-term finances of state and local governments is the obligation to fund retiree benefits. While state and local government pension obligations have been analyzed in great detail, much less attention has been paid to the costs of the other major retiree benefit provided by these governments: retiree health insurance. The first portion of the paper uses the information contained in the annual actuarial reports for public retiree health plans to reverse engineer the cash flows underlying the liabilities given in the report. Obtaining the cash flows allows us to construct liability estimates which are consistent across governments in terms of the discount rate, actuarial method and assumptions concerning medical cost inflation and mortality. We find that...


December 1998Demographics and Medical Care Spending: Standard and Non-Standard Effects
with David M. Cutler: w6866
In this paper, we examine the effects of likely demographic changes on medical spending for the elderly. Standard forecasts highlight the potential for greater life expectancy to increase costs: medical costs generally increase with age, and greater life expectancy means that more of the elderly will be in the older age groups. Two factors work in the other direction, however. First, increases in life expectancy mean that a smaller share of the elderly will be in the last year of life, when medical costs generally are very high. Furthermore, more of the elderly will be dying at older ages, and end-of-life costs typically decline with age at death. Second, disability rates among the surviving population have been declining in recent years by 0.5 to 1.5 percent annually. Reductions in...

Published: Auerbach, Alan and Ron Lee (eds.) Demographic Change and Fiscal Policy. Cambridge: Cambridge University Press, 2001.

August 1997Managed Care and the Growth of Medical Expenditures
with David M. Cutler: w6140
We use data across states to examine the relation between HMO enrollment and medical spending. We find that increased managed care enrollment significantly reduces hospital cost growth. While some of this effect is offset by increased spending on physicians, we generally find a significant reduction in total spending as well. In analyzing the sources of hospital cost reductions, we find preliminary evidence that managed care has reduced the diffusion of medical technologies. States with high managed care enrollment were technology leaders in the early 1980s; by the early 1990s those states were only average in their acquisition of new technologies. This finding suggests managed care may have a significant effect on the long-run growth of medical spending.


July 1992The Housing Wealth of the Aged
with David N. Weil: w4115
This paper examines the degree to which the elderly reduce homeownership as they age, and the factors which influence this process. We find that average levels of homeownership decline significantly with age, even when cohort effects are taken into consideration, and that the amount of housing held by people near death is quite low compared to what is seen in cross sections. We estimate that 42% of households will leave behind a house when the last member dies. We also find that the degree to which households reduce homeownership between age 65 and death does not differ greatly between the upper and lower income halves of our sample; that people who do not have children reduce their homeownership more slowly than those who do; that increases in house prices in a state make it more likely t...

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