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Q&A: Professor’s study addresses ‘hidden poor,’ health care accessibility

Steven P. Wallace, a chair in the Fielding School of Public Health, has researched the hidden poor in California. (Kristen Payne/Daily Bruin)

By Eliza Blackorby

March 3, 2016 11:42 p.m.

A UCLA study published Feb. 29 found nearly one in four California residents over the age of 65 have incomes above the federal poverty line, but still do not have enough money to make ends meet.

The study, published by the UCLA Center for Health Policy Research, determined a group of older residents live above the federal poverty level, making them ineligible to receive aid programs, but below the affordable standard of living. This gap is called the Elder Index’s poverty measure.

The fact sheet found about 655,000 older adults in California fall within this category of the “hidden poor.” These individuals are more more likely to be in poor physical or mental health condition, and report less timely health care compared to wealthier citizens.

Researchers spent eight years creating a new measure of economic insecurity among older adults, called the Elder Economic Security Standard Index, as an alternative to the federal poverty line. The federal poverty line, developed in the 1960s as part of a newly announced war on poverty, is a single number for citizens across the country and doesn’t take into account varied costs of living based on location.

The Daily Bruin’s Eliza Blackorby spoke to professor Steven P. Wallace, a lead author of the study and chair of the Fielding School of Public Health’s Department of Community Health Sciences about the hidden poor, the unique health problems they face and potential policy solutions.

Daily Bruin: Who are the “hidden poor”?

Steven Wallace: They are the group that falls above the federal poverty line but below the Elder Index. The index estimates three times as many poor people as the federal poverty line does. About a third of those under the federal poverty line said they were not able to get a medical appointment within three days, compared to 22 percent of hidden poor and 12 percent of non-poor.

DB: What is the overarching goal of this study?

SW: The goal of the study is to point out that not only does this population not have enough money to make ends meet, but it also has more health care needs than the general population and worse access to health care. It’s a group that needs to be paid attention to when creating policies and health care plans.

DB: How has the standard of living changed over the past 50 years?

SW: Health care costs have gone up dramatically, especially among older adults. The mix of costs has changed, we spend a lot less money on food and a lot more money on rent.

DB: How does the Elder Index account for these changes?

SW: The federal poverty line methodology was established in 1955 and hasn’t changed a bit. The index is an updated way of looking at how people make ends meet. It is based on the county level, with a specific index for each county. It looks at basic costs of senior living, including health care, food, transportation and miscellaneous costs, and considers different types of housing.

DB: What does the new fact sheet examine?

SW: This is the first time we’re looking at health of this group, asking if their health is more like the people with higher income or more like the people with lower income. What we showed in the fact sheet is this group of hidden poor has both health needs and barriers to health care that are ignored if you don’t pay attention to them. By not looking at the true cost of living in California, you’re ignoring a large pool of seniors who have health needs and problems because they’re lumped in with this other part of the population.

DB: What policy recommendations do you have?

SW: If you improve people’s incomes, you’re likely to improve their health, because they’re eating more nutritious diets, they’re able to afford their medications and they’re living in better housing. We can do that by improving the stock of affordable housing – in this group 40 percent are renters so they’re highly exposed to the rental market.

Another major factor for this group is health care. It’s important to make it possible for older adults to obtain low cost health care, whether through expanding Medicaid, expanding the availability of subsidies for prescription medications or providing private medicare coverage. We can also improve through programs such as Supplemental Security Income or by making health care programs more accessible.

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