Sandra L. Decker, Ph.D., has been a Senior Research Analyst at the International Longevity Center (ILC) in New York since September 2000. Her current work focuses on measuring socioeconomic disparities in health and aging and their relationship to the design of health programs in the U.S. and Canada More than ten percent of the near elderly (those aged 55 to 64) do not have group health insurance coverage in the U.S., and many lack options for purchasing affordable insurance to tide them over until they are eligible for Medicare at age 65. Many of those who do have coverage rely on retiree health insurance to tide them over until they become eligible for Medicare at age 65. A trend of significant cuts in retiree health benefits may lead to increasing uninsurance rates among the near elderly, the next group of persons to become eligible for Medicare at a time when policy makers continue to struggle with increasing Medicare expenditures.

In her HCFO study, Decker uses panel data from the Health and Retirement Study (HRS) to estimate the effect of turning 65 and becoming Medicare eligible among those who have been uninsured before the age of 65 compared to others on a broad set of measures of the use of health services and health status available in the HRS. Results show that those who have been uninsured before the age of 65 are in worse health than others, but use fewer health care services. However, those who have been uninsured before the age of 65 use more services than others after the age of 65 when on Medicare. This difference may suggest that those who have been uninsured before the age of 65 suffer from previously undiagnosed (and untreated) illnesses. Adjusting results for the availability of insurance supplementary to Medicare reduces the equalizing effect of Medicare on the use of health services, although a significant equalizing effect still remains. The findings from this HCFO-funded work are timely, as policies related to aging receiving heightened attention as the baby boomers approach the age of 65.

Decker’s past work has explored the effect of insurance coverage on stage of diagnosis and survival of breast cancer, the interdependence of cigarette and alcohol consumption, the role of health maintenance organizations in promoting the use of preventive health services, and the effect of the Medicaid program on children’s health, family composition, and welfare participation. Her work has been published in the Journal of Health Care Finance, Contemporary Economic Policy, Applied Economics, and other outlets. Full-time positions prior to joining ILC include seven years as an assistant professor of economics at New York University’s Wagner School of Public Service, and two years as a business analyst at McKinsey & Company. Dr. Decker holds a Ph.D. in economics from Harvard University, and an A.B. in economics from Dartmouth College. She is also a Research Economist at the National Bureau of Economic Research.