Income, Poverty, and Material Hardship Among Older Americans.

Using data from the 2008 and 2010 waves of the Health and Retirement Study to analyze the determinants of material hardship among individuals ages sixty-five and older, I look at five self-reported hardships: food insecurity, skipped meals, medication cutbacks, difficulty paying bills, and dissatisfaction with one's financial situation. One-fifth of the elderly report one or more of these hardships. Although hardship is more likely for those with low incomes, most older Americans experiencing hardship are not poor. I analyze whether alternative measures of resources do a better job of predicting hardship than does income relative to the federal poverty threshold. I find that spending relative to the poverty threshold does a worse job predicting hardship than does income relative to poverty. Subtracting out-of-pocket medical spending from income yields a measure that is an even better predictor of hardship. In multivariate models, I find that self-reported health, activity limitations, and disability are significant predictors of hardship. Having reliable children (as assessed by the respondent) or an able-bodied spouse reduces the likelihood of hardship. Poor health increases hardship through three channels: by lowering income, by increasing out-of-pocket medical spending, and through its direct effect on hardship. The first two of these-lower income and higher medical spending-are much less quantitatively important than the third; in a nutshell, poor health makes it harder to get by with less.