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As policy makers debate the future of the social security system and ponder increasing the Medicare eligibility age, old women are taking to the White House, to state capitols, and to the streets to fight for their right to adequate health care and prescription coverage, financial security, and support for caregiving of elderly relatives. Joining in this struggle is the National Center on Women and Aging (NCWA) at Brandeis University in Massachusetts. Sojourner spoke with Kathy Burnes, a research associate at NCWA about some of the public policy issues that face old women, and all of us as a society–issues which are at the core of NCWA’s work.

Established in 1995, NCWA has focused on economic security, health, and caregiving as they affect old women. NCWA combines the development and dissemination of research with the establishment of community partnerships, and has brought together a Council of Cooperating Organizations–including the National Council on Aging, the Older Women’s League, and the National Black Women’s Health Project along with 32 other organizations–to work on projects designed to better the lives of old women.

These projects have encompassed research on old women’s financial literacy, a national study on mid-life and old women’s experiences with health care, and research on the financial and emotional toll that caregiving for an elderly person takes on caregivers at mid-life and older.

The Center has entered the current national debate on the long-term solvency of the social security system, examining the trend towards the privatization of public pensions that dominate most reform proposals. Privatization, or concentrating responsibility for planning a pension with the individual rather than on an employer or the government, is the current focus of a research project by the Center that encompasses data from Australia, Great Britain, and the United States.

In conjunction with WISER, the Women's Institute for Secure Retirement, the Center has also developed a national center on women and retirement: the POWER Center, Program on Women's Education for Retirement. By focusing on research, workshops, and development of materials that can be used by lower-income women, the POWER Center seeks to address the gap in resources and information on lower-income women's retirement.

Noy Thrupkaew: What are the demographics of aging women in the United States?

Kathy Burnes: Over 60 percent of Americans over 65 are women. The minority population amongst the elderly in the year 2050 is going to be 20 to 25 percent.

Why do you think the incidence of poverty for elderly women is so high?

There are a number of reasons. Three-quarters of the nation's elderly poor are women, and it's not just because they live longer. The stage has been set well before then. It's not as if you hit the retirement age, and suddenly become poor. We earn less than men and both pension coverage and social security are correlated to wages. There's the wage gap - women are still earning about 74 percent of what men are earning, and that wage gap widens with age. Segregation of women into low-wage occupations in service, clerical, retail sectors often results in not only wage disparities but benefit [disparities] as well. Women are much more likely to work part-time, or temp.

The caregiving issue is also a critical issue for women. They move in and out of the labor force and these absences have a negative effect on their wages. Most women aren't getting private pensions. Women also don't save as much for all of the above reasons, particularly single women. I think all of those things contribute to poverty.

What does it mean for a low-income or poor elderly woman to be "retired?"

Retirement is a moving target. More and more women, by choice or necessity, are continuing to work past the standard retirement age, particularly older women of color. For those who are "retired," this means that they have started to collect social security at either age 62 (early retirement resulting in lower benefits) or 65. Social security is the key for women because it guarantees a lifetime benefit. It automatically adjusts to the cost of living and provides some protections to women who are widowed and divorced as well as disabled.

At retirement age, many women are kept out of poverty because they are part of a couple. The way social security and pensions are structured, it is unusual for married couples to have incomes below the poverty level. However, we all know that husbands tend to predecease their wives and the rate of divorce has increased. Once women are alone, their chances of falling into poverty increase significantly.

Over 90 percent of women collect social security but this alone is not enough to keep women out of poverty. Social security is tied to one's earnings and/or the earning of one's spouse. Though the system is structured to favor those with lower lifetime earnings (i.e. it is redistributive- the lower your income, the more you get back in social security benefits.) it was never designed to provide 100 percent of any person's retirement income. For most people, retirement income is comprised of some pension benefit, savings, in addition to social security. As I already mentioned, income from work has become an important fourth element of retirement income.

Many of the current proposals around social security reform seem to stress privatization - how would these proposals, if enacted, affect older women?

The current discussion around reform of social security [is] of great concern because a lot of the protection that social security offers is not being duplicated in any of the proposals to privatize. Even partial privatization can pose big risks for people with limited resources. The less money you have, the less you can invest and the less safely you are able to weather a market downturn.

Unlike social security, which pays a gender neutral benefit, privatized pensions or annuities are based on actuarial calculations, taking into account life expectancy. Because women live longer, there is the likelihood that a woman would end up getting a smaller benefit than a man who had the same lump-sum to invest in an annuity.

What were some of the findings from your health care studies?

The study we did focused on 700 women. Women, surprisingly, thought they were in pretty good shape. They are willing to talk about menopause issues, but they found that their health care providers were not talking about the long-term effects. Consequently, the risks that women have in later life are not being addressed: osteoporosis, heart disease. Also, women were not as aware that they were at risk for heart disease. The other interesting point was that women are not being asked about mental health, even women who have diagnosed depression.

How do HMOs and Medicare affect senior health coverage?

Well, the whole movement towards Medicare HMOs is falling by the wayside; it's really bad news. Initially, the thought was that senior plans were a good moneymaker for HMOs; they went out of their way to attract healthy older persons. For women, in particular, it has been an important answer to dealing with increasing out-of-pocket costs of health care. But it is not being seen as a profitable involvement anymore, so you're seeing a real diminution of HMO Medicare coverage.

The national discussion around Medicare is schizophrenic right now. There was a recent briefing for women at the White House on Clinton's proposed Medicare changes. On the one hand, there is a proposal to drop the age when one could get Medicare by allowing people to pay a premium or "buy in" to the Medicare system. On the face of it, that sounds good because there is a significant number of women under the age of 65 who have no health care insurance. Practically speaking, however, I think that such proposals are too expensive for individuals. It doesn't help women to have a benefit available that they can't afford to take advantage of. The underlying national policy issue is the solvency of the Medicare system. So, while it would be wonderful to extend the benefit to additional vulnerable populations, I don't know if lowering the age is the answer in light of the larger financial challenges facing the system.

On the other hand, you hear proposals to raise the age and decrease benefits to save money. That's why we are looking at the implications for raising the age eligibility for Medicare. We are concerned that raising the age would leave a larger portion of older women uncovered by health insurance.

A common misperception has always been that Medicare covered long-term care costs, for example nursing home costs (which are covered for eligible persons under Medicaid). This is not true and more Americans have an understanding of the limits of the Medicare program. In general, Medicare covers a certain percentage of the cost of hospitalization and doctor's visits and individuals must pay premiums and co-payments for this coverage. Medicare does not cover prescription drugs. Those that can afford it buy supplemental insurance to cover services not covered by Medicare.

A really key proposal is to include prescription drugs in the benefits- this would help women because we live longer and we have more chronic illness. Increasingly, prescription drugs are being used to manage these kinds of illnesses. But, the escalating cost of prescription drugs is a incredible problem.

Another national policy issue is the funding of Medicaid. While Medicare is available to almost anyone who is age eligible, Medicaid has stringent income requirements and is targeted to the poor. Even though the elderly represent a fairly small percentage of Medicaid beneficiaries, they are receiving about a third of that budget. So the whole issue of long-term care, which is what Medicaid addresses, is a huge issue, particularly for women who are the primary recipients of long-term care. There will need to be some kind of public-private solution around addressing [funding for] long-term care.

Could you elaborate on issues of concern for aging women of color?

Currently, persons of color have many, many problems unique to them, particularly around issues of health. There's a higher prevalence of diabetes among women of color, Black women in particular. Issues around access and utilization of health care are very different for communities of color. For example, there has been a fair amount of research on how people of color are managed- or not - around heart disease. Up until recently, almost all of the research was done primarily on men. And as a result, there has been an under-diagnosis and under-treatment of women with heart disease. Then you compound that with the fact that women of color tend to have less access to health care - we are talking about the need for more research around the heterogeneity of older women. Researchers cannot make sweeping generalizations anymore.

Elderly lesbian women also seem to face specific problems with economic stability - they cannot collect social security benefits from their partners, or receive compensation from the death of their partners. Could you speak to some of the challenges that elderly lesbian women might face? Inasmuch as lesbian women are representative of single women, the issues would be the same for them. Lesbians don't get any benefits from divorce, and even though divorced women are at a disadvantage, they do get something. If they have been married ten years, they get 50 percent of their former husband's social security benefit.

How does caregiving affect older women financially and emotionally?

We are working on a study on mid-life and older people who have been caregivers while they worked. It's not done yet, but so far, we've seen a correlation between wages lost and the subsequent impact on pension and social security. If you take time out to care for someone, it can affect [your own earnings].

In our study we spoke to a number of caregivers who simultaneously were dealing with their own chronic illnesses. I remember one woman telling me that she was hospitalized, and from her own bed she had to direct someone to care for her mother. Research is being done around how stress impacts people's overall health while caregiving. Caregiving takes a toll economically and physically. And there is an increasingly multigenerational effect, so you'll have people who are caring for children and parents at the same time.

One of the policy issues is how to credit caregivers, primarily women, for their caregiving. It is not paid labor, but it has an incredible economic value for society. For better or worse, caregiving has been more heavily concentrated among women, so we need policies that suggest and recognize that contribution from an economic and health standpoint.

What do you think we should be fighting for? What can we do to support elderly women in terms of changing public policy?

What we should be fighting for around economic security is pay equity, increased access to occupational areas currently dominated by men, greater numbers of women in positions of leadership. We should also support efforts to credit caregivers and/or provide increased opportunities for flexibility in the workplace along with greater access to health and pension benefits. On the health care front, continued expansion of research around women's health issues; increased access to and quality of health care, particularly for low-income women.

Noy Thrupkaew is the news editor of Sojourner.