Spencer Perry: health economics professor at ISER

Spencer Perry, PhD, is an assistant professor of Economics and Public Policy at the Institute for Social and Economic Research (ISER) at the University of Alaska Anchorage. Before earning his PhD in Economics at Arizona State University in Tempe, he worked for three years at the Federal Reserve. He moved to Anchorage a year ago when he began his job at ISER where he focuses on topics in health and public economics.

This episode was recorded on January 30, 2026.  

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a few papers now actually, have found that one really important thing that access to Medicaid through the Medicaid expansions did was reduce mortality outcomes. So reduce deaths, the likelihood of dying, for people in this 55 to 64 age range. Now, I also find that this expansion of Medicaid is gonna reduce mortality. Uh, and that's great, right? We want people to live longer and healthier lives. But that reduction in mortality has costs associated with it. If people are living longer and these are people who do have chronic conditions, they're gonna have relatively high healthcare expenditures. So in the long run, uh, this ends up costing more for the Medicare program- even though these people initially spend less. But I think the, the right thing to keep in mind is that, what is the goal of healthcare spending? It's to keep people alive. It's to keep them healthy, Welcome to the East Anchorage Book Club. I'm your host, Andrew Gray. The purpose of this podcast is to tell the stories of Alaskans of interest and importance. Today, our guest is Dr. Spencer Perry, who is an assistant professor of economics and public policy at the Institute for Social and Economic Research at the University of Alaska Anchorage. Before earning his PhD in economics at Arizona State University he worked for three years at the Federal Reserve. He moved to Anchorage a year ago, and he began his job at ISER, where he focuses on topics in health and public economics. Uh, I have to just say something before we get started, listeners. I recorded over ninety-five interviews last year for the podcast, and I actually recorded this interview with Dr. Perry in January when he was in Juneau, and I lost it.. I forgot I had the audio. Anyway, long story longer, this episode was intended to be released several months ago. However, all of it is relevant. All of it is current. Spencer Perry, welcome to the podcast. Hi. Happy to be here. Uh, tell us about your early life. Uh, well, so I grew up mostly in Chicago, Illinois. Went to high school there and played football. Uh, I actually ended up playing collegiate football at Davidson College, uh, in North Carolina where I did my undergrad. It was a great opportunity to play sports in college, but then I, uh, got injured my sophomore season and, uh, stepped away from sports and got really focused on economics, actually. Do you think if you hadn't gotten injured that you wouldn't have gotten in- interested in economics? So I was on track to major in economics before that, so I was interested in it, but I think I had this like, hole in terms of like interest and time in school, and I was like, "Oh, well, maybe I'm gonna get really into this, uh, this whole economics thing." So I, I do think that put me on the path to end up going to graduate school, and probably without stopping playing football, uh, and maybe even stopping at that specific time, I, I maybe would not have ended up on that track. And kind of fortunately, I think I The injury that I got my sophomore season was a pretty severe concussion, and I worked pretty closely with my faculty advisor who was an economics professor, uh, and I think actually our kind of bonding through that time made me more interested in pursuing economics more seriously, were there economists in your family? No. There were no, no economists in my family. None of my, uh, family went to graduate school. So, uh, it was not something growing up or even, you know, at the start of undergrad that I even considered, going to get a PhD in economics. That, that seemed, uh, like a totally foreign concept. Uh, I originally wanted to study physics in undergrad. I think I found the workload a little challenging, uh, initially with balancing school and, uh, sports. And I probably skipped class too many times and that, that kind of der- derailed my physics career. But then economics was kind of there as, as the alternative, and I ended up becoming kind of more interested in that, uh, than I ever was with physics, so. So then you went to work for the Federal Reserve? Yes. I was a research assistant for the Board of Governors in DC for three years. I worked in a section, uh, that looked at real estate financing and worked with some great economists there. Uh, and that was an opportunity for me to kind of build up my research skills on the job, and also take some courses that I didn't take in undergrad that were helpful for building my kind of resume for graduate school. Do you have warm feelings about the Federal Reserve? Like, was that a good time in your life? It was a, it was a great time. Uh, I think that the working for the Federal Reserve, and at that time, nowadays for economists people who wanna go to graduate school, uh, it's almost required that you do what's called a pre-doc or some sort of, like, after you graduate from undergrad, you do some sort of research assistantship, uh, whether that's, you know, paid or unpaid work, consulting with academics or, uh, maybe very low-paid work. And the Fed was kind of ahead of the curve in that s- sort of pre-doc, uh, or pre-doctoral research assistantship. Both in terms of, like, the opportunity it provided, you're getting a- access to a lot of really smart people, uh, just on a daily basis, but it also paid quite well. Uh, and living in DC was, at that time in my life, was, was quite fun. Um, I ended up meeting my partner there, and now we live in Anchorage. So, uh, yeah, no, it was, it was great, and, uh, I still talk with some of my mentors from, uh, the Fed. And one of my mentors at the Fed actually encouraged me to accept the job at UAA when I was kind of deciding what, what did I wanna do career-wise. So yeah, it was, it was a great time and a really good opportunity. And I don't think I would've had nearly as much success in graduate school or even had as many options of graduate schools to attend as I did, uh, had it not been for my time there, with attempts to fire Federal Reserve- Chair Jerome Powell and Lisa, what's her name? Lisa Cook? Lisa Cook. Yeah, uh-huh. Trying to get her removed from the board, it just seems like somebody who's, has warm, fuzzy feelings about the Federal Reserve would have feelings about attempts to dismantle the way we do it. Yeah. I think, uh, regardless of your politics I think that Federal Reserve independence is really a, a truly, uh, important part of the institution of the Fed. And I think markets are aware of that. Most people, the rest of the world is pretty aware of that. And so yeah, it's, it's unfortunate to see that kind of, uh, um- insulation from, uh, the executive branch being deteriorated. Well, I was there during the tail end of Obama's second term, and then during the first couple years of the first Trump administration. And I think that was a thing that was on people's radar of being a little concerned about independence. Uh, but it was almost not really a conversation that anyone had, 'cause it was so, taken for granted that, nobody would, no one would go in that direction of attacking Fed independence. Uh, so now being well removed from it i'm happy I'm not there now. But it is a shame to see. Federal Reserve independence seems like something that has bipartisan support. Uh, but we'll see. I mean, you know, uh, Donald Trump uh, nominated Powell the first time around, and now he's, uh, n- uh, public enemy number one, so who knows what, what'll happen? So after that you went to grad school? Yes. And where'd you go? Uh, so I did my PhD at Arizona State University in Tempe. And yeah, that It was a, another, I think, great experience, a good place to be at that time in my life. And did you know what you were gonna focus on when you got to grad school, or is it something that you found yourself- yeah. I didn't know exactly. So, I have always had an interest in, in healthcare in health policy. I think my Actually, in undergrad I did a thesis assignment, research assignment on a combination of healthcare and migration. Actually looking at could we potentially solve some of the problems that we face with the healthcare workforce by, uh, expanding, uh, or making it easier for doctors from other countries or healthcare professionals from other countries to migrate to the US and start practicing, or kind of reduce some of those- Mm-hmm practicing barriers. Uh, and then what would the consequences be for, you know, the, the- Mm physicians and providers who are currently in the US. And that, that project was almost more motivated by the migration side than the healthcare, so. Did it show that if we did that it would be helpful? Well, so I wasn't able to look actually at would it be helpful. I think But I was able to show that it wouldn't reduce, uh, wages for the existing, or wouldn't significantly- Right reduce wages. So the pushback that that would depress the pay that our- Mm-hmm homegrown physicians were getting- Mm-hmm that was unfounded. Yes. Now, I will caveat that with, you know, that was my undergraduate, uh, research thesis and, I've never published that in a peer review journal. And I don't know if it at this point would have a- That be 100% credible, I don't stand behind it at the same level I stand behind the rest of my work. But that was suggestive evidence to say that, yeah, this would prob- would have a limited effect on native provider wages. But just expanding that supply of providers presumably would be beneficial for the healthcare system across the board, right? So- and from my perspective, looking at wanting to reduce the cost of healthcare- I do not see a reduction in salaries for some specialists to be a negative outcome. Yeah. No, I mean, I, I think that, yeah, whether or not a reduction in, uh, pay is, is... that de- depends on where you're standing. From the provider's perspective it's negative. I think the maybe longer run concern associated with reductions in pay is how is that going to discourage, uh, or, people from going to medical school and joining those different types of specialties. Currently, there's certainly arbitrage that can be had with going into one specialty versus another. And, you know, do we think that those specialties are, uh, in terms of the health outcomes they produce, like generating as much value that's justifying that discrepancy in salary between, say, you know, like a dermatologist versus a primary care physician. But- How long have you been in Alaska? I've been in Alaska seven months, I think. Okay. Just about. Yeah, I moved up in July. Well, we have some specialists who make Multiple times more than the average salary in Washington, State. Yeah. Yeah. My joke, but it's not a joke, is like, well, do you think they'd be willing to do the job here for double? Like, maybe if What if they just got paid double- what they made in Washington State? Does it need to be 10 times higher to get them to move here? Obviously, I think that double would be plenty. Yeah, I mean, I think that's an empirical question at the end of the day, whether or not, uh, e- you know, what is the kind of wage premium or kind of compensate W- what, what we call in economics is, like, a compensating differential, people need to be paid in order to, be pulled into working in Alaska. Uh, I do, I do think that the one of the I mean, I have a somewhat limit- I would definitely say a, a limited understanding of the unique healthcare landscape in the state so far. Uh, but one thing that I am at least kind of, like, briefly been exposed to is that there is just a limit on the supply, right? We don't have the kind of competition- And there's been, there's been sort of a conglomeration of s- like, uh, I guess, like, a monopol- the creation of monopolies is what some folks have observed- where essentially certain specialties there's large practices in Anchorage, and most people use that prac- Mm-hmm the, the, and it, and that's happened over time, where it's just reduced the number of individual offices. They've all gotten together- Mm-hmm and they kind of have a control of the market. Did you decide you were gonna specialize in healthcare policy while you were in Arizona? Yeah. So I, um, had my, my research agenda in graduate school was a little bit broad, uh, and my research interests are, are quite varied. But healthcare was something I gravitated to naturally because of my interest, uh, and my exposure to h- health economics previously. And then I think also at the end of the day, sometimes we just end up in a field by some combination of interest and luck. Uh, and I think I just happened to come up with a interesting research question that was combining a few things that I'm interested, which is, you know, health elderly or kind of the aging population and also insurance, which, uh, this kind of, these questions around risk and uncertainty are broadly interesting to me, so was that your research on providing Medicaid to 60 to 64-year-olds and s- yeah. Mm-hmm. Yeah. So I guess, like, talk about that project, 'cause I love it. Yeah. So, my kind of main dissertation research in graduate school I was interested in this question of how does access to, health insurance at different points in your life maybe affect your longer run health outcomes? And this is a, a really challenging question to answer empirically just because, there's a issue called adverse selection, so there's these interesting selection patterns of people who have a higher demand for insurance are more likely to buy it, and sometimes those people are also sicker. If you're sick and you need a lot of care, you're more likely to go out and get that care. So it's difficult to then tease out, well, these people had insurance earlier in life and then maybe some of the people who didn't, and then say, well, 10 years down the line, who ended up being healthier? Uh, and that problem of selection ends up being really challenging to try to answer these questions. So, um, what I did was I focused on a pretty unique but important subset of the population of people who are aged 55 or 60 to 65 and I asked if some of these people were to get access to insurance when they otherwise wouldn't have had it, ages 60 to 64 what were their outcomes after they turned 65 and then are eligible for Medicare? And the kind of policy that I used to try to answer this question is the Affordable Care Act's Medicaid expansions. So what we're thinking about is in a world without the Medicaid expansion, there are some people age 60 to 64 who are gonna go without insurance, or maybe they're gonna have private insurance through their employer or, or maybe that, that they're buying on the healthcare exchanges or, or, or just other sources of private insurance and the question is, is if we gave those folks, some of those folks Medicaid instead of either uninsurance or these, these, uh, various forms of private insurance, how does that affect both their initial response to that insurance, so their initial healthcare expenditures and utilization in that age range of 60 to 64, but also then once they turn 65 and go onto Medicare, uh, what do their health expenditures look like at s- ages 65 and maybe through age 68? Mm-hmm. Um, and interestingly, what I find, uh, is something that's in that kinda first stage of what happens when we give people age 60 to 64 Medicaid, uh, I find something consistent with the literature that these people are more likely to utilize care and- interestingly, I find that some of the types of care that people are using at that time are things that we might expect could have some sort of benefits in terms of kind of chronic disease management. So for example, I find actually that people are more likely to get diagnosed with diabetes in that time period if they got Medicaid. But the reason is, is now they're gonna go to the doctor, uh, and then maybe they're able to manage that diabetes earlier in life, and that could reduce some complications down the line. Uh, and consistent with that, I find that these people, once they turn 65, end up consuming less healthcare and are healthier than the people who, prior to turning 65, did not get access to Medicaid through the ACA's expansions. Right. You had numbers. You had that the upfront costs for the folks who get Medicaid for the first time at between 60 to 64 112% increase in immediate expenditures. Mm-hmm. But a 77% less needed after they turned 65 and were gonna access Medicare. I guess like, I don't know if your research did it, but I mean, like, over the long term- Mm-hmm is it a cost savings? So it's a little complicated. One, one of the really interesting things that I find in my, in that project is that there is a kind of If you did just a basic accounting exercise of saying like, what are the initial dollars, uh, that were spent versus the dollars that were saved once going on Medicare, I do find that there does appear to be some cost savings. Uh, but one of the limitations of that initial exercise that I do is I can't observe those people through the remainder of their life. 'Cause you gotta, like, look out 20, 30 years. Yeah. So if they're, if they're, uh, you know I can maybe observe them from age 60 to 68, uh, but if they're gonna live until they're 85, I don't know what those additional healthcare expenditures- Mm look like. And actually, not my research, but a few papers now actually, have found that one really important thing that access to Medicaid through the Medicaid expansions did was reduce mortality outcomes. So reduce deaths, the likelihood of dying, for people in this 55 to 64 age range. Now, I also find through an additional modeling exercise that this expansion of Medicaid is gonna reduce mortality. Uh, and that's great, right? We want people to live longer and healthier lives. But that reduction in mortality has costs associated with it. If people are living longer and these are people who do have chronic conditions, even though they're managing them better, they're gonna live long- a longer period of time, and they're gonna have relatively high healthcare expenditures. So it's hard to say and I mean, actually what I find is that in the long run, uh, this ends up costing more for the Medicare program- even though these people initially spend less. But I think the, the right thing to keep in mind is that, what is the goal of healthcare spending? It's to keep people alive. It's to keep them healthy, right? There's been a lot of arguments that since our life expectancy has extended so much longer, that really our retirement age should go up to 68 or 70. Mm-hmm. And if we were to keep people healthier but also keep them in the workforce full time- then we might, there might be enough economic contribution from that population- Yeah, yeah. So- to counteract the higher cost of keeping them alive- those additional years of life expectancy. Yeah, so, so regardless of the any adjustments that we might make to, let's say, you know, a, a ability to claim Social Security- Mm-hmm what, what the age threshold is- Mm-hmm whether that's 65, or if it were to go up to 67 or go down to 62, for example what you're keying in on here is what's called a fiscal externality. So expanding Medicaid if it is improving health outcomes, it could also increase revenues for Social Security if people decide instead of claiming Social Security early or claiming it at 65, I'm gonna continue to work because I am healthier. On the other side, though, if people are living longer, Social Security's also paying them out for a longer period of time. Uh, so ultimately, the, the exact direction of that fiscal externality is hard to know for sure. I try to quantify that in, in my analysis. Uh, and I guess the main takeaway from my project is even though this actually does increase overall government outlays through both, uh, the initial in- increase in Medicaid expenditures and the long-run increase in Medicare expenditures because these people are living longer, and an increase in Social Security payments because these people are living longer, the value of those additional dollars spent to the individuals are actually greater than a dollar. So each dollar the government's spending is generating more than a dollar's worth of value to those people receiving the benefits. Uh, and I think I find it's around a dollar and 15 cents or something. Uh, so you know, the government could spend money on a lot of things, healthcare for 60 to 64-year-olds, and, and, uh, our elderly population is one of those things. They could also spend money on education for younger people or for children. And- I think a reasonable benchmark of is this a dollar well spent is this dollar generating more than a dollar's worth of benefits to recipients? And I, I do find in this case that that's true. Uh, it might not be true in all cases when we're talking about the government spending money on healthcare, uh, but that's again, you know, a question that should be taken on a case by case basis. So bouncing back, you did this project- Mm-hmm for your doctoral dissertation. Mm-hmm. And you had met your partner in DC? And so she went with you to Arizona? Yeah, so she, she has a PhD as well in, uh, marine biology. Oh, okay. So she's, and she's a, a, a policy researcher. She does research on, uh, ocean plastic pollution. Oh, okay. Um, so we both did our PhDs at Arizona State in different programs. And then now, yeah, when, when I took the job up here she- I guess I wanna just find out, like how'd you find out about the job? Oh, yeah, yeah. Um- What, what led you to take the job? Yeah, so in the economics profession when you finish your PhD, uh, you go on the job market, and there's a very, uh, centralized and coordinated process of matching new PhDs with jobs whether that's jobs in government or industry jobs or academic jobs like the one, uh, at UAA. Um, and so I, I think the normal strategy for a new PhD is to apply to, you know, over 100 jobs because they're all posted on more or less the same website, and you can apply quite easily. It's almost like a common app style, uh, application process. When I saw the University of Alaska Anchorage position, I was immediately interested because I'm a big outdoor enthusiast, skier, uh, rock climber general outdoors man and, uh, and recreator. Uh, so I was very excited, uh, when I saw the job and then on top of the location in Alaska, learning more about ISER and the kind of policy opportunities was something of interest to me. Having worked at the Federal Reserve and being in kind of a more policy-oriented space, I saw the value of that work at the federal level and being in a state like Alaska where there's a lot of opportunity and kind of a, there's not a ton of us here, right? Not a ton of, uh, policy experts. So you as an individual can have kind of a- Big fish, small pond. Yeah. Big fish, small pond. But yeah, and, uh, but it's also, uh, you know, it's important work 'cause it's a state with a lot of unique challenges. And so I Learned about the job, got very excited. I ended up having a few options of jobs to choose from. Some of those jobs were actually government jobs, which I was really glad that I didn't accept because had I accepted, I would've gotten fired almost immediately because of the, the probationary employee cuts at the start of the administration last year in 2025. But I also was fortunate that, So I graduated from my PhD at Arizona State in the spring of 2024. Uh, and then I did a year working at the University of Southern California Center for Social and Economic Research, uh, which is, sounds kind of similar to- Yeah the Institute of Social and Economic Research up at, at ISER. So, so I worked there as a postdoctoral scholar for one year and was able to defer my start position at UAA for that year, and then came up here last summer. And did your partner get a job in Anchorage as well? So she got, she got a job working for a, a, a NGO called Ocean Conservancy, and her, I guess technically her job is based in Portland, uh, but she works remotely. And there is an Arctic group at Ocean Conservancy that's based in Anchorage, so she has, uh, an off- office space there that she's able to access and some colleagues up there that she doesn't work directly with at this point, but it gives her at least kind of a sense of work community. We have a lot of Uber drivers in Anchorage. And you published a paper in the Journal of Labor Economics. Uh, it's not published yet. Oh. It's, it's under review still, but yeah. Got it. Okay. Well, you have a, a paper under review- Mm-hmm about college students and their, and the way that they're able to juggle- being full-time college students and taking advantage of the gig economy. Mm-hmm. I guess, can you talk a little bit about what the What your research showed? Yeah, so, so that project is looking at data that's generated from a unique partnership between Arizona State University and Uber, where Uber, uh, if for a certain set of Uber drivers who meet a number of requirements, I think it's something like they complete over 3,000 trips over their kind of Uber tenure and they drive with a certain level of frequency such as they meet these kind of standards, uh, I think it's a three-month rolling basis status that they have to maintain, uh, they qualify for a kind of completely subsidized tuition degree-seeking program at Arizona State at ASU's online only program. And ASU has a really robust online education infrastructure, and in fact, if you get in one of the degree-seeking ASU online programs and you graduate, your diploma does not say that you went to ASU online. It's just you have a diploma from Arizona State University. It's not distinguished between whether you were in person or a fully online student. Uh, so this was a, a unique opportunity to try to understand how do these Uber-driving individuals, how are they able to make trade-offs in terms of the time spent, whether that's time spent driving, trying to earn money in this kind of gig economy role for Uber versus how much time they wanna spend studying for their classes using the online platform that ASU provides, right? So, what we find interestingly is that, when drivers spend more time studying, they tend to reduce their driving hours a little bit. But driving more doesn't tend to crowd out study time. So there is this trade-off where, where students, they end up driving a little bit less in order to keep up with their coursework. But they're not crowding out study time in order to drive more if there are good labor market opportunities. Like the wage, for example, uh, that they could earn in a given week is relatively high because, I don't know, maybe there's a convention going on in town. And so what's interesting about this is that the kind of shorter run opportunity cost for the drivers of taking classes is quite low because they crowd out some driving time, but not very much in percentage terms in order to do their coursework. Um, and because they're not diminishing their coursework to drive more when there are good opportunities, they're not really losing any performance in their courses. One of the limitations of this though is that we, we don't at this point, and we're actually working on getting these data to try to beef up some of the conclusions of the paper, uh, we, we aren't able to observe a long enough time period to see how many of our drivers that we're analyzing actually stay in the program and end up graduating. We did a survey of the drivers and, and they approach it very seriously as if they want to graduate. And you know, a lot of students are enrolled for, multiple years, so they're, they're certainly working towards their degree in the data that we can see. Uh, but we, we don't know, you know, what is the actual rate of graduation. But ultimately what we, we take away from this analysis is that this kind of combination of flexibility coming both on the working side, you know, working f- in gig economy jobs, and on the education side of having this online asynchronous flexibility is a potentially viable path forward to increasing access to higher education in the US. And we think that these types of students who have what we might describe as maybe marginal attachment to the labor market, they're working in these gig jobs, a- and kind of a marginal interest or marginal attachment to higher education, 'cause they, a lot of them are part-time students. This is a really feasible way to bring those marginal students into higher education. Now, it's unlikely that everyone can be part of this partnership and get it fully paid for by Uber or by ASU. But, as the access to online education or the technology develops and the cost of providing online degrees decreases, uh, it'll become just more and more, uh, viable for drivers. And then they also don't have to make, uh, these sacrifices in terms of earning earning money, uh, while they're in school, which I think for a lot of people is a barrier to, taking classes. Even if you just wanna take part-time classes at night, you still have to go in person in the building. Uh, and I think our experience with COVID, uh, and kind of moving a lot of university courses online has almost provided an additional opportunity to build out that online education infrastructure. And, ideally combining the- these two types of flexibility is gonna be a way to, expand access to higher education. Yeah. Well, and it has definite applicability to the state of Alaska- Mm-hmm which is extraordinarily rural. Yeah. Lots of folks off the road system- having access to a variety of higher education opportunities with in, with better internet- as time goes by. Yeah. It's, um It would be awesome. Yeah. No, and I think you know, I, I taught a online asynchronous course at UAA in the fall, uh, and had a good experience, and I think UAA is providing a lot of courses to make that option available to people in Alaska, in particular for working professionals who wanna go back for graduate degrees. So, uh, my class was an MBA course, um, but I think this is true for the, at least in the business school, I'm familiar with, like, the master's in public policy and master's in administration, uh, as well. So I, I have a question about the asynchronous- Mm-hmm nature of it. So folks could watch the lecture at their convenience. Mm-hmm. And so when you actually deliver the lecture, were you delivering it to no one? I was just recording myself with my slides in my office by myself, yeah. Gotcha. Do you watch it back? Unfortunately. Yeah, I bring it- It, it's, it's painful to record I bring it up, um- Because I might need to have you come and testify in judiciary. Mm-hmm. We have been talking about ways of expanding UAA course offerings- to the prison system. And by the way, Arizona has done great things with- Mm-hmm the way they offer educational opportunities- in their DOC system. But because some of the pushback that you get is that, "Well, we can't allow the inmates to have unrestricted access to the internet." But in this asynchronous style course that you taught, like- Mm-hmm potentially I'm thinking that all that could be there is the lecture, and that they just could watch it when they can get to the computer lab. Yeah, I, I mean, there seems like there I, I mean, I'm not 100% certain, but I think there's The technology exists to restrict the, you know, web pages that you can browse. So if you limited the access, the internet access to, the course Blackboard page, whereas it's not just It has all the lecture videos, but it also has all the assessments and the exams and all those things, uh, and you made those available, it seems like, you know, you just have that one web page accessible- Right close off internet access to everything else, and then yeah, that seems like a, a pretty reasonable thing to do i- if that is, you know, is the goal. So last thing. I, you have not been in Alaska that long. But I guess can you talk a bit about what you've observed, what you've learned, what are the problems that you're gonna be working on? Yeah. The, the first thing I observed is that Alaska's beautiful. Uh, but in terms of, uh, research, I think one of the things that I'm really excited about in terms of healthcare policy and, and healthcare research for the state, is the opportunity that the Rural Health Transformation Program presents. There's, you know, a lot of interesting challenges that the state faces in terms of increasing both the kind of cost-effectiveness of care and access to care. And sometimes those things can work together, sometimes they're in tension. And these funds that are gonna be provided I think provide a really unique opportunity to try to experiment and see what works at achieving the goals of increasing cost-effectiveness while also maintaining or imp- even improving access, particularly for rural communities, but really for all of Alaska. And I think, W- there are a few projects that we are, uh, at ISER interested in pursuing you know, writing proposals to work with some of those funds. Uh, we're also trying to find ways to work with the Department of Health to maybe integrate some more rigorous kind of evidence-based or evaluation strategies. Um, i- that's, you know, maybe wanna cut that out 'cause that's really preliminary. We've, we've very r- briefly talked with some of the DOH officials about this. But I think that's a really exciting opportunity. Another thing that I've been fortunate to work on already in addition to the physical plan analysis, uh, the, for which I've provided some support, but is looking at the contribution of older Alaskans in the state. So ISER p- uh, wrote a br- policy brief, I think in 2005 or 2006, trying to analyze or estimate what is the contribution of older Alaskans. And then also some of the challenges that the state faces in terms of the demographic shift and the graying of, of the state. And, uh, I was able to update some of those numbers and finding that, you know, the contribution of older Alaskans has grown significantly since then. And in fact, it's kind of become a, a larger share of economic activity in the state than it was back then. Yeah, I'll re- uh, as of 2023, retired Alaskans age 60 plus generate roughly $6.7 billion in direct economic activity- which is significantly larger than the annual value of seafood harvests, mineral production, and tourism in the same period. Yes. Yeah. And you know, it's funny, I, I misread it when I read this before you came because I missed the part retired, so this is not economic activity being caused by high-paid workers. So this is the economic contribution I use the same, definition as the, the 2005 report- Mm-hmm of age 60 and up who are retired. Uh, and what we're thinking about in terms of their economic contributions is how much money are they spending, so how much are they consuming. So, and that could be financed from maybe they are working part-time even though they're retired, or this is coming from retirement income or other sources of income. Uh, and, and adding on to that, how many like federal dollars are coming into the state because of their presence. Basically health- well, and their healthcare expenditures, right? Mm-hmm. So this is mostly from Medicare, but also Medicaid for the dual-eligible population. So those are kind of the three big categories of, it's just like personal consumption for these, these folks, uh, and then their healthcare expenditures that are, not necessarily paid out of pocket by them. I guess what policy implication does that have that we, that our older population has a bigger economic impact than we expected? So I wouldn't necessarily even say this is a bigger impact than expected. This is kind of s- growth that you would expect just given the, the demographic shifts. I think the real things to consider policy-wise in terms of this growing economic contribution of older Alaskans is just thinking about, well, what are the needs of this population as it becomes a greater share? And, you know, how can we encourage these folks to stay? And maybe that's gonna require some changes to policy to do that. I was fortunate to present some of the preliminary work that I did for this on, uh, to the Alaska Commission on Aging. And, and there were a couple of things I highlighted in terms of challenges that I see, but there's myriad challenges that I'm not necessarily gonna discuss. But the, the two big ones from my perspective are out-migration of older Alaskans. So Like I said, you know, what are the kinds of things that we can do to change policy to meet the tastes of these folks? But also what do, uh, what is this gonna mean for kind of healthcare expenditures in the state? And in particular, thinking about questions related to cognitive decline and Alzheimer's and dementia, which is another focus of some of my research. And, as our population ages the rates of cognitive decline and Alzheimer's and dementia are only gonna grow. And having a non-trivial share of the population with those types of ailments present pretty significant challenges for communities, but also the healthcare system broadly. So we bought our house from an elderly couple who were lifelong Alaskans who left Alaska because they felt it was just too difficult for them to live here, and they moved to Seattle. Mm-hmm. So their house became available, and we love it. We're super grateful. We did a direct purchase. Mm-hmm. But I don't think, like, I have an, I'm an isolated story. Mm-hmm. I think that, lack of available housing, in Anchorage in particular, you've got older folks who are staying in their bigger houses 'cause they can't afford to move to a smaller one. And the smaller one maybe isn't available. So there's this benefit when they leave the state- that their houses become available. And then what I'm also hearing you say is, like, if we kept them here, that would really drive up healthcare costs, since the older someone is, the higher the cost of their healthcare. Is it s- is it still a, a benefit to keep them in their houses- Mm-hmm and, and have their healthcare be happening in Alaska? Yeah, I think, I think the, the question that we have to ask, and it's not a question that economics can answer, uh, or that I could answer but, you know, we could use tools and analysis from economics to maybe guide our thinking about the question, is what, what kind of state do we wanna be and how do we want to, who do we want to feel welcome in Alaska? And I think that there are, like I said, there are challenges associated with, uh, an aging population. And, I don't, I don't Y- yeah, like I said, I don't have an answer to, to do this- Well, I don't, I don't give an answer yeah Like, I think the bottom line is, is that- maybe the solution isn't to just let them leave. It's to build housing that's- Yeah, well, yes more appropriate for seniors. Yes. Uh-huh. To, um- Yeah have sen- more senior communities- Mm-hmm of single-level homes that are- Yeah attractive to older folks, that are easier for them to navigate- Mm-hmm that have well-plowed sidewalks and- uh, they're not gonna, like, slip and fall and break a hip. Yeah. You know, which is My neighborhood doesn't have sidewalks. And, you know, I mean, it's like- Yeah, yeah. Okay it's not s- it's not senior friendly. No. Yeah, no, that, that's true. I mean, yeah, that I think that is the, you know W- when we're trying to think about what would a state that is amenable to a, to the senior population, what would that look like, and how is that different from w- where things are currently? And I think you're exactly right to zero in on things like housing. I mean, move- being an older person in a large, a house, especially if you're, you know, if you're a widow or a widower, and you had a big house, but now it's just- And your kids have all moved away your kids are gone, and it's just you, maintaining a big house is a challenging thing to do. My grandma, she lived to be 101, and she lived in the house that her and my grandpa built together, uh, in the '50s. She lived in the house until the day she died. Fortunately, it was a small, manageable house with no stairs. But, um, uh, but yeah, th- it, it's a challenge, and I think that there are some structural barriers that exist to moving the state in general towards that version of, o- an Alaska where seniors are going to feel more welcome and be able to thrive, I suppose. Um, and yeah, changing potentially regulations around housing and building more housing, I mean, that's a, that's a problem that is not just something that seniors face, but a lot of, a lot of people in the state. But it, it would certainly help, uh, that community as well, I think to make more have more affordable housing and just more options especially for people looking to downsize. Dr. Spencer Perry- Mm-hmm thanks so much for being on the show today. Yeah, thank you. I really appreciate it. Thank you listeners. If you like what you heard, please subscribe, rate, and review us. To contact me, email rep.andrew.gray@akaleg.gov or call 907-269-0123.