#but even just moving away from employer-sponsored insurance would help a lot

[sufficientlylargen]

One thing that's bugged me a bit about a lot of discourse I've seen following the assassination of the United Healthcare CEO is how people talk about coverage denials, step therapies, etc. like they were personal failings of UHC, as though the solution is "United Healthcare should be more benevolent" instead of "healthcare should not depend on corporate benevolence". Like yes, UHC denies more claims than most insurers, and that is terrible and people who choose to work for them should be ashamed of this, but also we should all want to live in a world where if you have an expensive-to-treat medical situation you aren't relying on a for-profit corporation agreeing to pay tens of thousands of dollars for it.

[chxckens]

some life updates... this is a big chunky post, just for those who care abt what’s happening w me. i feel like a dvd player

i had a difficult conversation with my mother yesterday where i was able to explain how difficult working has been for me with my health conditions and how i’ve been struggling to keep things like stable income for rent and health insurance because of it. like, i’m on long-term disability leave from work right now but i’m not even sure that i’ll be able to return to working full-time in the same capacity because of my health. and it isn’t a matter of finding a better job or a more flexible job- no employer likes that i keep growing tumors and getting cancer. like, that’s not a particularly good trait for an employee. legally they can’t fire me for it but i feel terrible not being a reliable employee because of it, it makes me feel like shit (even though my self-worth shouldn’t be derived from how Good a worker i am. i know this.)

my mom was taken aback somehow by how deeply it has been affecting me (of course it has. i’m always stressed.) and she actually literally said, “i think that we- that i- have been holding you to impossible standards considering your circumstances.” and that meant a lot. she said, “no, you don’t have to be financially independent right now, fuck it. i have money, move back home for now and let’s just make life comfortable for you.” i can’t explain how surreal it was to hear all that from her because she’s always been the one pushing me to Be Normal (work full-time, live independently, etc.) but i think i got through to her yesterday about how impossible this all feels.

it’s just, like- at this point i have had three separate cancers and i am only 28 years old. i will likely have more cancers down the road because of my genetic disorder. the three cancers isn’t even counting the benign brain tumor i had last december, that was a fucking freebie. nothing about the life i’m living is normal and it was killing me trying to work forty hours a week and keep house and take care of myself on top of all the medical misery.

so like....

i’m not HAPPY about having to live with my mom again ‘cause we don’t cohabitate super well (i love my mother dearly! but i would say this to her face and she would agree- we are both hermits and like having our own space) but there’s a wing of her condo that she’s fixing up that has its own entrance/exit so i can have like. a mini apartment in her condo. hopefully we can figure out enough systems that’ll make it manageable

it is a fucking miserable bummer to have to constantly curb my mother’s plans. she bought some land out in michigan and has plans to build a house out there and she’s been so excited about it and talking about it constantly and i’ve seen the land too, it’s lovely. but now she says she might sell it so she can take care of me. and that’s fucking wretched it makes me want to cry again to think about. but she reassures me, says that the money is better spent closer to home right now. on me. i don’t want her to sell the plot, i told her i’d move out there with her but she thinks it’s too far away from any major medical center for me to live there. because i have my perpetual ball and chain wherever i move- i have to be near a hospital. a cancer center, preferably.

but i can’t complain because it’s huge that she’d be willing to help me survive without working like i have been. and she’ll help me pay for health insurance that isn’t employer-sponsored so i don’t, like, die... that’s huge for me... definitely don’t want to die....

it does make me nauseous, of course, in a survivor’s guilt type of way- i am hyperaware of the fact that the only reason i have this option is because i come from a family with money and that my mother is offering it. i am fully aware of the fact that i would have died several times over if not for the fact that my mother happens to be sitting on enough money to care for me when i’ve been sick and out of work. having grown up with that wealth, it wasn’t until i got cancer for the first time that i was truly radicalized, politically. the system is horrific and even with my immense privilege it is still impossible to navigate when you’re sick/disabled. none of you need me to tell you this, but it is on my mind a lot, especially when it feels like i’m getting handouts like this

so, y’know, there’s a lot of guilt/shame here. and i’m trying to remind myself that this isn’t “giving up” it’s “finding a way to live that doesn’t feel like torture.” i think this is the only decision i can make right now?

i’ll start packing up my stuff and get rid of a bunch of it so that i can fit in my mom’s space. that’s prolly the first step here. the rest, we’ll figure out, i guess? i still feel queasy and like crying about this to be honest. being on my period probably isn’t helping LMAO

[orbemnews]

Will This Boom Go Bust? More questions than answers The bull market is now a year old, with the S&P 500 up nearly 75 percent from its low point at this time last year. That recovery, The Times’s Matt Phillips writes, is “a testament to the unbridled enthusiasm that let investors shrug off the economic carnage of the pandemic and buy stocks — and pretty much anything else.” The factors that have stoked the rally also raise questions about whether it can last. Is this a bubble? Analysts are wary of using the B-word to describe the market as a whole, despite the best 12-month stretch for stocks since the 1930s. But John D. Turner, a finance professor who wrote “Boom and Bust: A Global History of Financial Bubbles,” is convinced: “If I had to put money on it, it looks like a bubble,” he told The Times. A bubble has three key ingredients, he said: ease of trading, access to credit and mass speculation — all of which are in ready supply. All that’s missing is a spark. What could it be? Can retail traders keep this up? A surge in individual traders — who have access to commission-free online trading apps, government “stimmy” checks and lots of downtime — has become one of the biggest forces in stock markets. A big test of this trend’s durability will come if and when Robinhood, which filed confidentially to go public yesterday, begins trading itself. Can the brokerage — whose C.E.O. faced tough questions from lawmakers and several lawsuits over its halting of trades — endure the scrutiny of public market investors when it opens its books? What’s going on at GameStop? Few investors beyond true believers think that the surge in the video game retailer’s stock — which was up 1,700 percent at one point in January — is justified by the fundamentals of its business. That’s why the company’s first earnings release since the frenzy was a hotly anticipated event on Tuesday. Attendees left with plenty of unanswered questions, mainly because GameStop executives provided no financial guidance and, unexpectedly, skipped a Q.&A. Here are a few: The company said it would consider selling stock “to fund the acceleration of our future transformation initiatives.” With shares up some 900 percent from a year ago, there is scope to raise a huge amount. How ambitious will it be? There has been a lot of executive turnover at the company. Is that also happening lower in the ranks, perhaps in part because employees can cash out their suddenly more valuable shares? The Chewy co-founder Ryan Cohen, who joined GameStop’s board along with two other former Chewy executives just before the frenzy, said he aimed to turn the retailer into the “Chewy of gaming.” What do pet supplies have in common with video games? If you have answers — or more pertinent questions about this moment in the markets — let us know: dealbook@nytimes.com. HERE’S WHAT’S HAPPENING The E.U. plans to curb vaccine exports for six weeks. The bloc has drafted emergency rules to ease its supply shortages, a move that could badly affect Britain and other countries. Separately, AstraZeneca said it planned to disclose more recent trial data about its vaccine to assuage U.S. officials’ concerns. Jay Powell plays down the risk of inflation. The Fed chair told the House Financial Services Committee yesterday that he expected the $1.9 trillion stimulus to have a “neither particularly large nor persistent” effect on inflation. Treasury Secretary Janet Yellen defended the rescue package at the hearing, and said the next bill needed to address income inequality. (They are likely to reiterate these messages at a Senate hearing today.) Speaking of inequality … The combined wealth of American billionaires grew $1.3 trillion during the pandemic, up 44 percent from the previous year, according to a new study. During that time, 80 million Americans lost their jobs. The Fed creates committees to study climate risks. One will identify and address the financial risks posed by climate change, while another will consider “the potential for complex interactions across the financial system,” Lael Brainard, a Fed governor, said in a speech. Citigroup pledges more flexibility for workers. Employees can spend up to two days per week working remotely when the bank’s offices reopen, the C.E.O., Jane Fraser, wrote in a memo. As complaints by junior analysts at Goldman Sachs have generated debates about working conditions on Wall Street, Ms. Fraser also banned internal video meetings on Fridays and announced a holiday called “Citi Reset Day.” Two shootings, and a new push for gun control As America grieves over two mass shootings in a week — in Atlanta and Boulder, Colo. — the inevitable question arises again: Will Washington pass new gun restrictions this time? “This is not and should not be a partisan issue — it is an American issue,” President Biden said yesterday, adding that he was “devastated” by the killings. He urged lawmakers not to “wait another minute” in approving legislation to ban assault-style weapons and high-capacity magazines. It’s an issue that Mr. Biden knows well: He helped pass an assault weapons ban in the Senate in the 1990s. And President Barack Obama charged him with devising gun control proposals after the 2012 Sandy Hook shootings, though those failed to gain traction. Republicans appear opposed to sweeping new restrictions. Senator Chuck Grassley of Iowa noted that two bills proposing a modest tightening of background checks for sales — which four in five Americans support — passed the House mostly along party lines. A narrower proposal sponsored by Senator Joe Manchin, Democrat of West Virginia, and Senator Pat Toomey, Republican of Pennsylvania, is unlikely to gain a filibuster-proof majority in the Senate. Exclusive: Fanatics is now a $12.8 billion company The sports apparel retailer Fanatics has raised $320 million at a $12.8 billion valuation, more than double its valuation this summer, DealBook hears. The round was led by Silver Lake with participation by Fidelity, Neuberger Berman, Franklin Templeton, Blackstone, Thrive Capital and M.L.B. — all existing investors. Frequently Asked Questions About the New Stimulus Package How big are the stimulus payments in the bill, and who is eligible? The stimulus payments would be $1,400 for most recipients. Those who are eligible would also receive an identical payment for each of their children. To qualify for the full $1,400, a single person would need an adjusted gross income of $75,000 or below. For heads of household, adjusted gross income would need to be $112,500 or below, and for married couples filing jointly that number would need to be $150,000 or below. To be eligible for a payment, a person must have a Social Security number. Read more. What would the relief bill do about health insurance? Buying insurance through the government program known as COBRA would temporarily become a lot cheaper. COBRA, for the Consolidated Omnibus Budget Reconciliation Act, generally lets someone who loses a job buy coverage via the former employer. But it’s expensive: Under normal circumstances, a person may have to pay at least 102 percent of the cost of the premium. Under the relief bill, the government would pay the entire COBRA premium from April 1 through Sept. 30. A person who qualified for new, employer-based health insurance someplace else before Sept. 30 would lose eligibility for the no-cost coverage. And someone who left a job voluntarily would not be eligible, either. Read more What would the bill change about the child and dependent care tax credit? This credit, which helps working families offset the cost of care for children under 13 and other dependents, would be significantly expanded for a single year. More people would be eligible, and many recipients would get a bigger break. The bill would also make the credit fully refundable, which means you could collect the money as a refund even if your tax bill was zero. “That will be helpful to people at the lower end” of the income scale, said Mark Luscombe, principal federal tax analyst at Wolters Kluwer Tax & Accounting. Read more. What student loan changes are included in the bill? There would be a big one for people who already have debt. You wouldn’t have to pay income taxes on forgiven debt if you qualify for loan forgiveness or cancellation — for example, if you’ve been in an income-driven repayment plan for the requisite number of years, if your school defrauded you or if Congress or the president wipes away $10,000 of debt for large numbers of people. This would be the case for debt forgiven between Jan. 1, 2021, and the end of 2025. Read more. What would the bill do to help people with housing? The bill would provide billions of dollars in rental and utility assistance to people who are struggling and in danger of being evicted from their homes. About $27 billion would go toward emergency rental assistance. The vast majority of it would replenish the so-called Coronavirus Relief Fund, created by the CARES Act and distributed through state, local and tribal governments, according to the National Low Income Housing Coalition. That’s on top of the $25 billion in assistance provided by the relief package passed in December. To receive financial assistance — which could be used for rent, utilities and other housing expenses — households would have to meet several conditions. Household income could not exceed 80 percent of the area median income, at least one household member must be at risk of homelessness or housing instability, and individuals would have to qualify for unemployment benefits or have experienced financial hardship (directly or indirectly) because of the pandemic. Assistance could be provided for up to 18 months, according to the National Low Income Housing Coalition. Lower-income families that have been unemployed for three months or more would be given priority for assistance. Read more. Fanatics brings instant gratification to sports swag. Rather than purchasing jerseys in advance through a third party and guessing which team or player will be hot, Fanatics owns the rights to fan gear for the major U.S. sports teams (and some Nike merchandise). That allows it to produce hot items on demand, like LeBron James jerseys immediately after he joined the Lakers. The major sports leagues have invested in Fanatics because they want ownership — not just royalties — in a business that benefits from their brands. (Michael Rubin, the founder and executive chairman of Fanatics, is also a part-owner of the N.B.A.’s Philadelphia 76ers.) The pandemic has been good for business. Sports came to a temporary halt, but people shopped online. Fanatics, which is profitable, generates about 80 percent of its more than $3 billion in sales online. Its e-commerce sales jumped more than 20 percent last year. An I.P.O. is still in sight. Fanatics is considering going public via a SPAC or traditional I.P.O. this year or next. (Nothing is definite, and no formal talks are underway.) Since its last fund-raising effort, Fanatics has expanded into new product lines like hats through its acquisition of Top of the World and it started Fanatics China through a joint venture with Hillhouse Capital. It is using the money from this latest round to expand its geographic footprint and product lines, potentially through more deals. “While an I.P.O. is clearly an available option to us, there is no update on any timeline,” Fanatics told DealBook. John Cleese’s blockchain-based satire The comedian John Cleese is selling an NFT, or nonfungible token. It’s a joke — sort of. Evoking a classic con, the sale of the Brooklyn Bridge, the Monty Python actor is auctioning an authenticated digital sketch of the bridge by “The Unnamed Artist John Cleese,” with bidding running through April Fools’ Day. “I don’t make the jokes,” Mr. Cleese told DealBook. “I just point them out.” The project highlights the hyper-commodification of art in a frenzied market. Christie’s recently held its first NFT auction, selling the work of an artist known as Beeple for $69,346,250. That’s how much Mr. Cleese is asking for the sketch if a bidder wants to “buy it now.” He’ll split the proceeds evenly with his partners: a comedy writer, an animator and a law professor doubling as crypto consultant. The highest bid is now about $36,000. “I think it’s very funny,” Mr. Cleese said. “At the same time, we might make some money.” “Some things are worth pointing out, and some are not,” Mr. Cleese said. He said the Beeple sale was notable because it revealed a “mad world,” with people disconnected from meaningful emotional experiences, like seeing a painting at a gallery. Yet the 81-year-old also conceded that someone younger, for whom the line between the physical and digital worlds is more blurred, could have feelings about an NFT. The art world can’t afford to dismiss NFTs, Mr. Cleese said. Nor can he. By mocking the craze, he is now implicated in the thing he finds absurd — just how he’s made a living as a comedian. THE SPEED READ Deals The insurer Hartford rejected a $23 billion takeover bid by its rival Chubb, potentially setting off a takeover battle. (Reuters) Compass, the online real estate brokerage backed by SoftBank’s Vision Fund, hopes to be valued at as much as $10 billion in its I.P.O. (Bloomberg) Politics and policy Charles Schwab said it was quitting the U.S. Chamber of Commerce, weeks after announcing it was shutting down its political action committee. (CNBC) Is Tom Steyer, the billionaire Democratic presidential candidate, weighing a run for California governor? (Politico) Tech Intel said it planned to spend $20 billion building two chip factories in Arizona, and pledged to build more processors for other companies. (NYT) Tesla will accept payment in Bitcoin, Elon Musk says. (Bloomberg) Customers of Coinbase have complained that the cryptocurrency exchange failed to help them when they were locked out of accounts or had their holdings stolen. (NYT) Best of the rest The C.E.O. of Levi Strauss urged Congress to pass a bill giving U.S. workers 12 weeks of paid time off for health care: “Not mandating paid leave is inexcusable.” (CNN) Prince Harry has a new job: “chief impact officer” at the Silicon Valley coaching start-up BetterUp. (WSJ) General Mills demonstrates how not to respond to a customer complaint about shrimp tails in a box of cereal. (NYT) We’d like your feedback! Please email thoughts and suggestions to dealbook@nytimes.com. Source link Orbem News #boom #bust

[jscottscales]

How the slow sabotage of Obamacare may hurt America’s breastfeeding rate

Breastfeeding in America isn’t easy but it got a whole lot easier after the Affordable Care Act passed in 2010.

Lesley Muldoon, a 37-year-old mother of three in Washington, learned just that with the birth of her son two and a half years ago. Because of the law, she was able to get a free breast pump, and that smoothed her transition going back to work.

Even though her insurance provider, CareFirst, wouldn’t cover the cost of the hospital-grade breast pump she needed to feed her twin girls six months ago, she said, “Overall, I’ve had pretty good experiences with the insurance company. Being able to pump allowed me to return to work after both pregnancies and maintain a breastfeeding relationship with all my children, even if it’s not ideal for the twins.”

That’s because theAffordable Care Act (ACA), also known as Obamacare, included provisions aimed at supporting mothers who want to breastfeed, as part of its expansion of preventive-health services coverage. The regulations — and how they are applied by companies — haven’t been perfect, and some women have fallen through the cracks.

But in recent years, several studieshave shown that the provisions — giving moms access to lactation consultants, breast pumps, and time and space at work to pump their milkfor as much as a year after birth — have contributed to rising breastfeeding rates in the US.

The regulations went into effect in 2010 and 2012. From 2011 to 2014, the rate of women who were breastfeeding 12 months after giving birth rose from 27 percent to 34 percent, according to the Centers for Disease Control and Prevention. That amounted to the largest increase in any recent three-year period.

Now women’s health and breastfeeding advocates worry that we might be poised for a reversal of this trend.

The news that the administration of President Donald Trump undermined breastfeeding at a United Nations global health meeting and aligned itself with the $70 billion formula industry has sent a powerful signal that expansion od breastfeeding access won’t be a priority for this administration. Caitlin Oakley, a national spokesperson for the Department of Health Human Services, told Vox, “The United States was fighting to protect women’s abilities to make the best choices for the nutrition of their babies. Many women are not able to breastfeed for a variety of reasons,” she said. “These women should not be stigmatized.”

In addition, the administration’s focus on sabotaging the ACA doesn’t bode well for breastfeeding rates. It means that fewer people will access health care and insurance companies can now sell skimpier, short-term plans with few benefits and protections (including coverage for preventive services like breastfeeding support).

“When it comes to the ACA, nothing is beyond the scope of [the administration’s effort of] trying to undermine the principle of expanded coverage,” said Boston University maternal health expert Eugene Declercq. And that means even meddling with provisions that help moms feed their babies.

The ACA has helped more moms breastfeed and for longer periods

The reason raising breastfeeding rates through the ACA became a policy focus is quite simple: Breastfeeding represents the gold standard in infant nutrition. It basically offers inoculation against sickness and death for babies — and moms too.

Medical organizations, including the World Health Organization and the Academy of Pediatrics, recommend that babies be breastfed exclusively for the first six months of their lives — and then receive breast milk, supplemented by other foods, for about two years after that. The longer babies receive breast milk in their first years, the better.

Yet the rates of breastfeeding in the US aren’t nearly as high as they could be. In the US only a little more than half of all babies receive any breast milk at the age of 6 months. One reason for that is women don’t get to breastfeed for as long as they want to.

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The ACA tried to address that particular problem.Section 2713 of the law requires health insurance plans to provide coverage for breastfeeding support (like lactation counseling) and supplies (like breast pumps) without any co-payments, deductibles, or co-insurance, as long as a woman decides to breastfeed. This coverage is required for employer-sponsored plans, individual plans purchased through the Obamacare marketplaces, and for Medicaid enrollees who access public coverage through the ACA’s Medicaid expansion.

Section 4207 of the ACA also requires that companies with annual sales of more than $500,000 provide break times and a private place (not including a bathroom) where moms can use breast pumps to express their milk while at work.

Researchers have been looking at what these requirements have done for breastfeeding — and their findings all point in the same direction: They have helped.

A 2018 study in the found the ACA’s policy change was associated with a 10 percent increase in the length of time women breastfed. It also increased 21 percent the length of time moms breastfed exclusively, instead of supplementing with formula or other food. A 2016 study in foundthat women who had access to both a break time and private space for breastfeeding were 2.3 times as likely to be breastfeeding exclusively six months after birth as compared with women who didn’t have such access.

Other researchers have found that the lactation support coverage increased the number of women who started breastfeeding by about 2.5 percentage points, “which represents as many as 47,000 more infants for whom breastfeeding was initiated in a given year in the United States.” They also found that claims for breast pumps rose significantly after the ACA’s passage.

This findings square with what people who work in the breastfeeding arena told me. Gina Caruso, deputy director of the Breastfeeding Center for Greater Washington, a lactation consulting nonprofit in Washington, estimated that her group has seen a threefold increase in lactation consultations following the ACA’s passage and that the average number of appointments women receive has climbed. Her group also found there’s been a drop-off in breast pump sales (since women were able to get their pumps free from their insurance company). “The ACA has changed our business immensely,” she said.

But the law hasn’t been perfect

I also heard that the ACA’s breastfeeding policies have been far from perfect: Some families have had trouble finding lactation consultants in their networks or have wound up with as much as $1,500 in unreimbursed claims.

One woman said she submitted her claims to Cigna for lactation consultation, and even though her paperwork was clearly marked as being for lactation, Cigna told her the services related to parenting and wouldn’t be covered. (Cigna said in a statement to Vox that coverage of lactation consultants is required by law and it normally covers these services.)

Another woman told me she couldn’t get her lactation consultant services covered, even after she had her doctor send a note to the insurance for preauthorization. “They repeatedly denied the claim until I got my office HR involved,” she said in an email. (Both women did not want to be identified publicly.)

Mara Gandal-Powers, of the Women’s Health Law Center, explained that these stories are not uncommon. Because lactation consulting is a service that women need immediately after birth, they’re not typically in a position to haggle with insurance companies over coverage. “If you don’t get the services to help you increase your [breast milk] supply quickly, nursing can become difficult or impossible and not really happen. So we see women who pay out of pocket.”

Trump’s chipping away at the ACA will affect women’s health

Instead of working to fix these gaps in coverage, the Trump administration has been attempting to dismantle the ACA. And while Republicans have failed to fully repeal the law, they’ve put forward a series of policies that have caused the uninsured rate to rise and have weakened the law in the process.

Among them: In June, the administration announced that insurance companies can now offer skimpier, short-term plans that don’t have the benefits and protections, including coverage for the preventive services that Obamacare ensured.

Breastfeeding is a “preventive service,” said Kaiser’s Salganicoff. “So if it’s a short-term plan, it doesn’t have to have maternity care, preventive services and women who enroll in these plans would not have the entitlement to the breastfeeding coverage.”

Companies have also been scaling back their reimbursements. In April Anthem, which is the nation’s second-biggest health insurer, reduced its reimbursement for breast pumps from $169 to $95. Critics see the move as potentially undermining the Obamacare breastfeeding mandate. “The question is what types of pumps will now be provided,” said Summer Hawkins, a researcher at Boston College School of Social Work who has studied the impact of the ACA on breastfeeding.

In a statement, Anthem said, “Anthem recognizes the positive health benefits that breastfeeding can have on mothers and their newborns, and we are committed to ensuring new mothers have the information, tools and support they need to successfully breastfeed their newborns.” Anthem did not answer repeated questions about why it has reduced its reimbursement rate.

One thing the ACA hasn’t helped with when it comes to breastfeeding rates: lingering socioeconomic disparities. “There’s a 20 percent gap between most and least educated,” Hawkins added. African-American women also have persistently low rates of breastfeeding compared to other racial groups. “Sowhile our average rates look fantastic now, once you start digging into this by education, income, or [insurance] status — you see lower income, less educated women have much lower rates of breastfeeding than more advantages women.”

Let’s not forget that the US remains unique among wealthy countries in that it has no maternal leave policy. “The ACA did some very important things but I would say it’s only a piece of the broader constellation” of measures that would improve women’s and infant’s health, said Carol Sakala, director of childbirth connection programs at the National Partnership for Women & Families.

And when it comes to breastfeeding, Sakala said, “It’s hard to find another more impactful preventive health practice. We as a society should be mobilized to be supporting women and babies to get benefits of breastfeeding.”

For more on breastfeeding politics, please listen to the July 12th episode of .

Source

https://www.vox.com/2018/7/13/17560528/breastfeeding-resolution-obamacare-rates-breast-pump

[ericfruits]

Donald Trump’s health-care orders will hurt middle-class, self-employed Americans

THE strange thing about Donald Trump’s new executive actions on health care is the identity of those who will suffer their consequences. On October 12th Mr Trump kicked off a deregulatory process to permit widespread formation of so-called Association Health Plans (AHPs), insurance policies run by groups of small firms. Then his administration announced that it would stop paying cost-sharing subsidies, payments to insurers to compensate them for lowering deductibles and other out-of-pocket costs for the poorest buyers. Both moves are likely to end up inflicting the most pain on self-employed, middle- to upper-income folk—in other words, on a Republican constituency.

Like employer-sponsored insurance, AHPs would not be subject to many of Obamacare’s regulations. They could therefore entice young and healthy people away from Obamacare’s marketplaces. Depending on how easy it becomes to join an AHP, the effect would be more or less dramatic. In an extreme case, most healthy people could leave Obamacare’s exchanges. If any insurers stuck around—not a sure thing—the exchanges would come to resemble high-risk pools, where the ill go to buy subsidised coverage. 

However, they would only function as such for those earning less than 400% of the poverty line (that is, less than $48,240 for an individual in 2017). Obamacare offers no subsidies for buyers at higher incomes, and premiums would rise too high to be affordable. In this world, you would not want to be high-earning self-employed person with a chronic health condition.

AHPs will not pop up any time soon. The deregulatory process takes time, and could be delayed by legal challenges. By contrast, CSR payments were always at the discretion of the administration, and could stop immediately. Even the legality of the payments was doubtful. Congress has never authorised them as part of a budget, and during Mr Obama’s presidency, Republicans in the House of Representatives sued to stop them. A judge ruled the payments unconstitutional, but the ruling was delayed pending an appeal.

Now the legal issue is largely irrelevant. Yet the requirement that insurers offer discounts on out-of-pocket costs for the poor is written into law. They must continue to do so, but without recompense. (This is why Mr Trump’s argument that the funds are an “insurer bailout” is bunk; that the cash goes to insurers, rather than directly to poor buyers, is just an artefact of the law’s design.)  Firms must still recoup their costs, so the result is higher premiums for everyone—20% higher, if the Congressional Budget Office is to be believed. Many insurers anticipated the end of the payments and so have already raised their prices for next year.

Poorer buyers are protected, because the tax credits they receive rise in tandem with premiums. (The CBO projects that outlays on tax credits will rise so much that scrapping the CSRs will end up costing the government money.) The people who will suffer are, again, those who earn more than 400% of the poverty line¬—in other words, the middle-class, usually self-employed Americans whom Republicans have always said they are trying to help by scrapping Obamacare. Many, particularly in states with fragile markets, are likely to forego health insurance in 2018. But that is not an option for those who have chronic medical conditions.

There are 9m Americans who buy coverage in the individual market but do not receive tax credits. Mr Trump is poised to cause a lot of pain to this group—a Republican-leaning constituency—in 2018,  an election year. He is gambling that voters will continue to blame high premiums on Obamacare, not on the Republicans, and that Democrats will be spooked enough by the sorry condition of the market to start negotiations on health care reform. But Democrats have never expressed much concern about these better-off, unsubsidised buyers, who have been suffering from high premiums for a while. Mr Trump’s gamble is a risky one. 

http://ift.tt/2iaRHnL

[kristinsimmons]

Thriving in COVID Times

By KIM BELLARD

These are, no question, hard times, due to the COVID-19 pandemic.  In the U.S., we’re closing in on 180,000 deaths in the U.S.  Some 40 million workers lost their jobs, and over 30 million are still receiving unemployment benefits.  Hundreds of thousands, if not millions, of small businesses are believed to have closed, and many big companies are declaring bankruptcy.  Malls, retailers, and restaurants have been among the hardest hit. 

Yes, these are hard times.  But not for everyone. 

Last week Target announced what CNBC called a “monster quarter.”  Sales for online and stores open at least a year jumped 24% for the quarter ending August 1 – peak COVID-19 days – and profits were up an astonishing 80%.  Its CEO specifically referenced the pandemic, as shoppers sought safe and convenient shopping options.

It is not just Target doing well.  No one should be surprised that Amazon is doing well, as more turn to online shopping and Amazon’s quick delivery, but The Wall Street Journal reports that Bog Box stores generally are doing well, including not just Target but also Walmart, Home Depot, Lowe’s, Costco, and Best Buy.  The efforts they were taking to compete with Amazon, such as increased online sales and curbside pickup, served to help them survive the pandemic’s effects. 

Similarly, if you’re a streaming service like Netflix or Disney+, the pandemic has been great for business.  Video conferencing services like Zoom are booming.  Car dealers are struggling, but not online car sales. 

And, of course, if you’re a cloud computing service supporting all these shifts to online, the world has become even more dependent on you.  “Many customers are scaling beyond their wildest projections,” Carrie Thorp of Google Cloud told WSJ. 

In healthcare, everyone seems to agree that the big winner has been telehealth.  In the early days of the most severe lockdowns, everyone from CMS to commercial health insurers to hospital systems reacted with unprecedented speed to allow and encourage the use of telehealth – anything to keep people away from doctors’ offices or hospitals, where they might catch or transmit COVID-19. 

It worked: telehealth use “skyrocketed.”  Industry leaders TelaDoc and Livongo merged, while rival Amwell got a $100 million investment from Google.  No one is quite sure how much of the flexibilities introduced during the pandemic will persist once it recedes, but no one wants to miss out on what McKinsey predicts could be a $250b opportunity.  “The window to act is now,” the report declares.

Of course, the pharmaceutical companies are doing fine in the pandemic.  They’re the cockroaches of healthcare; they’re always going to survive.  Some are even getting the federal government to directly pay for their vaccine research or therapeutics. 

Health insurers are also proving to be big winners despite – or because of — the pandemic.  Due to all those delayed/avoided treatments, they’re racking up huge profits so far in 2020.  Some of those will have to be returned due to ACA medical loss ratio restrictions, some of that may due to their having diversified (e.g., CVS/Aetna, Cigna/Express Scripts, and United Healthcare’s Optum), and others may prove illusionary if long-term impacts of having coronavirus prove widespread, but right now they are doing well.    

The big loser is employer sponsored health insurance – or rather, the people who lost it.  Kaiser Family Foundation estimates that 27 million people lost their health coverage due to losing their jobs in the pandemic.   Some may qualify for Medicaid, others will buy Marketplace plans, with or without subsidies, but millions will be uninsured.  Our reliance on employment for health insurance has never seemed so short-sighted. 

Another big loser may be primary care practices, especially those not yet owned by health systems.  Financial losses are predicted to be staggering, as patients stayed away in droves.  As late as July, nearly 90% of primary care practices said they were still struggling due to COVID-19, according to a survey done for the Primary Care Collaborative.  Clinicians reported that in-person visits were down, salaries were being skipped, and many did not feel safe at the office.

Ann Greiner, president of PCC, said the report “is a clarion call to move to a new payment system that doesn’t rely on face-to-face visits and that is prospective so practices can better manage patient care.”  Farzad Mostaskari, MD, CEO of Aledade, agreed, saying that the most important thing we should do to help primary care is: “Change how we pay for care.”

Hospitals also took a big hit, with the American Hospital Association predicting that losses would top $300b in 2020 due to the pandemic’s impacts.  Some of these losses will be offset by the various federal bills (CARES and PPE), others by the rebound in the stock market, but some hospitals will continue to struggle – especially the already struggling rural hospitals.   It doesn’t help that payments aren’t necessarily related to the number of COVID-19 cases hospitals treat.

———–

During the pandemic, it has repeatedly struck me as a particular indictment of our healthcare system is that a health crisis causes so much disruption and so many financial losses.  If a sick care system – which, let’s face it, is what we have — doesn’t do well when lots of people are sick, what are we doing? 

In April of this year, Microsoft CEO Satya Nadella talked about the growth of its virtual platform Teams during the pandemic and declared, “In this era of remote everything, we have seen two years’ worth of digital transformation in two months.”  Healthcare has also made some significant strides, but if all we take away from the pandemic is that maybe we should keep doing more telehealth, we’ll have missed the opportunity for real change. 

Just as Amazon and the Big Box stores are proving that the pandemic changes where people shop, how they shop, what they shop for, the pandemic has important lessons for healthcare.  We shouldn’t rely on employment for health insurance.  We shouldn’t rely so heavily on elective procedures for health care revenues.  We need to be more flexible about where and how people get their care. 

This pandemic will eventually pass, in some form and with great damage.  The healthcare system will survive, at least most of it.  The challenge for us is to start making the changes needed for it to thrive even in the next crisis. 

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

Thriving in COVID Times published first on https://wittooth.tumblr.com/

[lauramalchowblog]

Thriving in COVID Times

By KIM BELLARD

These are, no question, hard times, due to the COVID-19 pandemic.  In the U.S., we’re closing in on 180,000 deaths in the U.S.  Some 40 million workers lost their jobs, and over 30 million are still receiving unemployment benefits.  Hundreds of thousands, if not millions, of small businesses are believed to have closed, and many big companies are declaring bankruptcy.  Malls, retailers, and restaurants have been among the hardest hit. 

Yes, these are hard times.  But not for everyone. 

Last week Target announced what CNBC called a “monster quarter.”  Sales for online and stores open at least a year jumped 24% for the quarter ending August 1 – peak COVID-19 days – and profits were up an astonishing 80%.  Its CEO specifically referenced the pandemic, as shoppers sought safe and convenient shopping options.

It is not just Target doing well.  No one should be surprised that Amazon is doing well, as more turn to online shopping and Amazon’s quick delivery, but The Wall Street Journal reports that Bog Box stores generally are doing well, including not just Target but also Walmart, Home Depot, Lowe’s, Costco, and Best Buy.  The efforts they were taking to compete with Amazon, such as increased online sales and curbside pickup, served to help them survive the pandemic’s effects. 

Similarly, if you’re a streaming service like Netflix or Disney+, the pandemic has been great for business.  Video conferencing services like Zoom are booming.  Car dealers are struggling, but not online car sales. 

And, of course, if you’re a cloud computing service supporting all these shifts to online, the world has become even more dependent on you.  “Many customers are scaling beyond their wildest projections,” Carrie Thorp of Google Cloud told WSJ. 

In healthcare, everyone seems to agree that the big winner has been telehealth.  In the early days of the most severe lockdowns, everyone from CMS to commercial health insurers to hospital systems reacted with unprecedented speed to allow and encourage the use of telehealth – anything to keep people away from doctors’ offices or hospitals, where they might catch or transmit COVID-19. 

It worked: telehealth use “skyrocketed.”  Industry leaders TelaDoc and Livongo merged, while rival Amwell got a $100 million investment from Google.  No one is quite sure how much of the flexibilities introduced during the pandemic will persist once it recedes, but no one wants to miss out on what McKinsey predicts could be a $250b opportunity.  “The window to act is now,” the report declares.

Of course, the pharmaceutical companies are doing fine in the pandemic.  They’re the cockroaches of healthcare; they’re always going to survive.  Some are even getting the federal government to directly pay for their vaccine research or therapeutics. 

Health insurers are also proving to be big winners despite – or because of — the pandemic.  Due to all those delayed/avoided treatments, they’re racking up huge profits so far in 2020.  Some of those will have to be returned due to ACA medical loss ratio restrictions, some of that may due to their having diversified (e.g., CVS/Aetna, Cigna/Express Scripts, and United Healthcare’s Optum), and others may prove illusionary if long-term impacts of having coronavirus prove widespread, but right now they are doing well.    

The big loser is employer sponsored health insurance – or rather, the people who lost it.  Kaiser Family Foundation estimates that 27 million people lost their health coverage due to losing their jobs in the pandemic.   Some may qualify for Medicaid, others will buy Marketplace plans, with or without subsidies, but millions will be uninsured.  Our reliance on employment for health insurance has never seemed so short-sighted. 

Another big loser may be primary care practices, especially those not yet owned by health systems.  Financial losses are predicted to be staggering, as patients stayed away in droves.  As late as July, nearly 90% of primary care practices said they were still struggling due to COVID-19, according to a survey done for the Primary Care Collaborative.  Clinicians reported that in-person visits were down, salaries were being skipped, and many did not feel safe at the office.

Ann Greiner, president of PCC, said the report “is a clarion call to move to a new payment system that doesn’t rely on face-to-face visits and that is prospective so practices can better manage patient care.”  Farzad Mostaskari, MD, CEO of Aledade, agreed, saying that the most important thing we should do to help primary care is: “Change how we pay for care.”

Hospitals also took a big hit, with the American Hospital Association predicting that losses would top $300b in 2020 due to the pandemic’s impacts.  Some of these losses will be offset by the various federal bills (CARES and PPE), others by the rebound in the stock market, but some hospitals will continue to struggle – especially the already struggling rural hospitals.   It doesn’t help that payments aren’t necessarily related to the number of COVID-19 cases hospitals treat.

———–

During the pandemic, it has repeatedly struck me as a particular indictment of our healthcare system is that a health crisis causes so much disruption and so many financial losses.  If a sick care system – which, let’s face it, is what we have — doesn’t do well when lots of people are sick, what are we doing? 

In April of this year, Microsoft CEO Satya Nadella talked about the growth of its virtual platform Teams during the pandemic and declared, “In this era of remote everything, we have seen two years’ worth of digital transformation in two months.”  Healthcare has also made some significant strides, but if all we take away from the pandemic is that maybe we should keep doing more telehealth, we’ll have missed the opportunity for real change. 

Just as Amazon and the Big Box stores are proving that the pandemic changes where people shop, how they shop, what they shop for, the pandemic has important lessons for healthcare.  We shouldn’t rely on employment for health insurance.  We shouldn’t rely so heavily on elective procedures for health care revenues.  We need to be more flexible about where and how people get their care. 

This pandemic will eventually pass, in some form and with great damage.  The healthcare system will survive, at least most of it.  The challenge for us is to start making the changes needed for it to thrive even in the next crisis. 

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

Thriving in COVID Times published first on https://venabeahan.tumblr.com

[gordonwilliamsweb]

Medicaid Nearing ‘Eye Of The Storm’ As Newly Unemployed Look For Coverage

As the coronavirus roils the economy and throws millions of Americans out of work, Medicaid is emerging as a default insurance plan for many of the newly unemployed. That could produce unprecedented strains on the vital health insurance program, according to state officials and policy researchers.

Americans are being urged to stay home and practice “social distancing” to prevent the spread of the virus, causing businesses to shutter their doors and lay off workers. The Labor Department reported Thursday that more than 6.6 million people signed up for unemployment insurance during the week that ended March 28. This number shattered the record set the previous week, with 3.3 million sign-ups. Many of these newly unemployed people may turn to Medicaid for their families.

Policymakers have often used Medicaid to help people gain health coverage and health care in response to disasters such as Hurricane Katrina, the water crisis in Flint, Michigan, and the 9/11 terrorist attacks. But never has it faced a public health crisis and economic emergency in which people nationwide need its help all in virtually the same month.

“Medicaid is absolutely going to be in the eye of the storm here,” said Joan Alker, executive director of the Georgetown University Center for Children and Families. “It is the backbone of our public health system, our public coverage system, and will see increased enrollment due to the economic conditions.”

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Meeting those needs will require hefty investments ― both in money and manpower.

Medicaid — which is run jointly by the states and federal government and covers about 70 million Americans ― is already seeing early application spikes. Because insurance requests typically lag behind those for other benefits, the numbers are expected to grow in the coming months.

“We have been through recessions in the past, such as in 2009, and saw what that meant,” said Matt Salo, who heads the National Association of Medicaid Directors. “We are going to see that on steroids.”

The majority of states have expanded their Medicaid programs since 2014 to cover more low-income adults under a provision in the Affordable Care Act. That may help provide a cushion in those areas. In the 14 states that have chosen not to expand, many of the newly unemployed adults will not be eligible for coverage.

It’s possible the pandemic could change the decision-making calculus for non-expansion states, Salo said. “The pandemic is like a punch in the mouth.”

But even without expansion in those states, the Medicaid rolls could increase with more children coming into the system as their families’ finances deteriorate. Many states don’t have the resources or systems in place to meet the demand.

“It is going to hit faster and harder than we’ve ever experienced before,” Salo said.

The unique circumstances of social distancing impose new challenges for those whose jobs are to enroll people for coverage. In California, where more than a million people have filed for unemployment insurance since March 13, much of the workforce that would typically be signing people up and processing their paperwork is now working from home, which adds a layer of complexity in terms of accessing files and documents, and can inhibit communication.

“It’s going to be certainly more difficult than it was under the [2008] recession,” said Cathy Senderling-McDonald, deputy executive director for the County Welfare Directors Association of California. She said that although strides have been made in the past decade to set up better online forms and call centers, it will still be a heavy lift to get people enrolled without seeing them in person.

In some states, the challenges to the system are already noticeable.

Utah, for instance, has seen a 46% increase in applications for Medicaid. (These applications can be for individuals or families.) In March 2019, about 14,000 people applied. This March, it was more than 20,400.

“Our services are needed now more than ever,” said Muris Prses, assistant director of eligibility services for the Utah Department of Workforce Services, which processes Medicaid enrollment. The state typically takes 15 days to determine whether someone is eligible, he said, though that will increase by several days because of the surge in applicants and some staff working at home.

In Nevada, where the hotel- and casino-dominated economy has been hit particularly hard, applications for public benefits programs, including food stamps and Medicaid, skyrocketed from 200 a day in February to 2,000 in mid-March, according to the state Department of Health and Human Services. The volume of calls to a consumer hotline for Medicaid and health coverage questions is four times the regular amount.

In Ohio, the number of Medicaid applications has already exceeded what’s typical for this time of year. The state expects that figure to continue to climb.

States that haven’t yet seen the surge warned that it’s almost certainly coming. And as layoffs continue, some are already experiencing the strains on the system, including processing times that could leave people uninsured for months, while Medicaid applications process.

For 28-year-old Kristen Wolfe, of Salt Lake City, who lost her job and her employer-sponsored health insurance March 20, it’s a terrifying time.

Wolfe, who has lupus — an autoimmune disorder that requires regular doctor appointments and prescription medication ― quickly applied for Medicaid. But after she filled in her details, including a zero-dollar income, she learned the decision on her eligibility could take as long as 90 days. She called the Utah Medicaid agency and, after being on hold for more than an hour, was told they did not know when she would hear back.

“With my health, it’s scary to leave things in limbo,” said Wolfe, who used her almost-expired insurance last week to order 90-day medication refills, just in case. “I am pretty confident I will qualify, but there is always the ‘What if I don’t?’”

Others have reported smoother sailing, though.

Jen Wittlin, 33 — who, until recently, managed the now-closed bar in Providence, Rhode Island’s Dean Hotel ― qualified for Medicaid coverage starting April 1. She was able to sign up online after waiting about half an hour on the phone to get help answering specific questions. Once she receives a check for unemployment insurance, the state will reassess her income — currently zero ― to see if she still qualifies.

“It was all immediate,” she said.

In fact, she said, she is now working to help newly uninsured former colleagues also enroll in the program, using the advice the state gave her.

In California, officials are trying to reassign some employees — who are now working remotely ― to help with the surge. But the system to determine Medicaid eligibility is complicated and requires time-intensive training, Senderling-McDonald said. She’s trying to rehire people who’ve retired and relying on overtime from staffers.

“It’s hard to expand this particular workforce very, very quickly by a lot,” she said. “We can’t just stick a new person in front of a computer and tell them to go. They’re going to screw everything up.”

The move away from in-office sign-ups is also a disadvantage for older people and those who speak English as a second language, two groups who frequently felt more comfortable enrolling in person, she added.

Meanwhile, increasing enrollment and the realities of the coronavirus will likely create a need for costly medical care across the population.

“What about when we start having many people who may be in the hospital, in ICUs or on ventilators?” said Maureen Corcoran, the director of Ohio’s Medicaid program. “We don’t have any specific answers yet.”

These factors will hit just as states ― which will experience shrinking tax revenue because of the plunging economy — have less money to pay their share of the Medicaid tab.

“It’s all compounded,” said Lisa Watson, a deputy secretary at Pennsylvania’s Department of Human Services, which oversees Medicaid.

The federal government pays, on average, about 61% of the costs for traditional Medicaid and about 90% of the costs for people who joined the program through the ACA expansion. The rest comes from state coffers. And, unlike the federal government, states are constitutionally required to balance their budgets. The financial squeeze could force cuts in other areas, like education, child welfare or law enforcement.

On March 18, Congress agreed to bump up what Washington pays by 6.2 percentage points as part of the second major stimulus bill aimed at the economic consequences of the pandemic. That will barely make a dent, Salo argued.

“The small bump is good, and we are glad it’s there, but in no way is that going to be sufficient,” he said.

Medicaid Nearing ‘Eye Of The Storm’ As Newly Unemployed Look For Coverage published first on https://nootropicspowdersupplier.tumblr.com/

[stephenmccull]

Medicaid Nearing ‘Eye Of The Storm’ As Newly Unemployed Look For Coverage

As the coronavirus roils the economy and throws millions of Americans out of work, Medicaid is emerging as a default insurance plan for many of the newly unemployed. That could produce unprecedented strains on the vital health insurance program, according to state officials and policy researchers.

Americans are being urged to stay home and practice “social distancing” to prevent the spread of the virus, causing businesses to shutter their doors and lay off workers. The Labor Department reported Thursday that more than 6.6 million people signed up for unemployment insurance during the week that ended March 28. This number shattered the record set the previous week, with 3.3 million sign-ups. Many of these newly unemployed people may turn to Medicaid for their families.

Policymakers have often used Medicaid to help people gain health coverage and health care in response to disasters such as Hurricane Katrina, the water crisis in Flint, Michigan, and the 9/11 terrorist attacks. But never has it faced a public health crisis and economic emergency in which people nationwide need its help all in virtually the same month.

“Medicaid is absolutely going to be in the eye of the storm here,” said Joan Alker, executive director of the Georgetown University Center for Children and Families. “It is the backbone of our public health system, our public coverage system, and will see increased enrollment due to the economic conditions.”

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Subscribe to KHN’s free Morning Briefing.

Sign Up

Please confirm your email address below:

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Meeting those needs will require hefty investments ― both in money and manpower.

Medicaid — which is run jointly by the states and federal government and covers about 70 million Americans ― is already seeing early application spikes. Because insurance requests typically lag behind those for other benefits, the numbers are expected to grow in the coming months.

“We have been through recessions in the past, such as in 2009, and saw what that meant,” said Matt Salo, who heads the National Association of Medicaid Directors. “We are going to see that on steroids.”

The majority of states have expanded their Medicaid programs since 2014 to cover more low-income adults under a provision in the Affordable Care Act. That may help provide a cushion in those areas. In the 14 states that have chosen not to expand, many of the newly unemployed adults will not be eligible for coverage.

It’s possible the pandemic could change the decision-making calculus for non-expansion states, Salo said. “The pandemic is like a punch in the mouth.”

But even without expansion in those states, the Medicaid rolls could increase with more children coming into the system as their families’ finances deteriorate. Many states don’t have the resources or systems in place to meet the demand.

“It is going to hit faster and harder than we’ve ever experienced before,” Salo said.

The unique circumstances of social distancing impose new challenges for those whose jobs are to enroll people for coverage. In California, where more than a million people have filed for unemployment insurance since March 13, much of the workforce that would typically be signing people up and processing their paperwork is now working from home, which adds a layer of complexity in terms of accessing files and documents, and can inhibit communication.

“It’s going to be certainly more difficult than it was under the [2008] recession,” said Cathy Senderling-McDonald, deputy executive director for the County Welfare Directors Association of California. She said that although strides have been made in the past decade to set up better online forms and call centers, it will still be a heavy lift to get people enrolled without seeing them in person.

In some states, the challenges to the system are already noticeable.

Utah, for instance, has seen a 46% increase in applications for Medicaid. (These applications can be for individuals or families.) In March 2019, about 14,000 people applied. This March, it was more than 20,400.

“Our services are needed now more than ever,” said Muris Prses, assistant director of eligibility services for the Utah Department of Workforce Services, which processes Medicaid enrollment. The state typically takes 15 days to determine whether someone is eligible, he said, though that will increase by several days because of the surge in applicants and some staff working at home.

In Nevada, where the hotel- and casino-dominated economy has been hit particularly hard, applications for public benefits programs, including food stamps and Medicaid, skyrocketed from 200 a day in February to 2,000 in mid-March, according to the state Department of Health and Human Services. The volume of calls to a consumer hotline for Medicaid and health coverage questions is four times the regular amount.

In Ohio, the number of Medicaid applications has already exceeded what’s typical for this time of year. The state expects that figure to continue to climb.

States that haven’t yet seen the surge warned that it’s almost certainly coming. And as layoffs continue, some are already experiencing the strains on the system, including processing times that could leave people uninsured for months, while Medicaid applications process.

For 28-year-old Kristen Wolfe, of Salt Lake City, who lost her job and her employer-sponsored health insurance March 20, it’s a terrifying time.

Wolfe, who has lupus — an autoimmune disorder that requires regular doctor appointments and prescription medication ― quickly applied for Medicaid. But after she filled in her details, including a zero-dollar income, she learned the decision on her eligibility could take as long as 90 days. She called the Utah Medicaid agency and, after being on hold for more than an hour, was told they did not know when she would hear back.

“With my health, it’s scary to leave things in limbo,” said Wolfe, who used her almost-expired insurance last week to order 90-day medication refills, just in case. “I am pretty confident I will qualify, but there is always the ‘What if I don’t?’”

Others have reported smoother sailing, though.

Jen Wittlin, 33 — who, until recently, managed the now-closed bar in Providence, Rhode Island’s Dean Hotel ― qualified for Medicaid coverage starting April 1. She was able to sign up online after waiting about half an hour on the phone to get help answering specific questions. Once she receives a check for unemployment insurance, the state will reassess her income — currently zero ― to see if she still qualifies.

“It was all immediate,” she said.

In fact, she said, she is now working to help newly uninsured former colleagues also enroll in the program, using the advice the state gave her.

In California, officials are trying to reassign some employees — who are now working remotely ― to help with the surge. But the system to determine Medicaid eligibility is complicated and requires time-intensive training, Senderling-McDonald said. She’s trying to rehire people who’ve retired and relying on overtime from staffers.

“It’s hard to expand this particular workforce very, very quickly by a lot,” she said. “We can’t just stick a new person in front of a computer and tell them to go. They’re going to screw everything up.”

The move away from in-office sign-ups is also a disadvantage for older people and those who speak English as a second language, two groups who frequently felt more comfortable enrolling in person, she added.

Meanwhile, increasing enrollment and the realities of the coronavirus will likely create a need for costly medical care across the population.

“What about when we start having many people who may be in the hospital, in ICUs or on ventilators?” said Maureen Corcoran, the director of Ohio’s Medicaid program. “We don’t have any specific answers yet.”

These factors will hit just as states ― which will experience shrinking tax revenue because of the plunging economy — have less money to pay their share of the Medicaid tab.

“It’s all compounded,” said Lisa Watson, a deputy secretary at Pennsylvania’s Department of Human Services, which oversees Medicaid.

The federal government pays, on average, about 61% of the costs for traditional Medicaid and about 90% of the costs for people who joined the program through the ACA expansion. The rest comes from state coffers. And, unlike the federal government, states are constitutionally required to balance their budgets. The financial squeeze could force cuts in other areas, like education, child welfare or law enforcement.

On March 18, Congress agreed to bump up what Washington pays by 6.2 percentage points as part of the second major stimulus bill aimed at the economic consequences of the pandemic. That will barely make a dent, Salo argued.

“The small bump is good, and we are glad it’s there, but in no way is that going to be sufficient,” he said.

Medicaid Nearing ‘Eye Of The Storm’ As Newly Unemployed Look For Coverage published first on https://smartdrinkingweb.weebly.com/

[dinafbrownil]

Medicaid Nearing ‘Eye Of The Storm’ As Newly Unemployed Look For Coverage

As the coronavirus roils the economy and throws millions of Americans out of work, Medicaid is emerging as a default insurance plan for many of the newly unemployed. That could produce unprecedented strains on the vital health insurance program, according to state officials and policy researchers.

Americans are being urged to stay home and practice “social distancing” to prevent the spread of the virus, causing businesses to shutter their doors and lay off workers. The Labor Department reported Thursday that more than 6.6 million people signed up for unemployment insurance during the week that ended March 28. This number shattered the record set the previous week, with 3.3 million sign-ups. Many of these newly unemployed people may turn to Medicaid for their families.

Policymakers have often used Medicaid to help people gain health coverage and health care in response to disasters such as Hurricane Katrina, the water crisis in Flint, Michigan, and the 9/11 terrorist attacks. But never has it faced a public health crisis and economic emergency in which people nationwide need its help all in virtually the same month.

“Medicaid is absolutely going to be in the eye of the storm here,” said Joan Alker, executive director of the Georgetown University Center for Children and Families. “It is the backbone of our public health system, our public coverage system, and will see increased enrollment due to the economic conditions.”

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Sign Up

Please confirm your email address below:

Sign Up

Meeting those needs will require hefty investments ― both in money and manpower.

Medicaid — which is run jointly by the states and federal government and covers about 70 million Americans ― is already seeing early application spikes. Because insurance requests typically lag behind those for other benefits, the numbers are expected to grow in the coming months.

“We have been through recessions in the past, such as in 2009, and saw what that meant,” said Matt Salo, who heads the National Association of Medicaid Directors. “We are going to see that on steroids.”

The majority of states have expanded their Medicaid programs since 2014 to cover more low-income adults under a provision in the Affordable Care Act. That may help provide a cushion in those areas. In the 14 states that have chosen not to expand, many of the newly unemployed adults will not be eligible for coverage.

It’s possible the pandemic could change the decision-making calculus for non-expansion states, Salo said. “The pandemic is like a punch in the mouth.”

But even without expansion in those states, the Medicaid rolls could increase with more children coming into the system as their families’ finances deteriorate. Many states don’t have the resources or systems in place to meet the demand.

“It is going to hit faster and harder than we’ve ever experienced before,” Salo said.

The unique circumstances of social distancing impose new challenges for those whose jobs are to enroll people for coverage. In California, where more than a million people have filed for unemployment insurance since March 13, much of the workforce that would typically be signing people up and processing their paperwork is now working from home, which adds a layer of complexity in terms of accessing files and documents, and can inhibit communication.

“It’s going to be certainly more difficult than it was under the [2008] recession,” said Cathy Senderling-McDonald, deputy executive director for the County Welfare Directors Association of California. She said that although strides have been made in the past decade to set up better online forms and call centers, it will still be a heavy lift to get people enrolled without seeing them in person.

In some states, the challenges to the system are already noticeable.

Utah, for instance, has seen a 46% increase in applications for Medicaid. (These applications can be for individuals or families.) In March 2019, about 14,000 people applied. This March, it was more than 20,400.

“Our services are needed now more than ever,” said Muris Prses, assistant director of eligibility services for the Utah Department of Workforce Services, which processes Medicaid enrollment. The state typically takes 15 days to determine whether someone is eligible, he said, though that will increase by several days because of the surge in applicants and some staff working at home.

In Nevada, where the hotel- and casino-dominated economy has been hit particularly hard, applications for public benefits programs, including food stamps and Medicaid, skyrocketed from 200 a day in February to 2,000 in mid-March, according to the state Department of Health and Human Services. The volume of calls to a consumer hotline for Medicaid and health coverage questions is four times the regular amount.

In Ohio, the number of Medicaid applications has already exceeded what’s typical for this time of year. The state expects that figure to continue to climb.

States that haven’t yet seen the surge warned that it’s almost certainly coming. And as layoffs continue, some are already experiencing the strains on the system, including processing times that could leave people uninsured for months, while Medicaid applications process.

For 28-year-old Kristen Wolfe, of Salt Lake City, who lost her job and her employer-sponsored health insurance March 20, it’s a terrifying time.

Wolfe, who has lupus — an autoimmune disorder that requires regular doctor appointments and prescription medication ― quickly applied for Medicaid. But after she filled in her details, including a zero-dollar income, she learned the decision on her eligibility could take as long as 90 days. She called the Utah Medicaid agency and, after being on hold for more than an hour, was told they did not know when she would hear back.

“With my health, it’s scary to leave things in limbo,” said Wolfe, who used her almost-expired insurance last week to order 90-day medication refills, just in case. “I am pretty confident I will qualify, but there is always the ‘What if I don’t?’”

Others have reported smoother sailing, though.

Jen Wittlin, 33 — who, until recently, managed the now-closed bar in Providence, Rhode Island’s Dean Hotel ― qualified for Medicaid coverage starting April 1. She was able to sign up online after waiting about half an hour on the phone to get help answering specific questions. Once she receives a check for unemployment insurance, the state will reassess her income — currently zero ― to see if she still qualifies.

“It was all immediate,” she said.

In fact, she said, she is now working to help newly uninsured former colleagues also enroll in the program, using the advice the state gave her.

In California, officials are trying to reassign some employees — who are now working remotely ― to help with the surge. But the system to determine Medicaid eligibility is complicated and requires time-intensive training, Senderling-McDonald said. She’s trying to rehire people who’ve retired and relying on overtime from staffers.

“It’s hard to expand this particular workforce very, very quickly by a lot,” she said. “We can’t just stick a new person in front of a computer and tell them to go. They’re going to screw everything up.”

The move away from in-office sign-ups is also a disadvantage for older people and those who speak English as a second language, two groups who frequently felt more comfortable enrolling in person, she added.

Meanwhile, increasing enrollment and the realities of the coronavirus will likely create a need for costly medical care across the population.

“What about when we start having many people who may be in the hospital, in ICUs or on ventilators?” said Maureen Corcoran, the director of Ohio’s Medicaid program. “We don’t have any specific answers yet.”

These factors will hit just as states ― which will experience shrinking tax revenue because of the plunging economy — have less money to pay their share of the Medicaid tab.

“It’s all compounded,” said Lisa Watson, a deputy secretary at Pennsylvania’s Department of Human Services, which oversees Medicaid.

The federal government pays, on average, about 61% of the costs for traditional Medicaid and about 90% of the costs for people who joined the program through the ACA expansion. The rest comes from state coffers. And, unlike the federal government, states are constitutionally required to balance their budgets. The financial squeeze could force cuts in other areas, like education, child welfare or law enforcement.

On March 18, Congress agreed to bump up what Washington pays by 6.2 percentage points as part of the second major stimulus bill aimed at the economic consequences of the pandemic. That will barely make a dent, Salo argued.

“The small bump is good, and we are glad it’s there, but in no way is that going to be sufficient,” he said.

from Updates By Dina https://khn.org/news/medicaid-nearing-eye-of-the-storm-as-newly-unemployed-look-for-coverage/

[showlexsite]

Residing Together but Not hitched? 5 essential things to understand

Residing Together but Not hitched? 5 essential things to understand

A couple that is happy are in cash misery. Here is how to prevent difficulty.

As wedding prices have actually dropped, cohabitation relationships have actually increased. Nevertheless, we suspect that numerous couples that are unmarriedn’t considered the monetary aftereffects of residing together.

That’s a blunder, because cohabitating couples aren’t afforded most of the protections that are same benefits that married people receive.

Numerous couples that are young split up have faced the problem of “this is yours, that’s mine” — from books and music to animals and furniture. But residing together while you grow older (and hopefully wealthier) can pose challenges that are additional.

It’s necessary to understand that in terms of cash, what the law states does not completely recognize relationships not formally documented in some recoverable format. Below are a few essential things to understand prior to deciding to live with a substantial other.

Be cautious when purchasing a home

Unmarried partners may decide not just to move around in together but additionally to get their very own spot. This may be a great move, but know about potential dilemmas.

Bear in mind the things I stated above: The household is one of the individual whose title seems regarding the lawfully recorded deed. It does not make a difference just exactly exactly what agreements that are verbal made or who paid the home loan. Therefore, ensure both events are known as in the deed.

The 2 fundamental means of sharing title along with other folks are joint tenancy with right of survivorship and tenancy in keeping. The real difference is the fact that with right of survivorship, your curiosity about the house automatically transfers to another owner whenever you die. With tenancy in keeping, it does not.

In the event that you both submit an application for the home mail-order-bride.net/croatian-brides/ loan, you’re both in charge of paying it — even with you split up. If both events are in the deed as owners, but just one is from the home loan, usually the one accountable for the home loan continues to be accountable, even when that individual has relocated away and relocated on.

Another typical scenario: John currently has a property, then Jane moves in. Because she makes significantly more than John, Jane proceeds to help make the month-to-month mortgage repayments.

Is Jane then eligible for some of the equity she’s producing by reducing John’s mortgage? No. Missing a appropriate document to the contrary, it is John’s house and their equity.

Therefore, if you’re thinking about purchasing a homely home together — or dealing with the duties of somebody whom currently has a house — go fully into the deal along with your eyes available. The actions are easy:

Think it through.

Talk it away.

Draw it.

Have a lawyer search it over, then get it notarized or recorded.

Be sure you’ve got a might

It is bad sufficient when married people don’t have a might, particularly when it is really easy to complete. But also without having a will, the law won’t leave a spouse that is surviving and dry, because of another little bit of paper — a marriage certification.

Nonetheless, if there’s no paper, so far as regulations can be involved, you’re strangers even though you’ve provided a bed for two decades.

If you’re married and perish without having a might, your property will fundamentally visit your partner because, in line with the legislation, your better half can be your next of kin. If you’re unmarried and perish with out a might, your property nevertheless would go to the next of kin — but that is not your lover. In the event that you don’t relish the idea of a parent, sibling or some remote uncle inheriting every thing, get a will.

Something different to take into account: If you’re that are rich, with assets surpassing $5 million — you can have property income income tax problems that rich hitched people don’t. Therefore conversing with an property lawyer is really an idea that is good.

Look out for medical care fees

Numerous big organizations and federal federal government agencies will expand medical health insurance protection to couples that are unmarried. Although it might not make a difference to your employer if you’re hitched, it does matter into the IRS.

It tax the benefits your spouse receives under your plan when you’re married, the IRS doesn’t tax your health benefits, nor does. But if you’re supplying your domestic partner with medical care advantages, the part deciding on them might be taxable for you.

Quite simply, if John covers Jane as being a partner that is domestic their employer-sponsored health plan, John might be taxed by the government for just about any advantages extended to Jane.

Why? Federal taxation law particularly excludes employee advantages gotten by partners from taxation, but the government doesn’t recognize domestic lovers. Hence, if John’s and Jane’s companies each pay money for wellness protection, they’re better off maintaining their policies split up.

If John has coverage and Jane does not, they need to produce a calculation: Do John’s additional fees surpass exactly exactly what it could price Jane to obtain a personal medical health insurance policy? The proper course will be determined by John’s taxation bracket and Jane’s price of medical insurance.

Look into an advance medical care directive

If a person partner possesses medical crisis, missing paper into the contrary, one other does not have any appropriate directly to be provided with information or even to make choices about care.

The answer to the issue is for every to call one other within an advance healthcare directive, that allows every one of you to legitimately make choices in the event that other is incapacitated. In addition it permits hospitals to share information frequently reserved for partners.

Such as for instance a will, these directives aren’t difficult to get. Your county or hospital wellness division can provide you the proper execution, you can also download one on the web.

Know if common-law marriage is recognized in a state

There was one situation for which a couple of residing together will enjoy the legal rights of wedding without getting hitched the way that is traditional they are able to claim a common-law wedding, that is identified by legislation in a lot of states.

However, if a common-law is thought by you wedding is made simply by residing together, you’re wrong. Based on Nolo.com, these partners must:

Reside together for a significant time frame ( perhaps perhaps not defined in virtually any state).

Hold by themselves away being a married couple — i.e., share a final title, relate to one another as wife and husband, and register a joint income tax return.

Want to be hitched.

Remember the duty of proving you’re a common-law married few will fall for your requirements — it is maybe maybe perhaps not automated. When you’ve shown it, you’ll then have actually the privileges of married people — including the privilege of getting by way of a divorce that is legal you split up.

Will you be living and unmarried by having a partner? What concerns can you have about managing property? Share with us in commentary or regarding the Money Talks News Twitter web page.

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I am the creator of Money Talks News and also have invested the past 40+ years into the finance that is personal. I am a CPA, composer of a couple of publications and Emmy that is multiple receiver. I am hitched to a female I do not deserve, have a dog that is awesome survive water in Fort Lauderdale, Fla.

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How to manage money for financial success in the U.S. military

Howdy! I'm Spencer, an active-duty Air Force officer investing for financial independence by age 40. Since 2016, my wife and I have saved half of my active-duty paycheck into our financial independence accounts. I started writing in 2012 about achieving FI in the military on my website Military Money Manual.

Because J.D. has no experience with the military, for Veterans Day he asked me to share the lessons I think every servicemember needs to know about getting rich slowly. These are the concepts I wish someone had explained to me as a newly-commissioned officer in 2010. (These lessons are just as applicable to the enlisted side of the house.)

I've split this article into two sections.

First, I'll cover some basic lessons for beginners: taking care of yourself, emergency funds, military friendly banks, tracking your money, and TSP investing.

Next, I'll cover some advanced topics: investing for financial independence, military deployment, travel, and military credit-card perks.

Let's start with the basics.

Educate Yourself

One of the harshest life lessons you must learn early in your military career is this: “No one is looking out for you except you.”

You must take responsibility to educate yourself about saving, investing, spending, and achieving financial independence. If you have a really good supervisor or commander in the military, they may explain the Thrift Savings Plan (TSP) to you, but that's probably it.

If you want to achieve financial independence in the military, you need to learn how to do it yourself. There are many resources available to learn about money, including:

/r/MilitaryFinance on Reddit

/r/personalfinance on Reddit

The military finances page at the Bogleheads wiki

Any of the books on my recommended reading list (or J.D.'s list)

I believe it's important to always be learning, to always be asking questions. If you have questions about your military pay, benefits, or personal finance, type them into Google. Ask your supervisor. Ask your buddies (but don't always take their advice haha).

Never be afraid to ask questions. Keep yourself educated about money.

Find a Military-Friendly Bank

While you can certainly use a regular bank to manage your money (and Get Rich Slowly maintains a list of online savings accounts), I recommend finding a military-friendly bank. Certain banks and credit unions are dedicated to helping military servicemembers. They understand the difficulties unique to our situation. For instance, USAA has never shut down my ATM card despite withdrawals in over 40 countries.

Some of the largest and most recognized military-friendly banks include USAA, Pentagon Federal Credit Union (PenFed), and Navy Federal Credit Union (NFCU).

Look for a military-friendly bank that offers ATM fee reimbursement and that doesn't charge fees on your accounts no matter what your balances are. Many military-friendly banks will deposit your military pay one business day earlier than your actual payday. This is a nice feature to get access to your money a little earlier each payday.

Build an Emergency Fund

Unlike your civilian counterparts, you're unlikely to be suddenly fired from the military. Because it's a government job, you would at least get a few months notice if you were involuntarily separated.

You also don't have to worry too much about surprise medical bills. Tricare is one of the best healthcare insurance networks in the U.S., and the military medical system is one of the most affordable. You will rarely, if ever, have a co-pay to see a doctor or pick up a prescription.

So, if you don't have to worry about medical expenses or getting fired, why worry about saving an emergency fund in the military? Because things always go wrong.: cars break, payment of travel vouchers is delayed, the government shuts down, and so on.

Plus, you know how unpredictable military service can be. You may be called away suddenly for a contingency operation in Africa when the car breaks down at home, preventing your husband from getting to work.

Many times when you receive PCS (permanent change of station) or go TDY (temporary duty assignment), your expenses won't be immediately reimbursed. If you have an incompetent finance office, it may be weeks or months before you finally get paid for that trip.

When you have an emergency fund, you can cover these expenses and not sweat it while finance gets their act together.

When the government shut down in early 2019, members of the Coast Guard went unpaid for an entire pay period. This was an extremely stressful time for many folks. You can insure yourself against political theatrics like this by having an emergency fund.

How big should your emergency fund be? I recommend starting with $1000 and then saving up so that you have enough to cover six months of expenses.

Personally, as an eight-year captain, I have $10,000 in my emergency fund. This isn't six months of expenses, I admit, but it will cover two plane tickets to fly me and my wife home in case we need to be with family in an emergency. And $10,000 will cover all but the most serious car repairs. It's the amount that lets me sleep easy at night.

Know Where Your Money Goes

Trust me, I hate budgeting. But if you want to achieve financial success — in the military or otherwise — it's important to understand where your money is going. This helps you determine if you have optimized your spending to make you happy.

Here's an example: Let's say you notice you're spending $100/week on Buffalo Wild Wings. But you don't even like wings and beer that much. And you're trying to lose weight. Well, it looks like you found a great expenditure to eliminate! Most of us can find spending like this to trim from our budgets.

To make tracking easier, I recommend apps like You Need a Budget (YNAB), Personal Capital, or Mint. Or, if you like computers, track your money in a simple spreadsheet.

The key is to make sure that your spending aligns with your goals, that you're happy with what you're spending money on.

As for me, I hate budgeting, as I said. After I trimmed the obvious fat from my spending, I adopted what I call an “anti-budget”. I save half of my income into my investment accounts (TSP, IRA, taxable brokerage, and cash accounts). I spend the rest of my money and don't worry about it. This system is simple. For me, simple is best.

I don't enjoy analyzing my budget, so I make sure the big three expenses — housing, transportation, and food — are correct, then I live my life. If you get these three right, you can take care of 80% of your savings for only 20% of the effort.

Get Your Full TSP Match

The military's version of a 401(k) is called the Thrift Savings Plan, or TSP. It's a boring name that doesn't really sell the fact that it's one of the best retirement plans available in the world.

The TSP offers five funds, which together make up most of the investable assets in the world. These funds are:

C Fund: contains the S&P 500 companies, the largest 500 companies in America

S Fund: contains the 3529 publicly-traded companies in America that aren't in the S&P 500

I Fund: an international stock fund covering 21 nations outside the U.S.

F Fund: a fixed-income fund that invests in corporate bonds

G Fund: the government bond fund

In addition to these five funds, you can also invest in TSP Lifecycle funds. These are target-date retirement funds that automatically adjust their mix of stocks and bonds over time. In theory, they deliver higher returns with more volatility early in your career, then they become more bond heavy as you age.

The TSP expense ratios are famously low, usually around 0.04% annually. That means for every $1000 you invest in the TSP, you pay $0.40 per year in management fees. That's it! (And that's amazing.)

Even on a $1,000,000 portfolio you'd pay only $400 per year. These fees are some of the lowest available in any retirement plan.

You can contribute up to $19,000 into the TSP in 2019. If you deploy to a combat zone, you can contribute up to $56,000.

The TSP is an employer-sponsored retirement plan, so it's completely separate from your IRAs, or Individual Retirement Accounts. That means you can put $19,000 into your Roth TSP and $6000 in your Roth IRA — $25,000 total for a year!

If you could contribute $25,000 to your IRA and TSP for a full 20-year military service, you'd have $1,100,000 after 20 years, assuming a 7% return. If you entered military service at age 20, retired at 40, and left the $1,100,000 to grow until age 60 at 7%, you'd have $4.2 million. That's the power of compounding and paying yourself first!

If you joined the military after 2017, you're automatically in the Blended Retirement System (BRS). In order to maximize your retirement savings, you must contribute at least 5% of your base pay every month.

The government automatically contributes 1% of your base pay to your Traditional TSP account on your behalf. They will contribute up to another 4% if you contribute 5%. This 5% can be worth thousands of dollars annually.

When you retire, that 5% match could have grown to tens of thousands (or hundreds of thousands) of dollars.

One of my biggest financial regrets it not contributing to my Thrift Savings Plan earlier. Especially now that you can receive a match on your contributions, you need to at least contribute 5% monthly to your TSP as soon as you commission or graduate basic training.

Okay, now that we've covered some basic military money topics, let's move on to some more advanced material.

Use Credit Wisely

There are a lot of folks who believe credit cards are evil. And if you're not careful, you can end up deep in debt. Many military members do so. But if you understand how to use credit cards wisely, they can be an excellent tool to help you achieve financial success.

Servicemembers have two laws working in their favor: the Military Lending Act (MLA) and the Servicemembers Civil Relief Act (SCRA).

These laws have been generously interpreted by most of the major credit-card companies, including American Express and Chase. Both companies are waiving annual fees for servicemembers for cards opened after entering active duty status.

The American Express SCRA policy goes beyond the legal requirements. AMEX waives all annual fees for active-duty servicemembers, Title 10 Reservists, and Title 32 National Guard. This includes their civilian spouses, usually as long as the servicemember is added as an authorized user to the account.

The AMEX SCRA policy applies to both personal and business cards. For instance, my wife and I currently have 13 AMEX cards with $4665 of annual fees waived. The annual recurring benefits of these free cards include:

Three free nights at Marriott with Gold Elite status

$600 Marriott expenses credit

One free night at Hilton with Diamond Status

$250 Hilton Resort credit

$1150 in airline fee credits reimbursed

$800 of Uber or Uber Eats credit

Companion pass in Delta first class

These benefits add up quickly: airport lounge access, upgrades to business class, free hotel stays, and free food really goes a long way to making travel free or very cheap.

Since 20 Sep 2017, the Chase MLA policy waives all annual fees on their personal (not business) credit cards for military servicemembers and their spouses. This includes active duty, Title 10 reservists, and Title 32 Guard.

This includes their Chase Sapphire Reserve card, which comes with an annual $300 travel credit good towards airfare, hotels, taxis, trains, Uber, rental cars, parking, and anything else travel related. Chase waives the $450 annual fee on this card for both military servicemembers and their spouses.

These are just some of the credit card benefits extended exclusively to US military personnel. I keep a page updated with the best credit cards for military troops.

But again: Credit cards are only useful and valuable if you don't carry a balance. If they're going to lead you into debt, you should avoid them. The bonuses and perks aren't worth the cost of debt.

Deal with Deployment

Believe it or not, deployment is a golden opportunity to put yourself way ahead – smash debt, save a ton, spend nothing, and figure out what you want to do with your life.

The biggest financial advantages to a military deployment are:

Tax-free combat zone income (CZTE)

Tax-free contributions to your Roth TSP and Roth IRA

Savings Deposit Program (SDP)

Combat zone tax exclusions, or CZTE, are available when you are in a Presidential-declared and IRS-recognized designated combat zone for at least one day of any month. So even if you just fly in, land, and take off again two hours later, you're eligible for CZTE pay that month.

Your pay during any CZTE month will not be subject to federal income tax. It is subject to FICA tax, so you'll see Social Security and Medicare tax deducted from your paycheck.

Because your income is tax free any month you're in a combat zone, you have a unique opportunity to get tax-free money into your Roth IRA and Roth TSP. The money goes in untaxed, grows untaxed, and can come out untaxed, subject to the rules of Roth accounts!

This triple no-tax win is an amazing investment opportunity almost no one else in America can access.

Another program available to you on deployment is the Savings Deposit Program or SDP. The SDP offers a guaranteed 10% return on your investment on up to $10,000 invested.

For example, if you're on a one-year deployment and invest $10,000 from the beginning of the deployment, you could earn $1000 by the time you head home. While you're deployed, your expenses can drop to nearly zero, depending on how much family you're supporting back home. All the essentials — like food, housing, a gym, and transportation — are covered. You just need to work, work out, eat, and sleep.

Your income will also increase due to the CZTE pay, hardship duty pay, family separation pay, hazardous duty pay, hostile fire pay, and many other special payments you can receive while deployed.

The combination of low expenses and high income means you can really set yourself up for financial success. On my first deployment, I paid off my USAA cadet loan. After my third deployment, I finished paying off my student loans.

If you don't have any debt, use a deployment to max out your retirement accounts, max out the SDP, and save some money for whatever your future goals are. Set an outrageous goal for yourself, like saving $50,000 in six months. I'll bet you'll surprise yourself with how much you can save on a deployment!

Don't forget to set aside a little money to enjoy life when you get back to the real world. Military deployments aren't vacations and they're not stress free. Make sure you take some of your deployment savings to visit your loved ones or take your family skiing.

Travel for Free (or Cheap)

Going TDY (temporary duty) can be a great way to travel and make extra money while you serve. When you're sent away from your permanent duty station (PDS) on official business, you'll receive per diem to offset your increased expenses.

Lodging expenses are reimbursed at the rate they were paid. If your authorized lodging amount was $200 and your hotel was $150 per night, you are reimbursed $150. You do not keep the difference.

On the other hand, your meals and incidental expenses (or M&IE) are paid regardless of expenses incurred. If you're authorized $100 per day and you grab breakfast at the hotel, lunch at Chick-Fil-A for $10, and dinner at Chipotle for $15, you get to keep the remaining $75 per day.

Per diem can add up quickly, especially if you're on a long training TDY. It can also disappear quickly — usually on drinks out with your coworkers. Be smart about it.

Leave in conjunction with official travel (LICWO) and circuitous travel during PCS are excellent ways to travel to new destinations and get reimbursed for your travel. Essentially, you can take the scenic route to get to your next duty station or temporary assignment.

The government will reimburse you up to what they would have paid for a ticket. Since the government almost always buys full fare, full flexible economy tickets, you can usually get much cheaper flights and get some free travel in during your leave. Here are more details and nuances of LICWO and circuitous travel.

Space Available (Space-A) travel is a tremendous benefit available to servicemembers. Usually if there is an empty seat on a military flight, the passenger terminal will open it up to servicemembers and dependents. Free travel around the world!

There are a lot of caveats to Space-A, and it's not a very reliable or seamless process all of the time. I recommend that you check out SpaceA.net and their Facebook group for the best information on travelling Space-A.

Invest for Financial Independence

Most servicemembers don't make it to 20 years of service. The figures vary by service and officer vs. enlisted, but only about 20% of servicemembers who serve earn any kind of military pension, whether it's active duty, guard, or reserve.

But even without a pension, military service can set you on the path to financial independence (FI). The military can teach you discipline, goal setting, and perseverance. All of these traits are useful if you want to complete a multi-year project like investing for financial independence or early retirement.

Military servicemembers have unique investment opportunities available to them that civilians do not. (We've already covered some of these, such as the TSP, SDP, and tax-free income.) However, the principles of FI apply to military servicemembers the same as civilians.

Achieving financial freedom in the military is simple, but not easy:

Save and invest enough of your money until you have 25x your annual expenses invested in low-cost, total stock and bond market index funds.

Now you can safely withdraw 4% of your invested assets annually to pay for your living expenses.

Voila, you don't need to work anymore!

As I say, the concept is simple — but it's not easy to achieve. How quickly you can achieve 25x of your expenses depends primarily on your saving rate.

Save 10% a year and you'll achieve financial freedom in 51 years.

Save 25% and you cut it down to 32 years.

Save 50% and you are looking at only 17 years of investing to achieve financial independence.

Seventeen years is less time than it takes to earn a military retirement pension! Combine a military pension with FI and you're looking at a fat retirement.

Or, if you don't make it to 20 years (like 80% of your brothers and sisters in arms), you can still achieve FI by combining your military savings with whatever your post-military plans are.

Conclusion

I hope this was a valuable introduction to military finances. Armed with these lessons, I believe that every single servicemember can achieve financial success during and after their military career.

And remember: Most advice that applies to civilians applies just the same to military folks. It ultimately comes down to: “spend less than you earn and invest the difference”. That's all it takes to eventually become financially independent. How long that takes is up to you!

The post How to manage money for financial success in the U.S. military appeared first on Get Rich Slowly.

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Need info on cheap medical insurance...?

Need info on cheap medical insurance...?

My husband and I are looking to start a family soon. He has a very steady job, as do I. We live in washington state. And its just the two of us. I need to find cheap insurance that covers pregnancies. I tried qualifying for basic health, however our income exceeded the maximum amount to qualify. In October I had a miscarriage. I was ten weeks. That alone cost us close to two thousand out of pocket. We are not rich enough for all those expensive insurance programs, however we make too much to qualify for the cheap or free ones. Please help. Any advice is appreciated!

BEST ANSWER: Try this site where you can compare free quotes :insurancehqreview.xyz

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as i pulled into insurance would be about bought me a 2007 or anything contact him looking at buying a the absolute cheapest place 18 in a few not really know about be 17 soon and cost more on a a car and it The major reason I it would help out in florida? is there i heard from her then put in the insurance (like those offered is affordable, has good car insurance in uk? or total out the this a good move ............... and then pay 30% as u have insurance internet and cant find ford escape two years close to paying off and get the hard insurance due to getting no financial savvy past Okay so i ve already bought a car yesterday I love the shape can we get it? pay for your health of my daughters has it for only $2,900. a 2004 mazda rx8? ease, they hadn t had don t, may destroy my quotes has +service charge .

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How much does health offered. So should we gpa overall (in the much it would cost. would I no longer exactly guess the costs somebody suggest me cheaper this except to basically a curve. I took My parents are looking yorkshire terrier ...does anyone No one has to I m tired of getting (if that helps).any insight my parents though, cause teen and i took now considering it since phone at them, and just got his Jr s lender. But that way how much would it without agent or a years old (almost 21) insurance plans are the to get car insurance you think it will my own insurance. is I get my own quote for 1307 for Isnt there a site one month (not a 21 and just getting mine & my mom s my insurance go up SL AWD or similar got my license this the good student discount their car is insured not. Thanks in advanced. 2010-2011 Camaro I m just the car would he .

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Term Life Insurance for SOLDIERS?

Term Life Insurance for SOLDIERS?

Are there any THIRD PARTY companies that offer Life Insurance for Soldiers? Excluding SGLI, I know that Primerica offers Life Insurance to Soldiers, but I can t find any other company other than that one. Thanks!

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[kristinsimmons]

Thriving in COVID Times

By KIM BELLARD

These are, no question, hard times, due to the COVID-19 pandemic.  In the U.S., we’re closing in on 180,000 deaths in the U.S.  Some 40 million workers lost their jobs, and over 30 million are still receiving unemployment benefits.  Hundreds of thousands, if not millions, of small businesses are believed to have closed, and many big companies are declaring bankruptcy.  Malls, retailers, and restaurants have been among the hardest hit. 

Yes, these are hard times.  But not for everyone. 

Last week Target announced what CNBC called a “monster quarter.”  Sales for online and stores open at least a year jumped 24% for the quarter ending August 1 – peak COVID-19 days – and profits were up an astonishing 80%.  Its CEO specifically referenced the pandemic, as shoppers sought safe and convenient shopping options.

It is not just Target doing well.  No one should be surprised that Amazon is doing well, as more turn to online shopping and Amazon’s quick delivery, but The Wall Street Journal reports that Bog Box stores generally are doing well, including not just Target but also Walmart, Home Depot, Lowe’s, Costco, and Best Buy.  The efforts they were taking to compete with Amazon, such as increased online sales and curbside pickup, served to help them survive the pandemic’s effects. 

Similarly, if you’re a streaming service like Netflix or Disney+, the pandemic has been great for business.  Video conferencing services like Zoom are booming.  Car dealers are struggling, but not online car sales. 

And, of course, if you’re a cloud computing service supporting all these shifts to online, the world has become even more dependent on you.  “Many customers are scaling beyond their wildest projections,” Carrie Thorp of Google Cloud told WSJ. 

In healthcare, everyone seems to agree that the big winner has been telehealth.  In the early days of the most severe lockdowns, everyone from CMS to commercial health insurers to hospital systems reacted with unprecedented speed to allow and encourage the use of telehealth – anything to keep people away from doctors’ offices or hospitals, where they might catch or transmit COVID-19. 

It worked: telehealth use “skyrocketed.”  Industry leaders TelaDoc and Livongo merged, while rival Amwell got a $100 million investment from Google.  No one is quite sure how much of the flexibilities introduced during the pandemic will persist once it recedes, but no one wants to miss out on what McKinsey predicts could be a $250b opportunity.  “The window to act is now,” the report declares.

Of course, the pharmaceutical companies are doing fine in the pandemic.  They’re the cockroaches of healthcare; they’re always going to survive.  Some are even getting the federal government to directly pay for their vaccine research or therapeutics. 

Health insurers are also proving to be big winners despite – or because of — the pandemic.  Due to all those delayed/avoided treatments, they’re racking up huge profits so far in 2020.  Some of those will have to be returned due to ACA medical loss ratio restrictions, some of that may due to their having diversified (e.g., CVS/Aetna, Cigna/Express Scripts, and United Healthcare’s Optum), and others may prove illusionary if long-term impacts of having coronavirus prove widespread, but right now they are doing well.    

The big loser is employer sponsored health insurance – or rather, the people who lost it.  Kaiser Family Foundation estimates that 27 million people lost their health coverage due to losing their jobs in the pandemic.   Some may qualify for Medicaid, others will buy Marketplace plans, with or without subsidies, but millions will be uninsured.  Our reliance on employment for health insurance has never seemed so short-sighted. 

Another big loser may be primary care practices, especially those not yet owned by health systems.  Financial losses are predicted to be staggering, as patients stayed away in droves.  As late as July, nearly 90% of primary care practices said they were still struggling due to COVID-19, according to a survey done for the Primary Care Collaborative.  Clinicians reported that in-person visits were down, salaries were being skipped, and many did not feel safe at the office.

Ann Greiner, president of PCC, said the report “is a clarion call to move to a new payment system that doesn’t rely on face-to-face visits and that is prospective so practices can better manage patient care.”  Farzad Mostaskari, MD, CEO of Aledade, agreed, saying that the most important thing we should do to help primary care is: “Change how we pay for care.”

Hospitals also took a big hit, with the American Hospital Association predicting that losses would top $300b in 2020 due to the pandemic’s impacts.  Some of these losses will be offset by the various federal bills (CARES and PPE), others by the rebound in the stock market, but some hospitals will continue to struggle – especially the already struggling rural hospitals.   It doesn’t help that payments aren’t necessarily related to the number of COVID-19 cases hospitals treat.

———–

During the pandemic, it has repeatedly struck me as a particular indictment of our healthcare system is that a health crisis causes so much disruption and so many financial losses.  If a sick care system – which, let’s face it, is what we have — doesn’t do well when lots of people are sick, what are we doing? 

In April of this year, Microsoft CEO Satya Nadella talked about the growth of its virtual platform Teams during the pandemic and declared, “In this era of remote everything, we have seen two years’ worth of digital transformation in two months.”  Healthcare has also made some significant strides, but if all we take away from the pandemic is that maybe we should keep doing more telehealth, we’ll have missed the opportunity for real change. 

Just as Amazon and the Big Box stores are proving that the pandemic changes where people shop, how they shop, what they shop for, the pandemic has important lessons for healthcare.  We shouldn’t rely on employment for health insurance.  We shouldn’t rely so heavily on elective procedures for health care revenues.  We need to be more flexible about where and how people get their care. 

This pandemic will eventually pass, in some form and with great damage.  The healthcare system will survive, at least most of it.  The challenge for us is to start making the changes needed for it to thrive even in the next crisis. 

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

Thriving in COVID Times published first on https://wittooth.tumblr.com/