Family under an umbrella

5 Million Families Caught in an ACA Glitch

The states’ health insurance marketplaces will sell subsidized family policies to workers who have employer coverage on one condition: their employer premiums are deemed unaffordable.

But this condition has a quirk. Under the Affordable Care Act (ACA), a worker is eligible to buy a subsidized family plan only if he can’t afford his employer’s premiums for an individual policy, defined in the law as exceeding 9.83 percent of his income. Policymakers argue this is the wrong standard, because the ineligible worker needs a family policy, and employers’ family policies usually have much higher premiums than their individual policies.

The Kaiser Family Foundation estimates some 5.1 million workers are in this predicament, which is known as the “family glitch.”

The majority of workers who are not eligible for the ACA’s family coverage are buying the policies at work, and they spend an average of 16 percent of their income on premiums, Kaiser said. The people who can’t afford the employer insurance are forced to go without.

Tina Marie Mueller’s family is caught in the family glitch. She recently wrote in Health Affairs that her husband pays $1,500 per month for employer health insurance for the family, including their two children. “So, after paying for our family insurance, my husband brings home $400/wk,” Mueller said. “We are beyond frustrated that this part of the ACA hasn’t been fixed.”

The COVID relief package passed in March did temporarily expand access to the exchanges for more middle-class Americans by dramatically increasing the premium subsidies. But “people in the family glitch will still not be helped,” said Krutika Amin, a health care expert at the Kaiser Foundation. …Learn More

Films about Dementia Help Us Understand it

“Supernova” does not have a happy ending. But that’s how stories about Alzheimer’s go, and the film, which recently began streaming, is worth watching.

It’s one of those occasional movies that come along and portray the emotional aspects of this disease with nuance. The films, by using big-name stars like Stanley Tucci and Colin Firth in “Supernova,” lift some of the stigma around dementia that can isolate its victims and their caregivers.

Dementiais still very much a taboo topic,” said Bobbi Matchar, who, as director of the Duke Dementia Family Support Program, facilitates group discussions for people with dementia and their families. “Having movies that more accurately portray the face of dementia is really helpful.”

The newest of these films, “The Father,” is in contention for an Oscar on Sunday, as is its star, Anthony Hopkins.

Julianne Moore also won an Oscar for the lead in the 2014 film, “Still Alice” about a spirited college professor coming to terms with a failing memory. The most powerful scenes are her first realizations – forgetting a class lecture or not recognizing the center of campus, where her jog has taken her. Her denial ends when she admits to her husband (played by Alec Baldwin), “I’ve got something wrong with me.”

In “Away from Her,” Julie Christie is an older woman with Alzheimer’s who wanders the woods near her home on Lake Ontario. For her safety, she and her husband (played by Gordon Pinsent) agree she will move into a nursing home. This movie is about the disintegration of a loving marriage when one partner’s memories fade and then go dark, forcing her husband to grieve while she is still alive.

“Supernova” examines the implications of Alzheimer’s for two men who remain partners until the bitter end. On a road trip, they struggle to communicate about what Tusker’s dementia means for each of them.

Tusker (Tucci’s character) is a writer. His partner, Sam (Firth), becomes angry after discovering Tusker is hiding the extent of his dementia – he finds indecipherable scribbles in a notebook – so as not to burden Sam. …Learn More

woman with baby

How Many Kids Will 30-Somethings Have?

U.S. fertility is already at record lows, and women in their 30s have had only 1.3 children on average – well short of their expectations for more than two children.

But they still have time left on their biological clock. So, will they catch up?

Several factors are working specifically against the college graduates in this cohort. Religiously observant people usually have more children, and the decline in religious affiliation is reducing their fertility. Their fertility is also being hurt by the falling marriage rate, which leaves fewer couples ready to raise a family. In addition, the women’s careers often compete with having children.

In a new study, Anqi Chen and Nilufer Gok at the Center for Retirement Research predicted that the final fertility rate for Millennials in their 30s – the rate at the end of their childbearing years – will average 1.96 children.

If this prediction proves accurate, it would get them somewhat closer to what they’d expected and close to the number of children required to replace two parents.

Predicting the final fertility rate for the Millennial women born in the early 1980s required going back in time to analyze the established patterns of a generation that is now past its childbearing years: women born in the second half of the baby boom wave. The researchers applied what they learned about these late boomers and, after adjusting for recent trends, estimated final fertility for today’s 30-somethings.

The 1.96 fertility rate sounds encouraging, but that number applies only to these Millennials. The longer-term prospects suggest fertility may be lower in the future. …Learn More

First, Money Woes. 6 Years Later, Dementia

Gayle Blanton

Gayle Blanton, the blogger’s mother

My 85-year-old mother is on top of her bills. She pays several of them online, which is impressive enough, and she knows which bill is due when.

So, we should both take some comfort in the fact that she is not having difficulty managing her money, which is an early sign of dementia.

The connection between poor money management and declining cognitive capacity was established in research years ago. An obvious next question – when does this early warning system kick in? – is answered in The Journal of the American Medical Association.

The researchers followed more than 81,000 men on Medicare for more than a decade and linked their medical records to their Equifax credit reports. The men who would eventually be diagnosed with Alzheimer’s disease or dementia started missing the due dates on their bills about six years before the diagnosis.

There are many reasons for the gap between signs of trouble and an actual diagnosis. If family don’t detect a decline in cognitive ability, they won’t ask a doctor to administer a dementia test. Family might confuse early-stage dementia with memory loss, which is a natural part of aging. One financial manager said some of her clients try to hide that they’re having trouble handling their finances – or “do not want to admit the problem to themselves.”

If dementia goes undiagnosed, the financial problems get worse. A second finding in the study was that about 2½ years prior to a dementia diagnosis, retirees’ credit scores were much more likely to slip to subprime levels, or below 620 points. …Learn More

People in a nursing home

People Don’t Save for a Nursing Home Stay

About 13 percent of the older people in a recent study – average age 74 – who were initially living independently moved into a nursing home within five years.

Perhaps because they know their vulnerabilities, their expectations of whether they would one day need nursing home care helped predict their actual nursing home use, the study found.

In fact, the researchers said, the accuracy of the predictions showed that the older people must have taken into account personal information that went beyond what was apparent in the 1998-2016 survey data used in the study, which included details about their health, ease of functioning, and other influences on whether they need care.

However, foresight did not translate into facing up to the financial implications of a nursing home stay.

Nursing homes are expensive, currently averaging $7,700 per month for a room that is shared with another resident. The 10 percent of older people with a private long-term care insurance policy can pay for their care. Poor people’s nursing home expenses are covered by Medicaid.

It’s the people who fall outside these two groups who aren’t always clear about how to pay for a nursing home stay if they need it. Their lack of preparation for this expense was underscored in another of the study’s findings: the people who say they’re more likely to go into a nursing home were no more likely to have built up their savings to pay for it.

Of course, Medicaid is also a backup plan for nursing home residents who start out paying for their care but run through all of their savings. This study helps to explain why Medicaid covers six in 10 nursing home residents.

To read this study, authored by Padmaja Ayyagari and Yang Wang, see “Nursing Home Use Expectations and Wealth Accumulation Among Older Adults.”Learn More

Women of Color Go into Construction Trades

women for color in construction figureThe annual pay for a plumber in Omaha, Nebraska, with three years of experience is around $55,000 a year, while a certified nursing assistant there earns $30,000. Or compare an electrician in the Phoenix area making $62,000 to $39,000 for a dental assistant.

Recognizing that many of the occupations dominated by women don’t pay well, young women of color are increasingly moving into the construction trades. Black, Latina, and Asian women and women of mixed race account for 45 percent of the 308,000 women working in the trades. This exceeds their 38 percent share of the women’s labor force overall, according to an analysis of 2016-2018 data by Ariane Hegewisch of the Institute for Women’s Policy Research. The largest group is Latina women.

Women of color are gravitating to construction jobs – carpenter, electrician, laborer, plumber, mason, painter, and metal worker – because they offer paid apprenticeships, good pay, and benefits to workers who don’t have a college degree. The International Union of Painters and Allied Trades even has maternity leave.

woman cutting woodBeing a sheet metal worker has “given me the financial ability to take care of my family,” Monica Yamada, a member of Local 104 in San Francisco, said in a recent webinar hosted by the policy institute and Chicago Women in Trades.

But working in a man’s world is challenging. Women say they often feel marginalized or harassed, or they receive fewer opportunities for career-advancing training or assignments at the construction site. “Women must fight to advance and to learn new aspects of the trade that men automatically get to do,” said the institute’s study director, Chandra Childers. …Learn More

Minimum Wage and Disability Applications

Maid in hotel corridor

Do applications for federal disability benefits rise, fall, or remain unchanged when the minimum wage increases?

Understanding whether the minimum wage affects disability applications is an important issue as Congress debates an increase in the federal minimum and the states have been very active: 14 states began last year with a higher minimum wage after passing new legislation or ballot initiatives. Another seven states had previously enacted automatic yearly increases in their minimums.

One possibility considered in a new study is that applications to the U.S. Social Security Administration for disability benefits could decline if wages increase enough to make a steady paycheck that much more appealing than a modest monthly disability check. But Syracuse University economist Gary Engelhardt finds that hiking the minimum wage did not reduce applications from 2002 through 2017.

Since applications didn’t go down, could a higher minimum wage increase applications instead? Some economists argue that employers, when faced with a higher mandatory wage, may lay off some of their less-skilled hourly employees or cut back their hours. This might – indirectly – be a motivation to apply for disability.

Engelhardt tested this idea in a second analysis, recognizing that it takes time for employers to make staffing changes in response to a higher wage. Once again, he found no impact on disability applications.

“Changes in the minimum wage are not moving individuals on and off” of disability, the researcher concluded. 

To read this study, authored by Gary Engelhardt, see “The Impact of the Minimum Wage on DI Participation.” Learn More