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ACA Insurance in the Time of COVID-19

The urgency of the pandemic ushered in important changes to the Affordable Care Act (ACA), including a steep reduction in premiums for health insurance policies purchased on the state and federal exchanges through the end of 2022. Now Congress is debating reforms such as making the larger premium subsidies permanent and broadening the reach of the federal-state Medicaid program beyond the expansion introduced in the 2010 ACA.

We spoke with Tyson Lester, an independent insurance agent in southern California, about what the changes so far have meant for consumers. Tyson is licensed to sell policies in California, Florida, and Texas.

Tyson LesterTyson Lester

Has the Affordable Care Act promoted disease prevention and care during the pandemic?

Some of the best feedback we got from our clients was about using the telehealth and remote options in their policies. It’s been an option for quite some time, but it was utilized more frequently during COVID-19. People were able to access primary care physicians, receive consultation and be diagnosed with COVID over the phone. It was amazing. It helped them because: 1) they were able to just make a phone call; 2) they were able to receive good consultation; and 3) if testing was necessary, they were able to go to a testing facility.

In response to COVID, did you see a rush into ACA policies last year?

ACA enrollment increased last year, but consumers’ response to the pandemic was mixed. In 2020, 12 states and Washington D.C. temporarily reopened their health insurance exchanges but people didn’t have the additional premium assistance to make it more affordable. In the remaining states, working people who lacked employer health insurance didn’t have the ACA as another option for coverage when the pandemic hit.

As for the workers who did have employer health insurance last year but then lost their jobs, they had to make a tough decision between whether they wanted to elect their employer’s COBRA, which is expensive, go uninsured, or go on the insurance exchange. But many people weren’t fully aware of the ACA’s longstanding option: when someone loses group health insurance from their employer, they can buy what’s known as a special enrollment ACA plan. In Texas, for example, part of the reason for last year’s increase in the uninsured population, in the midst of COVID-19, was that people who lost their jobs – and their employer coverage – weren’t even aware the ACA exchanges were available to them. We actually put a flyer together for this specific topic last year, because it was so important.

In March, the American Rescue Plan significantly increased the ACA premium subsidies through December 2022. What has been the effect?

For anybody who was previously enrolled, the American Rescue Plan significantly reduced premiums in California, Texas, and Florida and potentially their total out-of-pocket costs. As a result of the larger subsidies, I saw an influx of new customers throughout this year on California’s exchange, which – unlike most other states – opened a special enrollment for all of 2021. Earlier this year, the federal exchange opened, which caused an influx of customers too. This is where Texas, Florida and many other states sell their ACA policies. All states on the federal exchange shut down again in August but will reopen for 2022 in November. …
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Federal Minimum Wage is 40% Below 1968

minimum wage figureLargely missing from the debate about raising the federal minimum wage is how much its value has eroded over the past 50 years.

The current federal minimum is $7.25 an hour. If the 1968 wage were converted to today’s dollars, it would be worth about $12 an hour.

At $7.25 an hour, a full-time worker earns just over $15,000 a year before taxes, which is less than the federal poverty standard for a family of two. The Biden administration has proposed more than doubling the federal minimum to $15 by 2025, and one proposal in Congress would begin indexing the minimum wage to general wages so it keeps up with inflation.

A $15 an hour minimum isn’t enough, said one sympathetic Florida contractor who voted in November to gradually increase the state’s mandatory minimum wage to $15. “I’d like to see some of the American people go out there and try to make a living and put a roof over their head and raise a family,” he told a reporter. “It’s literally impossible.”

Customer receiving from McDonald's drive thru serviceBut small businesses say raising the minimum wage would increase their financial pressures at the worst time – during a pandemic. At least 100,000 U.S. small businesses closed last year as governments restricted public gatherings to suppress the virus, and the Congressional Budget Office (CBO) estimates a higher federal minimum could eliminate 1.4 million jobs.

This evidence ignores the complexity of low-wage workers’ situations. Employee turnover is extremely common in low-wage jobs in fast food establishments, for example, and workers frequently have bouts of unemployment that further reduce their already low earning power. Raising the minimum wage could somewhat compensate for their spotty employment and provide more money for essential items. And while the CBO warns of job losses, it also predicts that a higher federal minimum wage would lift 900,000 million workers out of poverty.

Many states have approved incremental automatic annual increases, and a $15 minimum wage has been approved in eight states, including Florida. Voters – over the objections of the Florida Chamber of Commerce – approved raising the state’s minimum wage from $8.65 this year to $15 in 2026.

“We won’t get fifteen for another five years. We need that now,” an Orlando McDonald’s worker, Cristian Cardona, told The New Yorker.

Once again, inflation is a problem. “By the time we get fifteen, it’s going to be even less,” he said. …Learn More

Diverse Population Uses Nursing Homes Less

Son with father in wheel chair

Since the 1980s, the share of the U.S. population over 65 has grown steadily. At the same time, the share of low-income older people living in nursing homes has declined sharply.

New research by the University of Wisconsin’s Mary Hamman finds that this trend is, to some extent, being driven by an increasingly diverse population of Hispanic, Black, Asian, and Native Americans. They are more likely to live with an adult child or other caregiver than non-Hispanic whites, due, in some cases, to cultural preferences for multigenerational households.

Nursing home residence is also declining among older white Americans. However, in contrast to the Black population, whites are increasingly moving into assisted living facilities. This creates what Hamman calls a “potentially troubling pattern” of differences in living arrangements that might reflect disparities in access to assisted living care or perhaps discriminatory practices. Notably, the researcher finds that the Black-white gap in assisted living use persists even when she limits her analysis to higher-income adults.

Eight states have seen the biggest drops in nursing home use: Florida, Georgia, Louisiana, New Jersey, New Mexico, North Carolina, South Carolina, and Tennessee. Many of these states have experienced fast growth in their minority populations or have more generous state allocations of Medicaid funds for long-term care services delivered in the home.

Growing diversity is actually the second-biggest reason for lower nursing home residence, accounting for one-fifth of the decline, according to the study, which was funded by the U.S. Social Security Administration and is based on U.S. Census data.

As one might expect, the lion’s share of the decline – about two-thirds – is due to policy, specifically changes to Medicaid designed to encourage the home care that surveys show the elderly usually prefer. …Learn More

Map of the United States

Where Will You Retire? This Might Help

The toughest part of Paul and Cathy Brustowicz’s decision to relocate from New Jersey to Summerville, South Carolina, was leaving behind their two grandchildren. The retirees also miss the theater and dinners in Manhattan.

A big advantage of South Carolina, though, is “more house for the money,” Paul Brustowicz said. The couple also had a few old friends who were already living there, and the warm weather is nice, though it, too, involves a tradeoff: high summer humidity and hurricane season. As for amenities, it’s a quick drive to Charleston for dinner, the airport, and the Medical University of South Carolina.

“Overall, it was the right move for us,” he said about the 2012 relocation.

South Carolina ranked a very respectable 14th in WalletHub’s 2021 report on the best and worst states to retire. New Jersey, on the other hand, is squarely in last place because of its steep cost of living.

Also at the bottom of the ranking are New York – another very high-cost state – and Mississippi, which is ranked as having a subpar health care system.

Wallet Hub’s 50-state rankings are based on three categories: affordability, quality of life, and health care. A chart displays each state’s ranking overall and in each category.

Florida, with its year-round sun, golf, and very large retiree community, came out on top. Housing is a relative bargain there, and taxes are low. The tradeoff is the state’s mediocre health care system.

After Florida comes Colorado, which gets high marks all around, and Delaware, which is an affordable retirement spot. …Learn More

Estimate Your Unemployment Check Here

People standing in line for a grocery store during the pandemic

Florida’s unemployment office, after denying benefits to some 260,000 residents, said that it made a mistake. From Maine to California, laid-off workers scheme to outfox crashing websites or wait for hours on the phone to apply for benefits at state unemployment offices.

Thirty million people have filed for unemployment benefits so far, and countless others are trying. Frustration is a way of life for millions of people desperately in need of money for essentials.

If you’re curious about how much your benefit will be – when you eventually get through – or if you fear a layoff is in your future, Zippia has something for you.

Highest and Lowest UI benefitsThe job listing and career advice website has created a calculator that will provide a ballpark estimate of your weekly benefit. Just enter your income and the state you live in, and Zippia’s estimate will be calculated using your state’s unique benefit formula.

The estimate is the total of your benefit from the state, which is based on your pay, plus the $600 additional payment Congress recently threw in. These new federal payments are scheduled to expire at the end of July.

The size of the unemployment check roughly corresponds with each state’s cost of living. Nevertheless, the weekly maximum benefits in some states are disproportionately higher, including in Massachusetts, where the maximum is $823 per week, followed by Washington ($790). The lowest maximum benefits are in Arizona ($240) and Mississippi ($235).

“Our goal is to give as much useful information for people who are in a really tough situation,” said Zippia’s Kathy Morris, who was involved in collecting the state data and designing the calculator.

Whatever your state provides to the unemployed, if you’re entitled to a benefit, you should get it. …Learn More

State Uninsured Rates All Over the Map

Map of Uninsured rates

A decade after the passage of the Affordable Care Act, about one out of every five Texans under age 65 still do not have health insurance. Georgia, Oklahoma and Florida are close behind.

The contrast with Hawaii, Minnesota, Michigan, and New Hampshire is stark – only about one in 20 of their residents lacked insurance in 2018, the most recent year of available data, according to the Kaiser Family Foundation’s annual roundup of insurance coverage in the 50 states.

Despite this glaring disparity, the share of Americans lacking coverage has dropped dramatically across the board, including in Texas. Texas’ uninsured rate fell from 26 percent in 2010 to 18 percent in 2018. This translates to 2.3 million more people with health insurance. (Large populations of undocumented immigrants in states like Texas can push up the uninsured rate.)

States that had fairly broad coverage even prior to the Affordable Care Act’s (ACA) 2010 passage didn’t have as far to fall. For example, Connecticut’s uninsured rate is 6 percent, down from 10 percent in 2010.

One upshot of these two trends is that the disparity between the high- and low-coverage states has shrunk. Certainly, the strong job market gets credit for reducing the ranks of the uninsured. But millions of Americans who don’t have employer insurance have either purchased a policy on the insurance exchanges or gained coverage when their state expanded Medicaid to more low-income residents under the ACA.

For example, just two years after Louisiana’s 2016 Medicaid expansion, the uninsured rate had fallen from 12 percent to 9 percent.

But the initial benefits of the ACA seem to have played out. The U.S. uninsured rate increased slightly, from 10 percent to 10.4 percent between 2016 and 2018.

The share of people who are underinsured is also rising, the Commonwealth Fund found in a recent analysis. …

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Retiring in Florida: The Villages vs Reality

Photo of golf carts in a row

May all your dreams come true.

This hope, displayed on a sign in The Villages retirement community in north central Florida, is why thousands of people flock there every year to retire.

During my annual holiday trek to visit my 84-year-old mother in Orlando, my husband and I drove her to The Villages to visit her good friend who had moved there. What struck me was the contrast between its over-the-top comforts and my mother’s modest retirement community just outside Orlando, where many of the residents, who heavily depend on their Social Security, are just barely getting by.

The differences in lifestyles reflect the retirement disparities that exist in this country and are a continuation of the disparities in our working population. But I was also struck by the similarities in what retirees – regardless of their socioeconomic status – are seeking: to live out their remaining days healthy and without worry.

The Villages is 32-square-miles of unbridled growth. The 55+ community features three Disney-like town squares – Spanish Springs, Brownwood, and Sumter Lake – with a fourth, Southern Oaks, under development. Retirees zip along in colorful golf carts through the perfectly landscaped grounds on paths that were designed for the vehicles. The residents use the golf carts to move between their tidy houses, the town squares, activity centers, and one of The Villages’ 53 golf courses and 100 pickle ball courts. There’s even a gas station for golf carts – that’s how integral they are to retirees’ lives.

It seems that the box stores and supermarkets have been placed on the edges of this sprawling development so as not to spoil the vibe – retirees drive cars to these destinations. Also on the periphery are establishments catering to the unappealing aspects of growing old: laser eye surgery centers, dialysis centers, assisted living facilities, and funeral homes. Old age is tough – even in The Villages. For example, my mother’s friend lost her husband and then – a few years later – her fiancé died.

Photo of a man golfingThe Villages’ creature comforts are expensive. Prices are high by the standards of Florida’s interior, ranging between $250,000 and $800,000. Residents often pay for them by selling a house up north to cash in on the appreciation. They also pay an assessment to cover the development’s infrastructure costs and a monthly fee of just over $1,000 for utilities, trash pickup and endless amenities, which, in addition to golf, include numerous activity centers, lakes for fishing, and easy access to the town centers’ restaurants, Starbucks, shopping, and movie theaters.

But this enclave of privilege and play doesn’t reflect the reality for most retirees. My straight-talking Midwestern mom’s assessment of The Villages is, simply, “I can’t afford it.” …Learn More