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American Rescue Plan: Benefits for the Breast Cancer Community
Joanna Fawzy Morales, Esq.
March 29, 2021

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Joanna Fawzy Morales is a cancer rights attorney, author, speaker, and CEO of Triage Cancer, a national nonprofit organization providing free education on the legal and practical issues that may affect people diagnosed with cancer and their caregivers. Joanna has spent more than 27 years working on behalf of people with cancer, including 5 as an adjunct professor of law at Loyola Law School, teaching a seminar in cancer rights law, and 8 years at the John Wayne Cancer Institute’s Psychosocial Care Program. Currently, she’s also an adjunct law professor at Wayne State University.

Listen to the episode to hear her explain the American Rescue Plan and the benefits it may offer to people diagnosed with breast cancer, including:

  • additional economic impact payments for individuals who make up to $75,000 or couples who make up to $150,000
  • the increase in health insurance marketplace subsidies
  • when the benefits begin and how long they will last

Running time: 27:27

Show Full Transcript

Jamie DePolo: Hello. Thanks for listening. Our guest is Joanna Fawzy Morales, a cancer rights attorney, author, speaker, and CEO of Triage Cancer, a national nonprofit organization providing free education on the legal and practical issues that may affect people diagnosed with cancer and their caregivers. Joanna has spent more than 27 years working on behalf of people with cancer, including 5 as an adjunct professor of law at Loyola Law School, teaching a seminar in Cancer Rights Law, and 8 years at the John Wayne Cancer Institute Psychosocial Care Program. Currently, she's also an adjunct law professor at Wayne State University.

She joins us today to talk about the American Rescue Plan passed by Congress in March 2021 and how the plan affects subsidies for comprehensive health insurance available under the Affordable Care Act.

Joanna, welcome back to the podcast. It's always a pleasure to talk to you.

Joanna Fawzy Morales: It's a pleasure to be here with you.

Jamie DePolo: So, to start, I know the American Rescue Plan has a lot of things in it. What aspects of the plan are important for people who've been diagnosed with breast cancer?

Joanna Fawzy Morales: There are actually a number of items included in the American Rescue Plan that may be useful for the breast cancer community, but I do feel like I need to share that the information that I will be sharing is based on what we know so far. The Federal Government and states are constantly releasing details about how these new options are actually going to work for people. So, I'm going to give you some details, but know that you can always visit TriageCancer.org for the latest information.

So, there are a number of things in the American Rescue Plan that try to address the financial challenges that people have been experiencing over the last year due to the pandemic, but many of these new things will greatly help the breast cancer community, specifically. There are additional Economic Impact Payments that are already being received by people. For any individual with an income up to $75,000 or couples up to $150,000, they'll get a $1,400 cash payment. Families will also receive an additional $1,400 for each dependent child, and for the first time, adult dependents also qualify. They weren't included in last year's stimulus package.

Jamie DePolo: I just wanted to ask if you could clarify, because I'm not sure I understand what it means. What is an adult dependent? Is that somebody that you take care of that is over the age of 18?

Joanna Fawzy Morales: It is. So if you have a family member, maybe with a developmental disability, who you take care of and you financially also support them, they qualify as an adult dependent under IRS standards. So, anyone in that circumstance can also qualify for additional financial help.

Jamie DePolo: Oh, okay. Thank you.

Joanna Fawzy Morales: There are also programs that include rent and food assistance, there's help with utility and water payments, and there are some additional key tax breaks that will help many individuals and families as well.

So, first, there's the Earned Income Tax Credit, which is available to workers with lower wage jobs that will lower their taxes. The American Rescue Plan actually increases the number of people who now qualify for this tax credit. For workers without children, the tax credit is increased to $1,500, which means that more than 17 million workers with annual incomes below $21,000 now qualify for this tax credit. So, basically, what this means is a worker earning around $13,000 a year could pay up to $900 less in taxes this year.

Jamie DePolo: Oh, that's great.

Joanna Fawzy Morales: It is a great financial benefit. There is also the Child Tax Credit for 2021, which gets increased from $2,000 to as much as $3,600 for children under the age of 6, and $3,000 for children ages 6 to 17. And this is actually the first time that this tax credit applies to 17 year olds. So, again, individuals with incomes up to $75,000 and couples with incomes up to $150,000 can qualify. This kind of breaks down to about 65 million children are going to receive these increased tax credits.

And what this plan does is go even a step further, because families can actually receive advanced payments from July to December of this year, as opposed to just getting the tax credit on your taxes. And that's a big difference. It puts money in people's pockets right away, but the details are still to come. The IRS hopes that this is going to be a monthly payment that people can receive from the Federal Government, but we don't know exactly how that's going to work out yet.

Jamie DePolo: Okay. Okay. Was there more on that, or should we switch over to the Marketplace subsidy?

Joanna Fawzy Morales: There are a couple of benefits for individuals who've been unemployed. If you have been receiving unemployment benefits, the federal government is adding an additional $300 a week to what states provide for benefits. This was going to end in March, but it's been extended through September 6, 2021. And if you received unemployment benefits during 2020, when you go to pay your taxes, the first $10,200 of the benefits that you've received are not going to be taxed. So, it lowers people's tax burden for last year.

Jamie DePolo: Oh, okay. I see. I do have a question about that, because I thought I heard — and if I'm mistaken please tell me — that when people were receiving these unemployment benefits because of the pandemic, that taxes were not taken out of them. And sometimes people were not accounting for that and perhaps were not putting aside enough money to pay for taxes. And it sounds like this new plan is sort of trying to help that.

Joanna Fawzy Morales: Absolutely. So, generally, when someone qualifies for unemployment benefits, the state sends you a payment, and they don't take out any income taxes. They send you the full payment, and you're responsible for including that on your taxes for that year, and you may have to pay taxes based on that income that you've received. So, this is actually helping people. Again, for the first $10,200, they don't have to pay taxes on those amounts, and that really speaks to the financial challenges that so many people are facing because of the pandemic.

Jamie DePolo: Okay. So, let's switch the focus to the increase in Marketplace subsidies. So, what does this mean for people of various income levels? I saw a news article, and it made it sound like most uninsured citizens were going to be eligible for free or very low-cost health insurance. Is this true, or was this kind of media hype?

Joanna Fawzy Morales: It is true. If you are currently uninsured, it's very likely that you'll be eligible for free or low-cost health insurance through the state health insurance Marketplaces. But it may also be true if you already have health insurance through the Marketplace that you can update your information and actually receive more financial help to lower your monthly premium.

So, the American Rescue Plan did two very important things to expand access to health insurance coverage by making it more affordable for people. The first is that individuals with a household income between 138 and 150% of the federal poverty level now qualify for a Marketplace plan at the Silver level for a monthly premium of $10 or less. So, this comes out to be helping individuals earning about $19,000 a year or for a family of four earning $39,000 a year. So, it's kind of amazing to think that you could get health insurance for a monthly premium of $10 or less.

Jamie DePolo: Yeah, that's amazing, and that's really expanding the pool of people who can qualify for that. Is my understanding of that right? It seemed like it was more narrow before.

Joanna Fawzy Morales: Yes, and it greatly reduced the actual monthly premiums for people. In most states, if your household income is below 138% of the federal poverty level, you actually qualify for Medicaid under the Affordable Care Act, which is also known as Obamacare. But this increased between 138 and 150% the financial assistance to buy that Marketplace plan.

Jamie DePolo: Okay. That's great. Now, I also read that people who are receiving unemployment insurance get a special discount on health insurance. Is that correct, and if so, could you talk about that?

Joanna Fawzy Morales: That's right. For anyone who has a lower income level and collected unemployment benefits for any week of 2021, they may qualify for a free Silver plan, meaning that their monthly premium for health insurance is $0. And that's obviously a huge benefit to help people stay insured. And we know that many people in the cancer community have lost their jobs or had to leave their jobs over the last year because they were concerned about exposure to COVID, so this really helps people who were in treatment and need that health insurance coverage.

Jamie DePolo: Absolutely. Absolutely. Now, I guess my big question, too, is: so this was an act passed to help people through the pandemic. So, when do these benefits start, and how long do they last?

Joanna Fawzy Morales: All of these benefits begin on April 1, 2021. They gave the federal government a couple of weeks to actually update the process and update the computer system so that people could get access to these benefits. How long they last actually depends on the benefit. So, the financial help for getting health insurance coverage for individuals who receive unemployment benefits only lasts through 2021, but the other financial assistance in the Marketplaces will exist through the end of 2022.

Jamie DePolo: Okay. So, then, I'm curious, how does that work? So, say I qualify to get free health insurance for 2021, and I sign up on April 1. What happens at the end of 2021?

Joanna Fawzy Morales: So, Marketplace coverage is only calendar-year coverage. So anytime you sign up for a Marketplace plan, it's only going to go from January to December. So this new benefit is only going to go through this December, and then we don't know exactly the details yet, but what usually happens is in the fall, there's an open enrollment period where you can either choose to stay with the plan that you have, or you can make changes to the plan, or if you don't have a Marketplace plan, that's your opportunity to buy in the Marketplace. And so you're signing up in the fall for coverage that is going to begin on January 1.

Jamie DePolo: I see. Okay. Well, then this raises another question in my mind. So, say I don’t have a Marketplace plan now, but I lost my job at the beginning of 2021. Can I sign up for a Marketplace plan on April 1, even if I didn't sign up during that open enrollment period last fall?

Joanna Fawzy Morales: Yes, and that's because the president not only reopened the Marketplaces for enrollment from February 15 to May 15 of this year, but he just announced that the Marketplaces are actually going to stay open until August 15 of 2021.

So, that's a huge period of time where people can get access to these new options with new financial assistance, but it's also the moment where if you already have a Marketplace plan, you can actually go into the Marketplace, go into your account, update your information, and you can change plans. Because maybe you chose a Bronze plan because that's all you could afford when you first signed up for coverage, but now, because of the new financial assistance, you could actually lower your monthly premium or you could pick a plan with better coverage with an even lower monthly premium. So, it gives everybody a huge amount of flexibility in this great, new opportunity to not only look at your plan again and make sure it works the best for you, but also get access to that financial help.

Jamie DePolo: Oh, that's great. I did not realize that the Marketplaces were staying open that long. That's really helpful.

Joanna Fawzy Morales: Yes. It is. It is very useful for people. I think, also, what is really important is for people to understand the timing of this, because if you have a Marketplace plan, or if you would like to get a Marketplace plan, you can do that at HealthCare.gov, and that's available for the 36 states that use the federal website for their Marketplaces. But some states actually run their own Marketplace and have their own websites.

But even if you're in one of those states, you can still start at HealthCare.gov, and it's going to point you to their state website. And you can always visit HealthCare.gov at any time to see what plans are available to you based on where you live. You can also always visit TriageCancer.org to learn more about the Marketplaces, your different health insurance options, and how to pick a plan that's going to work best for you.

Jamie DePolo: Okay. That's great. Thank you for mentioning that website, because I'm sure I can't be the only one. I've seen ads on TV that direct people to different websites that sort of purport to be the federal plan, but it's really a private company that wants to charge you to set you up with a plan. So, I don't know if that has ended or if that is still going on, but I do want to emphasize that everyone should go to HealthCare.gov to look for plans.

Joanna Fawzy Morales: That is an excellent point. We do see a lot of scams, and there's a lot of misinformation out there, and I think commercials just contribute to that. So, if you start at HealthCare.gov, you know that you'll be in the Marketplace.

Jamie DePolo: Okay. Perfect. Now, I've also heard that there are some benefits, for people who are eligible, to COBRA, which is the coordination of benefits. So, if they lost their old insurance, they have the right to — I guess I think of it as sort of a bridge. Coverage between the two insurance plans. So, is that right, and could you talk about that?

Joanna Fawzy Morales: Yes. There are some new benefits. COBRA is that federal law that allows eligible employees to keep their health insurance coverage through work when they leave or lose their jobs, among other things. And one of the challenges with COBRA is that the monthly premiums can be very expensive, because it's not just what you were paying for your monthly premium, it also includes what your employer was paying. And I often say we don't appreciate what our employers pay for our health insurance coverage until we have to write that check ourselves. So, the American Rescue Plan actually addresses that by paying 100% of COBRA premiums for people who are eligible for COBRA because they lost their job.

Jamie DePolo: And how long does that last?

Joanna Fawzy Morales: So, it begins April 1, and it will go until September 30. So, it is 6 months of paying for those COBRA premiums.

Jamie DePolo: And the idea is, help me understand this. The idea is during that 6 months, the person would be then looking for other insurance, say, through the Marketplace or through another private plan? Is that the idea with that?

Joanna Fawzy Morales: Well, the idea, I think, is just to provide some financial help to people who have lost their jobs and to continue to help them access health insurance coverage, which is especially important for the cancer community and for anyone who's in the middle of treatment, not having to worry about paying for health insurance. But certainly someone could also look at their Marketplace options and compare the two and see which one is actually going to work better for them. But there's a couple of key things that I want to mention about this new benefit because it is really quite flexible and beneficial for people to understand.

So, this new benefit also gives you a second chance to get COBRA. So, if you decided not to take COBRA because it was going to be too expensive, and you're currently uninsured, you actually have a chance now to sign up for COBRA. And you don't have to pay any back payments, which is huge because you normally would. And if you actually took COBRA and stopped paying for it because it was too expensive, you now get a chance to go back onto COBRA starting April 1.

You only get to keep the COBRA coverage, though, through the period that you originally would have been eligible for COBRA. So, for most people who lose their job, they're eligible for COBRA for 18 months. So, if you lost your job January 1 of 2020, you could elect COBRA on April 1 of this year, but it's still going to end 18 months from January 1 of 2020. So, it's going to end on June 30. But at least you could have COBRA April, May, and June, and have it paid for fully.

Jamie DePolo: Okay. I see. Yeah. That's helpful. And then, when the COBRA runs out, somebody would then have to figure out what other plan they wanted, what other type of insurance they wanted, whether it's through the Marketplace or something else.

Joanna Fawzy Morales: Yes. So, when someone gets to the end of their COBRA eligibility, it actually triggers a special enrollment period for the Marketplace. So, that would give someone another opportunity to look at the Marketplace.

Jamie DePolo: Oh, that's interesting. So, somebody who is eligible for COBRA, they might have some choices depending on these new benefits. If they qualify for a better plan at a lower cost through the Marketplace, then they may have some choices to make. Like, do I want to stay with COBRA, or do I want to switch over to the Marketplace?

Joanna Fawzy Morales: Exactly. We always recommend that people look at all of their options related to health insurance and do some math and make sure that your providers and your facilities are actually covered by your plan's network, and make sure that your prescription drugs are covered, and make sure that the plan is actually working for you. Because if it's not, if all the providers you want to see are outside of your plan's network, this is an opportunity to actually assess your coverage and find a new plan that works best for you with a lot of financial help to do that.

Jamie DePolo: Okay. Now, are there other things in the American Rescue Plan that might benefit the breast cancer community that we haven't talked about so far?

Joanna Fawzy Morales: Well, when you get a Marketplace plan, you estimate your income for the year ahead. So, if you're in 2020, you estimated your income for 2021. But if you estimate too low and you actually make more money during the year, you actually have to pay back some of the financial help that you got. This plan actually eliminates that requirement for 2020. And the idea is, really, that so many people had a change in their incomes during 2020 that this just makes it easier for everyone and eliminates this requirement, so that you don't have to pay back the financial help that you received for health insurance through the Marketplace for 2020.

If someone has already filed taxes for 2020, the IRS is currently figuring out how to get you a refund, and the IRS has also actually extended the tax filing deadline for everyone from April 15 to May 17 of this year.

Jamie DePolo: Well, that's helpful. I did see that in the news. So, that's very helpful. I'm curious, too. If somebody underestimated their income, do they get any extra benefits, or, say, they thought they were going to make, I don't know, $20,000, and they only ended up making $13,000. Do they get anything extra because of that or no?

Joanna Fawzy Morales: That's a great question. That's a great question. So, they actually do. They get the amount of financial assistance they would have received if they had reported their income at that time. One of the ways to avoid having to deal with this at the end of the year is that any time you have a change in income during the year, you report that to the Marketplace, and they adjust what you pay for your health insurance based on your new income level. So, for someone who loses their job in the middle of the year, and their income goes down considerably, it's a really good idea to report that immediately to the Marketplace because then the Marketplace, moving forward, will lower what you pay for your monthly premiums.

Jamie DePolo: Interesting. Okay, I did not know that. That's very helpful. Okay. Anything else that might benefit somebody?

Joanna Fawzy Morales: Yeah. I did just want to mention that the Rescue Plan also removes the cap on financial help for people with a household income over 400% of the federal poverty level. So, previously, you could only get financial assistance up to 400%. Now there isn't a cap, but it's based on the idea that you shouldn't have to pay more than 8.5% of your income on health insurance coverage. So, now they do the math to see, based on your household income and the number of people in your household and the cost of health insurance where you live, they'll lower your monthly premium to reduce it, so that it isn't more than 8.5% of your income.

Jamie DePolo: Oh. That's really helpful. And just for my own knowledge, when you say 400% of the poverty level, is there a rough figure for that?

Joanna Fawzy Morales: Yes. So, an individual, that's about $51,000 a year, and for a family of four, that's about $105,000 a year. So, for example, a family of four earning $110,000 a year previously wouldn’t have been eligible for any financial assistance to lower their monthly premium. But now, their maximum health insurance premium for the family of four would be less than $780 a month in the Marketplace.

Jamie DePolo: Okay. That's very helpful. That's very good to know, and I do hope people take advantage of that. Any other things in the plan that we should know about?

Joanna Fawzy Morales: I think those are the key things in the plan. There are some other things that have been helpful for the cancer community that have happened over the last couple of months. One of the most significant things is that normally if you leave your job, voluntarily, you're not eligible for unemployment benefits. But because of the pandemic, many people in the cancer community couldn't go back into the workplace because of their concern over having a compromised immune system and their potential exposure to COVID.

So, they didn't return to work, and they got let go or their employer reported that as them quitting, and the U.S. Department of Labor over the last couple of months has actually released some guidance that adds “concern over exposure to COVID” as a reason that you could refuse work but still get access to unemployment benefits, which I think is a huge change in the way that they handle that and provides an additional protection for the cancer community.

Jamie DePolo: Absolutely. Absolutely. Were there other things that you wanted to mention?

Joanna Fawzy Morales: I just generally want to tell people if they're having trouble paying for any of their expenses, that there is financial assistance out there. There are programs at the federal, state, county, and city levels that have existed before the pandemic, but there are a lot of new ones now, and to really look to see what's available to you and to not ignore your bills but try work with your creditors to see what's available because of all of these new programs.

Jamie DePolo: Sure. That's excellent advice. Joanna, thank you so much for helping us and me understand this very complicated topic. It does sound like there are some things that people who've been diagnosed with breast cancer should definitely check out and take advantage of if they qualify, because they could be very helpful.

Joanna Fawzy Morales: Absolutely. I hope that people learn more and take advantage of them.

Jamie DePolo: Thank you so much.

Joanna Fawzy Morales: Thank you.

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