For the last two years, Syd Winlock has had a major burden lifted from his surgically repaired shoulder.
Federal subsidies passed as part of a temporary pandemic relief package have drastically cut how much he pays in healthcare premiums, allowing the Sacramento-area small-business owner to purchase an insurance plan during the last two years that provided better coverage for his shoulder and knee replacements.
Those federal subsidies, however, will expire at the end of this year if Congress does not extend the program. His “very manageable” price — about $700 a month for him and his wife — will increase to $2,300, Winlock said.
“Even if we went to a lesser-type policy, it would still be about $1,800 a month,” Winlock, 63, said. “I mean, that’s more than my mortgage.”
Roughly 150,000 lower- and middle-income Californians would be similarly priced out of coverage by the rising premiums if the federal subsidies are not extended, a Covered California analysis recently estimated.
The federal subsidies were passed in early 2021 as part of the Biden administration’s American Rescue Plan Act, which temporarily provided help to Americans to recover from the economic and health effects of the COVID-19 pandemic.
Under the act, health insurance premiums were capped at 8.5% of a household’s income. That significantly dropped monthly payments and led to more consumers signing up through Covered California, the insurance marketplace created by the 2010 Affordable Care Act for working-age people who aren’t covered by a health plan at their job.
Enrollment in the state’s exchange has hit a record-high 1.8 million, of which Covered California reported that 92% received some form of subsidy.
“These enhanced subsidies have fundamentally delivered affordability and delivered on the promise of the Affordable Care Act in the way that it was intended,” said Jessica Altman, executive director of Covered California.
“There were a lot of people who said things like, ‘Oh, my gosh, you know, for the first time I can afford my health insurance and my child care....’ This is particularly important given the inflationary environment we are in now.”
More than 1 million lower-income earners — individuals making between $17,775 and $32,200 and families of four with income between $36,570 and $66,250 — would see their premiums more than double if Congress doesn’t extend the program, according to the Covered California analysis. Monthly premiums for middle-income earners would increase, on average, by $272 per member next year.
John Baackes, the chief executive of L.A. Care, a health insurance plan serving Los Angeles County’s poorest and most vulnerable residents, said that although the enhanced subsidies don’t expire until the end of the year, the window for Congress to act is growing smaller because of its monthlong August recess. At that point, legislation typically slows down in an election year.
Baackes said health plans will need time to send renewal notices to consumers of anticipated rates for the 2023 coverage year, which are mailed in October.
“So we’re very concerned about it,” Baackes said. “The American Rescue Plan provided increased subsidies that are really a wonderful thing. And many of our members benefited from it.”
With open enrollment beginning one week before the Nov. 8 midterm elections, Democrats on Capitol Hill are increasingly eager to prevent consumers from receiving notices about huge increases in insurance premiums before voters go to the polls. But the debate about whether to extend the subsidies or — as some have pushed — make them permanent has been hamstrung by wrangling over the price tag and the effect on skyrocketing inflation.
Gov. Gavin Newsom and state lawmakers proposed spending $304 million in separate state healthcare subsidies to lessen the burden if the federal program is not extended. That money, which is included in a state budget that is expected to be finalized this month, would offset premium increases for more than 700,000 residents.
However, those state-funded subsidies will cover only a fraction of the federal premium discount currently available under the American Rescue Plan, which provided $1.7 billion to California in each of the last two years to help with healthcare costs.
“Nearly half of the folks in Covered California are paying less than $10 a month,” said Anthony Wright, the executive director of Health Access California, a consumer group that is pushing Congress to make the increased federal subsidies permanent. “We live in a high-cost-of-living state, so people will have to make decisions about how much healthcare they can afford.”
That worries Tuan Nguyen, a caregiver in the Silicon Valley city of Milpitas. Having been diagnosed six years ago with a rare and painful disorder called glossopharyngeal neuropathy, Nguyen said he has to buy more costly insurance coverage that allows him to see particular specialists.
“I need the healthcare plan,” said Nguyen, 44. “I need to see my doctor. I need my treatment. These are things that are a necessary part of my life, and they’re all very expensive and getting much harder to afford.”
Reducing the number of uninsured residents in the state has been a top priority for Newsom and legislative leaders, who in 2019 approved legislation creating a fee for anyone who does not have insurance. The individual mandate was intended to induce younger and healthier individuals to buy coverage through Covered California to widen the pool and lower rates overall as Democratic leaders move California closer to universal coverage.
As part of that effort, California has incrementally expanded eligibility for Medi-Cal, the state’s healthcare program for the poor, to certain age groups of low-income people regardless of immigration status. California’s pending budget would offer Medi-Cal to the final remaining age group in 2024, opening the healthcare program to residents 26 to 49 years old regardless of immigration status. Newsom said the move will make California “the first state in the country to achieve universal access to health coverage.”
Miranda Dietz, a research and policy associate at UC Berkeley Labor Center, said the significant increase in the number of Californians with health insurance over the last two years would be in jeopardy without the federal subsidies. Dietz co-wrote a study in partnership with the UCLA Center for Health Policy Research that projects that as many as 1 million people will forgo insurance in California next year if federal subsidies expire.
“It makes it so it’s very disheartening to take away these extra subsidies that have been really crucial in improving affordability for folks,” Dietz said. “It’s a real blow towards that goal of universal coverage and more affordable coverage.”
The added cost of premiums “will be a real struggle for folks who are deciding between rent and groceries,” Dietz said.
For Winlock, the small-business owner, the added cost if federal subsidies are not extended would be temporary. Next year, Winlock and his wife turn 65 and will qualify for Medicare. In the meantime, he would probably look for the cheapest plan possible and hope for the best.
“We probably would look at some alternative ways to get healthcare,” Winlock said. “We certainly wouldn’t be able to afford mainstream healthcare. It is just out of our budget.”
Times staff writer Jennifer Haberkorn in Washington contributed to this report.
The COVID-19 pandemic shocked the world affecting organizations and institutions that supported the delivery of nutrition programs at all levels. To timely respond to the needs of the nutrition community, the Agile Core Team for Nutrition
Monitoring (ACT-NM) group, a collaboration amongst UNICEF, USAID, WHO and USAID Advancing Nutrition, developed an analytical framework for exploring pathways for the impact of COVD-19 pandemic on key nutrition outcomes.
The comprehensive analytical framework encompasses the six maternal, infant and young children nutrition targets endorsed by WHA, the outcomes monitored towards the elimination of malnutrition in all its forms, one of the Sustainable Development Goals
Linking the overarching categories of food, health, social protection, education, water, and sanitation to outcomes and impacts of COVID-19 on nutrition, the Analytical Framework the is an useful tool that allows users to construct context-specific pathways
to study the impact of COVID-19 and future shocks.
The Analytical Framework Visualizer can be accessed at https://www.who.int/tools/covid19-nutrition-analytical-framework
Health care professionals, community health workers, business owners, and policy makers can all delve into the impacts of a given shock, exploring various contexts that expand into underlying determinants. Policy makers can also click on the visualizer’s
interactive features to expand, collapse, and build out their own pathways and explore the impacts of specific shocks, such as a lockdown or supply chain disruption. The tool allows for the download a pool of potential data sources for the several
factors included in the framework, the data mapping tool.
Apple may have the best smartwatch around, but there are still some areas where it lags the competition, particularly in exercise and sleep tracking. With watchOS 9, the company is bringing a robust slate of Workout updates, alongside new watch faces, redesigned apps and the ability to detect sleep zones. Now that the public beta is here, we can get a first look at whether the company can close those gaps.
To install the watchOS beta, you’ll need to have an Apple Watch Series 4 or newer, as well as an iPhone running the iOS 16 beta. That means if you don’t want to risk losing your data, you might want to wait until an official release before updating.
Hearty changes in Workouts
Some of the most impactful updates are in workouts. Apple added pages that present more data when you’re logging an activity, so you can easily keep track of things like your segments and splits or elevations. Of these new screens, my favorite is the Cardio Zones view, while I found the Activity Rings page the least helpful.
It was satisfying to see where my heart rate was during a 45-minute HIIT session, and the Apple Watch displayed that information clearly. There were five zones in different colors on screen, and the one I was in was highlighted. Afterwards, I learned through the Fitness app’s new summary page that I had spent most of the time (about 22 minutes) in Zone 4, and Apple also helpfully displays the heart rate range for each zone.
The Cardio view is supposed to be available for all workouts, but I didn’t see it in activities like Yoga, Dance or Cooldown. They do all support the new custom workout feature, though, which lets you create specific goals to focus on during your session. This is much more useful in distance or endurance-related activities like running, cycling, rowing or HIIT, where Apple offers suggested templates like 8 x 400m repeats, 1 mile repeats or 20 min of 20 sec / 10 sec. You’ll get haptic and audio alerts when you hit your target heart rate, distance, calories or time.
You can scroll all the way down to set up your own, but this experience is pretty inconsistent across different workout types. For some activities, you’ll have plenty of options like Pacer, Distance, Calories or Time. For others, like Open Water Swim or Rower, you’ll only see Calories and Time, along with a Custom option that lets you set specific periods of work and recovery.
Not every activity is going to be compatible with distance or pace, so this inconsistency is understandable. Just don’t expect the custom workouts feature to behave the same way for all your exercises.
Runners will find a lot of the watchOS 9 tools helpful, though. Apple also added new running form metrics like stride length, ground contact time, vertical oscillation and something it calls Power. That last one measures your responsive energy demand and is displayed as a number of watts. These new metrics are automatically calculated, and are only available during Outdoor Run workouts. You’ll need to be using an Apple Watch Series 6, Watch SE or newer, too.
If you tend to run or bike along the same routes, watchOS 9 can also let you race against yourself in the new Race Route feature. When you complete Outdoor Run, Outdoor Cycle or Wheelchair Run Pace workouts, your iPhone will use on-device processing to group similar routes. The next time you start one of these activities, the Route view will tell you if you’re ahead or behind your typical time, how much distance is left and alert you if you go off your usual path. Apple also added a new Pacer mode that lets you set a target time to complete a distance you specify, and will then guide you to hit the required pace to meet that goal. Garmin and Samsung watches have similar features, so Apple isn’t breaking new ground here, but it’s nice to see come to watchOS.
I don’t usually bike, swim and run within one session, but for triathletes, the new Multisport workout mode makes it easier to switch between the three activities so you don’t have to fiddle with your watch. Apple also added support for Kickboard as a stroke type, and swimmers can see a SWOLF efficiency score on their summaries.
New watch faces and interface
One of the nicer things about each watchOS update is the new faces, which offer a way to refresh your device. This time, Apple not only added the ability to change the background color of existing options like Modular and X-Large, it’s also introducing new Playtime, Metropolitan and Lunar designs. The company redesigned the Astronomy screen, too, and it’s similar to the iPhone version where you can choose between views of the earth, moon or the solar system. Meanwhile, Lunar lets you pick from the Chinese, Hebrew or Islamic calendars to display around the clock.
I never knew how much I’d appreciate having the Chinese Lunar calendar within reach until I added this face. It has Mandarin characters telling me it’s currently the fifteenth day of the sixth month, and I can use this to count how far we are from the next Lunar New Year or my grandmother’s birthday (which my family bases on the Chinese calendar).
Apple also redesigned the calendar app, making it easier to add new events from your wrist. Siri also no longer takes over your whole screen when triggered, instead appearing as an orb floating over the clock.
Because I had set up Medications on my iPhone on the iOS 16 preview, I also received an alert on watchOS 9 when it came time to take my supplement. I could easily log that I had taken my meds, skipped them or snooze the reminder.
Sleep zones and other updates
Speaking of snoozing, Apple also added sleep stage-detection to watchOS 9, using data from the accelerometer and heart rate monitor. It’ll detect when you’re awake, and distinguish between zones like REM, Core or Deep sleep. This feature is way overdue, considering Fitbit has long been able to do this with even its midrange trackers. But while I didn’t get around to testing Apple’s system in time for this preview, I look forward to seeing how it compares when I do a full review.
There are some other updates I’d like to spend more time with, too, like the additional metrics when doing a Fitness+ workout. So far, my experience with the watchOS 9 beta has been smooth, and honestly the cardio zones workout view alone has made the installation worthwhile (for a gym fiend like me, anyway). If you’re comfortable with the risk involved in running beta software, and can’t wait till a stable release to get these new features, you’ll likely enjoy what Apple has to offer today.
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