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As Open Enrollment Begins, Health Benefits May Not Change Much

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Open enrollment season is here again for workers fortunate enough to have health insurance through their job.

Workers could pay 4 to 5 percent more for their health premiums next year, according to various estimates of cost increases.

That’s in line with increases in recent years, even as the pandemic continues to bring economic challenges and uncertainty for both workers and their employers. People may use more medical services in 2021 because they put off routine care this year during the pandemic shutdowns. And the costs of treating coronavirus cases continue, while the country awaits a vaccine.

Still, many employers have indicated that they are trying to avoid major changes in health benefits for next year, to avoid jarring workers already stressed by the pandemic. Some employers may absorb much of the cost increase so workers pay about the same in premiums as they do this year, said Steve Wojcik, vice president of policy with the Business Group on Health.

“Quite a number are recognizing the financial challenges employees face,” said Mr. Wojcik, whose organization represents employers on health care and benefit matters.

Of more than 1,100 employers responding to a survey by the benefits consultant Mercer since early July, more than half said they would make no changes of any kind that would reduce their costs in 2021. Just 18 percent said they would take steps to shift more costs to employees, like increasing co-payments and raising deductibles — the amount workers pay out of pocket for care before the plan starts paying.

“That’s very good news for employees,” said Tracy Watts, a senior consultant at Mercer.

This year, the average annual family health premium increased 4 percent to more than $21,000, according to the Kaiser Family Foundation. Workers, on average, contributed about $5,600 toward the cost, and employers paid the rest. (Kaiser surveyed 1,765 randomly selected employers with three or more workers. About half of the interviews were done before employers had felt the full impact of the pandemic.)

Most Americans have employer-provided health insurance. But during the pandemic, millions lost their jobs and related benefits. Estimates vary, but a study from the Commonwealth Fund published this month suggests that as many as 14.6 million people — 7.7 million workers and nearly seven million dependents — had lost employer-based coverage as of June because of the pandemic-induced recession.

It’s unclear how many of those people lost coverage permanently. Some job losses may have been temporary, and some workers may have continued paying the full cost of their group coverage through the federal COBRA program. Others may have found coverage through Medicaid, the government health plan for the poor, or under the Affordable Care Act, which both expanded Medicaid coverage in some states and authorized the sale of subsidized, private health plans through federal and state marketplaces.

(The future of the Affordable Care Act’s safety net is uncertain, as a court challenge to the law awaits a hearing before the Supreme Court, scheduled for the week after the Nov. 3 presidential election.)

Like many workplace meetings, benefits discussions are moving online during the pandemic. Many employers are shifting to virtual enrollment fairs, instead of holding traditional gatherings in the office cafeteria.

In some employer offerings, Mercer said, workers can earn points for “visiting” online information booths and earn the chance to win gifts, like an iPad.

Care itself is also increasingly moving online. About half of large employers will offer more virtual care options in 2021, according to the Business Group on Health. Many people became more comfortable with seeing doctors remotely during the pandemic, whether for an online visit with their own doctor or a session with an independent telehealth provider, said Ellen Kelsay, president and chief executive of the group. Employers also expect to expand virtual options for mental health treatments, via online sessions, videos and apps.

Many employers said they expected to add on-site health clinics next year, according to the Business Group on Health. Some types of businesses, including manufacturing and health care companies, have found that on-site clinics have been useful for coronavirus screening and testing as well as for telehealth services, Ms. Kelsay said.

Here are some questions and answers about open enrollment this year:

How should I choose a health plan?

Open enrollment periods vary by employer, but typically last several weeks. When evaluating options, employees should be careful to review a plan’s network of doctors and hospitals, said Cheryl Fish-Parcham, director of access initiatives with Families USA, a health care advocacy group. Some employers may offer “narrow” network plans at lower cost, but those plans typically include a limited number of doctors and a single hospital. Some plans are “open,” meaning you can go outside the network for a fee, but others pay nothing unless you are within the network, she said.

You may want to call to confirm that your regular doctor participates in the plan. “Make sure it includes the providers you want,” Ms. Fish-Parcham said.

If you take medication regularly for a chronic condition, she added, make sure the plan’s prescription benefit covers it.

If your employer offers multiple plan choices, Ms. Watts of Mercer said, you should take the time to compare the total cost of coverage for each option — don’t just look at the premiums. She advises taking the total premium and subtracting any contributions made by your employer, such as to a health savings account, to compare the cost of different plans.

“Do the math,” she said.

To see your total potential financial exposure, add the plan deductible. If you are generally healthy and don’t take regular medication, a plan with a higher deductible may save you money. If you can’t afford unexpected costs, a lower deductible — typically with a higher premium — may be the best option. The average deductible for an individual is $1,644, Kaiser found.

Theresa Adams, senior knowledge adviser at the Society for Human Resource Management, said many workers didn’t take enough time to evaluate benefits. She encouraged them to make use of online tools offered by their employers to help choose options and to reach out with questions.

How much can I contribute to a health savings account in 2021?

Contribution limits ticked up for next year, the Internal Revenue Service announced. The maximum contribution is $3,600 for an individual and $7,200 for family coverage. (People 55 and older can save an extra $1,000.) H.S.A.s, however, are available only with specific types of health plans with high deductibles — at least $1,400 for individual coverage and $2,800 for family coverage for 2021. Typically, your employer will specify if a plan is H.S.A. qualified.

Some plans have a different option, called a health care flexible spending account. You can contribute to it before taxes, via paycheck withdrawals, to pay for care and products that your health plan doesn’t cover. Contribution limits are lower than with an H.S.A., and if you change jobs, your flexible spending account doesn’t go with you, as an H.S.A. does.

When is open enrollment for the Affordable Care Act marketplace?

According to Healthcare.gov, open enrollment for coverage starting on Jan. 1 runs from Nov. 1 through Dec. 15. Open enrollment for state-run marketplaces may vary.

The legal challenge before the Supreme Court isn’t expected to affect this year’s open enrollment, as the court’s decision would probably come before next summer.

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The Trump campaign celebrated a growth record that Democrats downplayed.

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The White House celebrated economic growth numbers for the third quarter released on Thursday, even as Joseph R. Biden Jr.’s presidential campaign sought to throw cold water on the report — the last major data release leading up to the Nov. 3 election — and warned that the economic recovery was losing steam.

The economy grew at a record pace last quarter, but the upswing was a partial bounce-back after an enormous decline and left the economy smaller than it was before the pandemic. The White House took no notice of those glum caveats.

“This record economic growth is absolute validation of President Trump’s policies, which create jobs and opportunities for Americans in every corner of the country,” Mr. Trump’s re-election campaign said in a statement, highlighting a rebound of 33.1 percent at an annualized rate. Mr. Trump heralded the data on Twitter, posting that he was “so glad” that the number had come out before Election Day.

The annualized rate that the White House emphasized extrapolates growth numbers as if the current pace held up for a year, and risks overstating big swings. Because the economy’s growth has been so volatile amid the pandemic, economists have urged focusing on quarterly numbers.

Those showed a 7.4 percent gain in the third quarter. That rebound, by far the biggest since reliable statistics began after World War II, still leaves the economy short of its pre-pandemic levels. The pace of recovery has also slowed, and now coronavirus cases are rising again across much of the United States, raising the prospect of further pullback.

“The recovery is stalling out, thanks to Trump’s refusal to have a serious plan to deal with Covid or to pass a new economic relief plan for workers, small businesses and communities,” Mr. Biden’s campaign said in a release ahead of Thursday’s report. The rebound was widely expected, and the campaign characterized it as “a partial return from a catastrophic hit.”

Economists have warned that the recovery could face serious roadblocks ahead. Temporary measures meant to shore up households and businesses — including unemployment insurance supplements and forgivable loans — have run dry. Swaths of the service sector remain shut down as the virus continues to spread, and job losses that were temporary are increasingly turning permanent.

“With coronavirus infections hitting a record high in recent days and any additional fiscal stimulus unlikely to arrive until, at the earliest, the start of next year, further progress will be much slower,” Paul Ashworth, chief United States economist at Capital Economics, wrote in a note following the report.

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Black and Hispanic workers, especially women, lag in the U.S. economic recovery.

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The surge in economic output in the third quarter set a record, but the recovery isn’t reaching everyone.

Economists have long warned that aggregate statistics like gross domestic product can obscure important differences beneath the surface. In the aftermath of the last recession, for example, G.D.P. returned to its previous level in early 2011, even as poverty rates remained high and the unemployment rate for Black Americans was above 15 percent.

Aggregate statistics could be even more misleading during the current crisis. The job losses in the initial months of the pandemic disproportionately struck low-wage service workers, many of them Black and Hispanic women. Service-sector jobs have been slow to return, while school closings are keeping many parents, especially mothers, from returning to work. Nearly half a million Hispanic women have left the labor force over the last three months.

“If we’re thinking that the economy is recovering completely and uniformly, that is simply not the case,” said Michelle Holder, an economist at John Jay College in New York. “This rebound is unevenly distributed along racial and gender lines.”

The G.D.P. report released Thursday doesn’t break down the data by race, sex or income. But other sources make the disparities clear. A pair of studies by researchers at the Urban Institute released this week found that Black and Hispanic adults were more likely to have lost jobs or income since March, and were twice as likely as white adults to experience food insecurity in September.

The financial impact of the pandemic hit many of the families that were least able to afford it, even as white-collar workers were largely spared, said Michael Karpman, an Urban Institute researcher and one of the studies’ authors.

“A lot of people who were already in a precarious position before the pandemic are now in worse shape, whereas people who were better off have generally been faring better financially,” he said.

Federal relief programs, such as expanded unemployment benefits, helped offset the damage for many families in the first months of the pandemic. But those programs have mostly ended, and talks to revive them have stalled in Washington. With virus cases surging in much of the country, Mr. Karpman warned, the economic toll could increase.

“There could be a lot more hardship coming up this winter if there’s not more relief from Congress, with the impact falling disproportionately on Black and Hispanic workers and their families,” he said.

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Ant Challenged Beijing and Prospered. Now It Toes the Line.

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As Jack Ma of Alibaba helped turn China into the world’s biggest e-commerce market over the past two decades, he was also vowing to pull off a more audacious transformation.

“If the banks don’t change, we’ll change the banks,” he said in 2008, decrying how hard it was for small businesses in China to borrow from government-run lenders.

“The financial industry needs disrupters,” he told People’s Daily, the official Communist Party newspaper, a few years later. His goal, he said, was to make banks and other state-owned enterprises “feel unwell.”

The scope of Mr. Ma’s success is becoming clearer. The vehicle for his financial-technology ambitions, an Alibaba spinoff called Ant Group, is preparing for the largest initial public offering on record. Ant is set to raise $34 billion by selling its shares to the public in Hong Kong and Shanghai, according to stock exchange documents released on Monday. After the listing, Ant would be worth around $310 billion, much more than many global banks.

The company is going public not as a scrappy upstart, but as a leviathan deeply dependent on the good will of the government Mr. Ma once relished prodding.

More than 730 million people use Ant’s Alipay app every month to pay for lunch, invest their savings and shop on credit. Yet Alipay’s size and importance have made it an inevitable target for China’s regulators, which have already brought its business to heel in certain areas.

These days, Ant talks mostly about creating partnerships with big banks, not disrupting or supplanting them. Several government-owned funds and institutions are Ant shareholders and stand to profit handsomely from the public offering.

The question now is how much higher Ant can fly without provoking the Chinese authorities into clipping its wings further.

Excitable investors see Ant as a buzzy internet innovator. The risk is that it becomes more like a heavily regulated “financial digital utility,” said Fraser Howie, the co-author of “Red Capitalism: The Fragile Financial Foundation of China’s Extraordinary Rise.”

“Utility stocks, as far as I remember, were not the ones to be seen as the most exciting,” Mr. Howie said.

Ant declined to comment, citing the quiet period demanded by regulators before its share sale.

The company has played give-and-take with Beijing for years. As smartphone payments became ubiquitous in China, Ant found itself managing huge piles of money in Alipay users’ virtual wallets. The central bank made it park those funds in special accounts where they would earn minimal interest.

After people piled into an easy-to-use investment fund inside Alipay, the government forced the fund to shed risk and lower returns. Regulators curbed a plan to use Alipay data as the basis for a credit-scoring system akin to Americans’ FICO scores.

China’s Supreme Court this summer capped interest rates for consumer loans, though it was unclear how the ceiling would apply to Ant. The central bank is preparing a new virtual currency that could compete against Alipay and another digital wallet, the messaging app WeChat, as an everyday payment tool.

Ant has learned ways of keeping the authorities on its side. Mr. Ma once boasted at the World Economic Forum in Davos, Switzerland, about never taking money from the Chinese government. Today, funds associated with China’s social security system, its sovereign wealth fund, a state-owned life insurance company and the national postal carrier hold stakes in Ant. The I.P.O. is likely to increase the value of their holdings considerably.

“That’s how the state gets its payoff,” Mr. Howie said. With Ant, he said, “the line between state-owned enterprise and private enterprise is highly, highly blurred.”

China, in less than two generations, went from having a state-planned financial system to being at the global vanguard of internet finance, with trillions of dollars in transactions being made on mobile devices each year. Alipay had a lot to do with it.

Alibaba created the service in the early 2000s to hold payments for online purchases in escrow. Its broader usefulness quickly became clear in a country that mostly missed out on the credit card era. Features were added and users piled in. It became impossible for regulators and banks not to see the app as a threat.

ImageAnt Group’s headquarters in Hangzhou, China.
Credit…Alex Plavevski/EPA, via Shutterstock

A big test came when Ant began making an offer to Alipay users: Park your money in a section of the app called Yu’ebao, which means “leftover treasure,” and we will pay you more than the low rates fixed by the government at banks.

People could invest as much or as little as they wanted, making them feel like they were putting their pocket change to use. Yu’ebao was a hit, becoming one of the world’s largest money market funds.

The banks were terrified. One commentator for a state broadcaster called the fund a “vampire” and a “parasite.”

Still, “all the main regulators remained unanimous in saying that this was a positive thing for the Chinese financial system,” said Martin Chorzempa, a research fellow at the Peterson Institute for International Economics in Washington.

“If you can’t actually reform the banks,” Mr. Chorzempa said, “you can inject more competition.”

But then came worries about shadowy, unregulated corners of finance and the dangers they posed to the wider economy. Today, Chinese regulators are tightening supervision of financial holding companies, Ant included. Beijing has kept close watch on the financial instruments that small lenders create out of their consumer loans and sell to investors. Such securities help Ant fund some of its lending. But they also amplify the blowup if too many of those loans aren’t repaid.

“Those kinds of derivative products are something the government is really concerned about,” said Tian X. Hou, founder of the research firm TH Data Capital. Given Ant’s size, she said, “the government should be concerned.”

The broader worry for China is about growing levels of household debt. Beijing wants to cultivate a consumer economy, but excessive borrowing could eventually weigh on people’s spending power. The names of two of Alipay’s popular credit functions, Huabei and Jiebei, are jaunty invitations to spend and borrow.

Huang Ling, 22, started using Huabei when she was in high school. At the time, she didn’t qualify for a credit card. With Huabei’s help, she bought a drone, a scooter, a laptop and more.

The credit line made her feel rich. It also made her realize that if she actually wanted to be rich, she had to get busy.

“Living beyond my means forced me to work harder,” Ms. Huang said.

First, she opened a clothing shop in her hometown, Nanchang, in southeastern China. Then she started an advertising company in the inland metropolis of Chongqing. When the business needed cash, she borrowed from Jiebei.

Online shopping became a way to soothe daily anxieties, and Ms. Huang sometimes racked up thousands of dollars in Huabei bills, which only made her even more anxious. When the pandemic slammed her business, she started falling behind on her payments. That cast her into a deep depression.

Finally, early this month, with her parents’ help, she paid off her debts and closed her Huabei and Jiebei accounts. She felt “elated,” she said.

China’s recent troubles with freewheeling online loan platforms have put the government under pressure to protect ordinary borrowers.

Ant is helped by the fact that its business lines up with many of the Chinese leadership’s priorities: encouraging entrepreneurship and financial inclusion, and expanding the middle class. This year, the company helped the eastern city of Hangzhou, where it is based, set up an early version of the government’s app-based system for dictating coronavirus quarantines.

Such coziness is bound to raise hackles overseas. In Washington, Chinese tech companies that are seen as close to the government are radioactive.

In January 2017, Eric Jing, then Ant’s chief executive, said the company aimed to be serving two billion users worldwide within a decade. Shortly after, Ant announced that it was acquiring the money transfer company MoneyGram to increase its U.S. footprint. By the following January, the deal was dead, thwarted by data security concerns.

More recently, top officials in the Trump administration have discussed whether to place Ant Group on the so-called entity list, which prohibits foreign companies from purchasing American products. Officials from the State Department have suggested that an interagency committee, which also includes officials from the departments of defense, commerce and energy, review Ant for the potential entity listing, according to three people familiar with the matter.

Ant does not talk much anymore about expanding in the United States.

Ana Swanson contributed reporting.

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