“This is a significant, historic investment,” Mr. Espinoza said. “But when you take into account the magnitude of the crisis in front of us, it’s clear that this is only a first step.”

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Turning Away From Nursing Homes, to What?

The PACE provider manages all of a person’s health care needs that are covered by Medicare or Medicaid. “It becomes your form of health care coverage,” said Peter Fitzgerald, executive vice president for policy and strategy at the National PACE Association, a membership and advocacy organization.

States decide whether to offer PACE programs; currently 30 have programs serving about 55,000 people, Mr. Fitzgerald said.

Some states and regions are moving to address the needs of their aging citizens.

In January, Gov. Gavin Newsom released a master plan for aging for California. It calls for creating, over the next decade, millions of housing units for older residents, one million high-quality caregiving jobs, and inclusion goals such as closing the digital divide and creating opportunities for work and volunteering. Colorado, Massachusetts, Minnesota and Texas have already established master plans, and a number of other states are working on them.

California’s plan also calls for a new state office focused on finding ways to innovate using Medicare funds, especially for low-income, chronically ill seniors who also participate in Medicaid.

“We think this can really help our state by bringing together medical and nonmedical services for people who want to live well in the place they call home,” said Gretchen E. Alkema, vice president of policy and communications at the SCAN Foundation, a nonprofit focused on elder care that has worked with California and other states on age-friendly models.

In the Atlanta metropolitan area, which began tackling these issues head-on in 2002, one in five residents will be 65 or older by 2050, according to the Atlanta Regional Commission, a planning organization. The group has responded by developing a “lifelong communities initiative” to raise awareness in local government of the need for housing that is affordable and convenient to sidewalks, shopping and transportation.

Atlanta and four suburbs have joined an AARP-sponsored network of age-friendly communities, and several city neighborhoods have created plans.

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Here Are Five Key Facts About Gun Violence

It’s a dismal ritual of American life: A mass shooting occurs — sometimes more than one, in quick succession. The country mourns the victims. And nothing changes.

I expect the same will happen following the killings in Atlanta and Boulder, Colo. But it is still worth taking a few minutes to lay out the basic facts about gun violence. The key one is simply this: The scale of gun deaths in the United States is not inevitable. The country could reduce the death toll, perhaps substantially, if it chose to.

When gun violence is counted as a single category — spanning homicides, suicides and accidents — it kills about 40,000 Americans a year.

That’s far behind the country’s biggest killers, like heart disease (about 650,000 annual deaths) or Alzheimer’s (about 125,000). But it is broadly comparable to the toll from many well-known causes of death, including an average flu season (35,000), vehicle accidents (39,000), breast cancer (42,000), liver disease (43,000) or pancreatic cancer (45,000).

dismissed calls for restricting gun availability, saying, “There’s not a big appetite among our members to do things that would appear to be addressing it, but actually don’t do anything to fix the problem.”

But there is overwhelming evidence that this country has a unique problem with gun violence, mostly because it has unique gun availability.

Michael Siegel of Boston University’s School of Public Health says.

“The main lesson that comes out of this research is that we know which laws work,” Siegel says. (Nicholas Kristof, the Times columnist, has written a good overview, called “How to Reduce Shootings.”)

one out of every 400 gun deaths was the result of a mass shooting (defined as any attack with at least four deaths). More than half of gun deaths are from suicides, as Margot Sanger-Katz of The Times has noted.

Still, many of the policies that experts say would reduce gun deaths — like requiring gun licenses and background checks — would likely affect both mass shootings and the larger problem.

Yes, an overwhelming majority of Americans support many gun-regulation proposals — like background checks — that congressional Republicans have blocked. And, yes, the campaign donations of the National Rifle Association influence the debate.

But the main reason that members of Congress feel comfortable blocking gun control is that most Americans don’t feel strongly enough about the issue to change their votes because of it. If Americans stopped voting for opponents of gun control, gun-control laws would pass very quickly. This country’s level of gun violence is as high as it is because many Americans have decided that they are OK with it.

Gun control is yet another issue in which the filibuster helps Republican policy priorities and hurts Democratic priorities. On guns (as on climate change, taxes, Medicare access, the minimum wage, immigration and other issues), Republicans are happier with the status quo than Democrats. The filibuster — which requires 60 Senate votes to pass most bills, rather than a straight majority of 51 — protects the status quo.

If Democrats were to change the filibuster, as many favor, it isn’t hard to imagine how a gun-control bill could become law this year. With the filibuster, it is almost impossible to imagine.

a song by Kermit the Frog.

Lives Lived: Jessica McClintock dressed generations of women in calico, lace and beribboned pastiches known as granny dresses. Her clients included Vanna White and a 27-year-old Hillary Rodham for her 1975 wedding to Bill Clinton. McClintock died at 90.

Ian Parker writes in The New Yorker. “The latest streaming-video subscriptions have been sold on the promise of content that is remarkable.” HGTV, as Parker notes, “is low-budget and unassuming.”

Torn Down for What.”

HGTV is now part of the Discovery+ streaming platform, which is tiny compared with Netflix and Disney+. But HGTV’s value also lies in the size of its library, which includes hundreds of episodes of popular shows like “House Hunters” and “Fixer Upper.”

For more: Discovery+ brings a cable-era way of watching TV to streaming.

play online.

today’s Mini Crossword, and a clue: Frequent flier (five letters).

If you’re in the mood to play more, find all our games here.


Thanks for spending part of your morning with The Times. See you tomorrow. — David

P.S. Priya Krishna, a food writer who previously worked at Bon Appétit, is joining The Times, where she will write and appear on NYT Cooking’s YouTube channel.

You can see today’s print front page here.

Today’s episode of “The Daily” is about the vaccine rollout. On “Sway,” Glennon Doyle discusses misogyny, the power of apologies and more.

Lalena Fisher, Claire Moses, Ian Prasad Philbrick, Tom Wright-Piersanti and Sanam Yar contributed to The Morning. You can reach the team at themorning@nytimes.com.

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Biden’s Big Plan

A new president needs to make choices. Recent history suggests that an administration has only about a year to push major legislation through Congress before attention turns to the midterm elections (which rarely go well for the party in power). Any bill not at the very top of the president’s list is unlikely to happen.

For the past few decades, new presidents have focused on two issues above all others: taxes and health care. Bill Clinton and Barack Obama both made expanding access to health insurance their top long-term priority, with Clinton failing and Obama succeeding. George W. Bush focused on cutting taxes, and Donald Trump tried to cut taxes and repeal Obamacare.

President Biden will break this pattern.

His advisers are preparing a set of proposals intended to reshape the U.S. economy and other parts of American life. If they pass, they will almost certainly have a more lasting effect on people’s lives than the virus-relief bill that Biden signed two weeks ago. And while the proposals include measures on health care and taxes, they are broader — more diffuse, a critic might say — than the top priorities of other recent presidents.

During last year’s campaign, Biden described the package with the phrase “build back better.” It is an attempt to create a more prosperous, equal and sustainable economy. It’s the Democratic Party’s answer to decades of rising inequality and growing damage from climate change.

latest episode of Ezra Klein’s Times podcast. “Now we have to deal with the long-term structural problems facing our country that have long, long been neglected, way before the pandemic. And that is the need to rebuild a crumbling infrastructure, the need to address the existential threat of climate change, the need to create many millions of jobs, decent-paying jobs.”

The White House has not yet released all of the details, and they will probably change as the package moves through Congress. But here’s an overview of what we know about the major pieces.

a monthly child payment that starts at $250 per child for most families, as well as a big expansion of paid family leave. These provision would significantly reduce both economic and racial inequalities.

Health care. Biden’s plan would expand Obamacare by extending several two-year provisions in the virus-relief bill, The Times’s Margot Sanger-Katz says. It would cut costs for nearly every family that receives coverage through the law and expand subsidies to some making more than $100,000 a year.

The package may also include a measure to limit how much pharmaceutical companies can charge Medicare for prescription drugs, which could lead to lower prices for private insurance plans.

The plan does not appear to include another idea Biden has said he favors — expanding access to government insurance plans, through a public option or allowing younger people to buy into Medicare.

Lower prescription-drug costs would cover some of the package’s $3 trillion to $4 trillion in new spending over 10 years. But a bigger source of money would be higher taxes on the affluent — people making at least $400,000 a year — and on corporations.

Republicans are unlikely to support any such tax increases, which means Democrats would need to pass major parts of the package through a Senate mechanism known as reconciliation. Bills that go through reconciliation need only 51 votes in the Senate, rather than 60, to pass.

have almost uniformly opposed the top legislative priorities of each new Democratic president over the past three decades.

have rallied across Britain in opposition to a bill that would give the police more power to crack down on nonviolent demonstrations.

  • The U.S. Supreme Court will review a case considering the death penalty for Dzhokhar Tsarnaev, one of the Boston Marathon bombers.

  • Since Ellen DeGeneres apologized over accusations of workplace misconduct, her talk show has lost about one million viewers, more than 40 percent of its audience.

  • Ancient: The oldest wooden sculpture is 12,500 years old. It’s teaching us about prehistory.

    Lives Lived: Elgin Baylor played above the rim in a Hall of Fame career with the Lakers. His acrobatic brilliance foreshadowed the freewheeling shows put on by future N.B.A. stars. Baylor died at 86.

    is selling thousands of books. Some enthusiastic readers — mostly women in their teens and 20s — are posting videos of themselves reading or recommending novels. Occasionally, they sob into the camera after a particularly devastating ending.

    a popular TikTok video last year, and the book is now selling roughly nine times as many copies a week as it was in 2012, when it won a prestigious fiction award. The book is currently third on the New York Times best-seller list for paperback fiction.

    Seeing the potential, some publishers have begun paying — or sending free books to — users with large followings. The fees range from a few hundred to a few thousand dollars per post. For now, though, the majority of these videos remain unsponsored, happening organically.

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    Biden Team Preparing Up to $3 Trillion in New Spending for the Economy

    WASHINGTON — President Biden’s economic advisers are preparing to recommend spending as much as $3 trillion on a sweeping set of efforts aimed at boosting the economy, reducing carbon emissions and narrowing economic inequality, beginning with a giant infrastructure plan that may be financed in part through tax increases on corporations and the rich.

    After months of internal debate, Mr. Biden’s advisers are expected to present a proposal to the president this week that recommends carving his economic agenda into separate legislative pieces, rather than trying to push a mammoth package through Congress, according to people familiar with the plans and documents obtained by The New York Times.

    The total new spending in the plans would likely be $3 trillion, a person familiar with them said. That figure does not include the cost of extending new temporary tax cuts meant to fight poverty, which could reach hundreds of billions of dollars, according to estimates prepared by administration officials. Officials have not yet determined the exact breakdown in cost between the two packages.

    Mr. Biden supports all of the individual spending and tax cut proposals under consideration, but it is unclear whether he will back splitting his agenda into pieces, or what legislative strategy he and Democratic leaders will pursue to maximize the chances of pushing the new programs through Congress given their narrow majorities in both chambers.

    high-technology industries in an escalating battle with China and other foreign competitors.

    While the $1.9 trillion economic aid package that Mr. Biden signed into law earlier this month includes money to help vulnerable people and businesses survive until the pandemic ends, it does little to advance the longer-term economic agenda that Mr. Biden campaigned on.

    The package under consideration would begin that effort in earnest. The first legislative piece under discussion, which some Biden officials consider more appealing to Republicans, business leaders and many moderate Senate Democrats, would combine investments in manufacturing and advanced industries with what would be the most aggressive spending yet by the United States to reduce carbon emissions and combat climate change.

    It would spend heavily on infrastructure improvements, clean energy deployment and the development of other “high-growth industries of the future” like 5G telecommunications. It includes money for rural broadband, advanced training for millions of workers and 1 million affordable and energy-efficient housing units. Documents suggest it will include nearly $1 trillion in spending alone on the construction of roads, bridges, rail lines, ports, electric vehicle charging stations and improvements to the electric grid and other parts of the power sector.

    Whether it can muster Republican support will depend in large part on how the bill is paid for.

    Officials have discussed offsetting some or all of the infrastructure spending by raising taxes on corporations, including increasing the corporate income tax rate above the current 21 percent rate and a variety of measures to force multinational corporations to pay more tax in the United States on income they earn abroad. That strategy is unlikely to garner Republican votes.

    told reporters last week. He predicted the administration’s infrastructure plan would be a “Trojan horse” for tax increases.

    Mr. Biden’s team has debated the merits of aggressively pursuing compromise with Republicans and business leaders on an infrastructure package, which would most likely require dropping or scaling back plans to raise taxes on corporations, or preparing to move another sweeping bill through a special parliamentary process that would require only Democratic votes. Mr. Biden’s advisers plan to present the proposal to congressional leaders this week.

    “President Biden and his team are considering a range of potential options for how to invest in working families and reform our tax code so it rewards work, not wealth,” Jen Psaki, the White House press secretary, said. “Those conversations are ongoing, so any speculation about future economic proposals is premature and not a reflection of the White House’s thinking.”

    Mr. Biden said in January that his relief bill would be followed by a “Build Back Better Recovery Plan,” echoing the language of his campaign agenda. He said that plan would “make historic investments in infrastructure and manufacturing, innovation, research and development, and clean energy. Investments in the caregiving economy and in skills and training needed by our workers to compete and win the global economy of the future.”

    The timing of that proposal — which Mr. Biden initially had said would come in February — slipped as administration officials focused on completing the relief package. In the interim, administration officials have concluded their best chance to advance Mr. Biden’s larger agenda in Congress will be to split “Build Back Better” into component proposals.

    The first plan, centered on infrastructure, includes large portions of the plan Mr. Biden offered in the 2020 election. His campaign predicted that Mr. Biden’s investments would create 5 million new jobs in manufacturing and advanced industries, on top of restoring all the jobs lost last year in the Covid-19 crisis.

    aimed at cutting poverty, particularly for children.

    Officials have weighed financing that plan through initiatives that would reduce federal spending by as much as $700 billion over a decade, like allowing Medicare to negotiate prescription drug costs with pharmaceutical companies. The officials have discussed further offsetting the spending increases by raising taxes on high-earning individuals and households, like raising the top marginal income tax rate to 39.6 percent from 37 percent.

    Administration officials were still debating details of the tax increases late last week. One question is how, exactly, to apply Mr. Biden’s campaign promise that no one earning less than $400,000 a year would pay more in federal taxes under his plan. Currently, the top marginal income tax rate starts at just above $500,000 for individuals and above $600,000 for couples. Mr. Biden proposed raising that rate in the campaign.

    Officials say they are committed to not raising the tax bills of any individual earning less than $400,000. But they have debated whether to lower the income threshold for the top marginal rate, to tax all individual income above $400,000 at 39.6 percent, in order to raise more revenue for his spending plans.

    Mr. Biden’s broader economic agenda will face a more difficult road in Congress than his relief bill, which was financed entirely by federal borrowing and passed using a special parliamentary tactic with only Democratic votes. Mr. Biden could again attempt to use that same budget reconciliation process to pass a bill on party lines. But moderate Democrats in the Senate have insisted that the president engage Republicans on the next wave of economic legislation, and that the new spending be offset by tax increases.

    Large business groups and some congressional Republicans have expressed support for some of Mr. Biden’s broad goals, most notably efforts to rebuild roads, bridges, water and sewer systems and other infrastructure across the country. The U.S. Chamber of Commerce and National Association of Manufacturers have both spoken favorably of spending up to $2 trillion on infrastructure this year.

    But Republicans are united in opposition to most of the tax increases Mr. Biden has proposed. Business groups have warned that corporate tax increases would scuttle their support for an infrastructure plan. “That’s the kind of thing that can just wreck the competitiveness in a country,” Aric Newhouse, senior vice president of policy and government relations at the National Association of Manufacturers, said last month.

    Administration officials are considering offering to extend some 2017 tax breaks that are set to expire, like the ability to immediately deduct new investments, as part of their plans in order to win over business support.

    Top business groups have also expressed an openness to Mr. Biden breaking up his “Build Back Better” agenda in order to pass smaller pieces with bipartisan support.

    “If you try to solve every major issue in one bill, I don’t know that’s a recipe for success,” Neil Bradley, executive vice president and chief policy officer at the U.S. Chamber of Commerce, said in an interview last month. “These don’t have to be done in one package.”

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    The Week in Business: Go Ahead, Put Off Your Taxes

    Good morning and happy spring. Here’s hoping you can enjoy another Sunday spent ignoring your tax returns (or, if you’ve already done them, feeling smug about it). But first, here’s what you need to know in business and tech news for the week ahead. — Charlotte Cowles

    Credit…Giacomo Bagnara

    Good news for procrastinators like me, or anyone whose taxes were complicated by the pandemic: The Internal Revenue Service has extended the deadline to file taxes by one month, to May 17. The extra time will help people navigate new tax rules that took effect with the passage of the American Rescue Plan. The law made the first $10,200 of unemployment benefits tax-free for people who earned less than $150,000 last year, a significant benefit for many people whose jobs were disrupted. But if you’ve already filed, don’t worry — the I.R.S. said it would automatically send those refunds to people who qualify.

    Relations between China and the Biden administration got off to a rocky start last week at the first face-to-face meeting between diplomats. The United States set a confrontational tone on the eve of the talks by imposing sanctions on 24 Chinese officials for undermining democracy in Hong Kong. In turn, China’s top diplomat accused his American counterparts of being “condescending,” among other claims. The purpose of the three-day meeting, according to President Biden’s team, was to find common ground on climate change and on controlling the pandemic, and to address U.S. concerns about Chinese trade and military encroachments. The tension does not bode well for making headway in future negotiations.

    suing the Walt Disney Company for what they call “rampant gender pay discrimination” have added another accusation to their list: that Disney “maintains a strict policy of pay secrecy.” A new section of the lawsuit refers to an episode in which one female Disney employee was “disciplined for disclosing her pay to co-workers.” Pay transparency is considered an important part of closing racial and gender wage gaps, and retaliation for discussing your own salary violates California law as well as the National Labor Relations Act. Disney has denied the claims and vowed to defend itself.

    Credit…Giacomo Bagnara

    Walmart is jumping on the vaccine passport bandwagon, saying it will provide standardized digital vaccination credentials to anyone who gets vaccinated at one of its stores or at Sam’s Club. The retailer will develop a health passport app that people can use to verify their status at airports, schools, sports arenas and other potentially crowded places. Walmart joins an existing push by major health centers and tech companies, including Microsoft, Oracle, Salesforce and the Mayo Clinic, as well as a proposal from the European Union, which would require vaccine verification for travel in certain areas.

    How Has the Pandemic Changed Your Taxes?

    Nope. The so-called economic impact payments are not treated as income. In fact, they’re technically an advance on a tax credit, known as the Recovery Rebate Credit. The payments could indirectly affect what you pay in state income taxes in a handful of states, where federal tax is deductible against state taxable income, as our colleague Ann Carrns wrote. Read more.

    Mostly.  Unemployment insurance is generally subject to federal as well as state income tax, though there are exceptions (Nine states don’t impose their own income taxes, and another six exempt unemployment payments from taxation, according to the Tax Foundation). But you won’t owe so-called payroll taxes, which pay for Social Security and Medicare. The new relief bill will make the first $10,200 of benefits tax-free if your income is less than $150,000. This applies to 2020 only. (If you’ve already filed your taxes, watch for I.R.S. guidance.) Unlike paychecks from an employer, taxes for unemployment aren’t automatically withheld. Recipients must opt in — and even when they do, federal taxes are withheld only at a flat rate of 10 percent of benefits. While the new tax break will provide a cushion, some people could still owe the I.R.S. or certain states money. Read more.

    Probably not, unless you’re self-employed, an independent contractor or a gig worker. The tax law overhaul of late 2019 eliminated the home office deduction for employees from 2018 through 2025. “Employees who receive a paycheck or a W-2 exclusively from an employer are not eligible for the deduction, even if they are currently working from home,” the I.R.S. said. Read more.

    Self-employed people can take paid caregiving leave if their child’s school is closed or their usual child care provider is unavailable because of the outbreak. This works similarly to the smaller sick leave credit — 67 percent of average daily earnings (for either 2020 or 2019), up to $200 a day. But the caregiving leave can be taken for 50 days. Read more.

    Yes. This year, you can deduct up to $300 for charitable contributions, even if you use the standard deduction. Previously, only people who itemized could claim these deductions. Donations must be made in cash (for these purposes, this includes check, credit card or debit card), and can’t include securities, household items or other property. For 2021, the deduction limit will double to $600 for joint filers. Rules for itemizers became more generous as well. The limit on charitable donations has been suspended, so individuals can contribute up to 100 percent of their adjusted gross income, up from 60 percent. But these donations must be made to public charities in cash; the old rules apply to contributions made to donor-advised funds, for example. Both provisions are available through 2021. Read more.

    Chief executives from Facebook, Google and Twitter will be grilled in Congress this Thursday, this time over their failure to crack down on the spread of misinformation. Tech executives were last summoned by lawmakers in November 2020, when Mark Zuckerberg of Facebook and Jack Dorsey of Twitter faced a firestorm of questioning about content moderation, mostly regarding their attempts to prevent a wave of falsehoods about the presidential election. This time, they will be asked about coronavirus vaccine misinformation and about the election fraud conspiracy theories that continue to spread on their platforms.

    The two biggest names in economic policy — the Federal Reserve chair, Jerome Powell, and Treasury Secretary Janet Yellen — will make their first joint appearance this week when they testify before the House Financial Services Committee on the progress of pandemic relief efforts. The hearing comes one week after the Fed revised its economic outlook to project stronger growth and offered more reassurances that it would keep interest rates near zero for the coming years.

    jettisoned a Trump-era policy that limited debt relief for students who were defrauded by for-profit educational institutions. The newly hired Teen Vogue editor, Alexi McCammond, resigned over racist and homophobic tweets that she posted a decade ago. And retail sales dropped 3 percent in February as consumers grappled with declining stimulus effects and devastating winter storms.

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    Bringing Rigorous Testing to Health Care Policy

    That evaluation method is reminiscent of the traditional approach to assessing new surgical techniques — which have sometimes been shown to be worthless or worse, after being subjected to more rigorous testing. Radical mastectomies, for example, were widely used for decades before randomized trials showed that much less extensive and disfiguring surgery followed by radiation was an equally effective treatment.

    Of course, conducting randomized trials can pose more challenges for evaluating a new surgery than a new drug. A surgical technique may be harder to standardize enough to be able to test it on a broad population, and blinding the patient to which treatment she receives can be far more difficult.

    But such feasibility issues do not apply to new payment methods, which are well-defined and standardized interventions, and where blinding medical providers to the payment rules is not desired.

    Still, as in medicine, not all public policies can — or should — have randomized evaluations. One-of-a-kind government projects — like the “Big Dig” in Boston or the Superconducting Super Collider in Texas — have no natural comparison group, randomized or otherwise. In times of crisis, or when policy disagreements are more about ideology than impact, evaluation itself may be ill advised.

    But when — as is often the case — there is an opportunity for prospective evaluation and the law requires it, the Innovation Center’s experience underscores the value and feasibility of randomized trials of social policy. They can often be done at the same speed and cost as any prospective study, and can yield more compelling results. Random assignment where the government chooses by lottery who can receive the program may also be the fairest way to allocate an intervention on a limited basis.

    Randomized testing may not be the standard for government evaluation yet, but such things take time. For example, the Food and Drug Administration was empowered in 1962 to obtain “substantial evidence” of a new drug’s safety and efficacy, yet it took more than five years for the agency to embrace randomized trials as the appropriate standard.

    Now that the Biden administration is, again, properly emphasizing that all federal agencies need to make “evidence-based decisions” based on the highest scientific standards, perhaps truly rigorous testing of social policy will become as commonplace as it is for new vaccines. That would help ensure that government services are delivered as effectively and efficiently as possible.


    Amy Finkelstein is the John and Jennie S. MacDonald professor of economics at M.I.T. She co-directs J-PAL North America, a research center at M.I.T. that conducts randomized evaluations.

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    The Triple Tax Break You May Be Missing: A Health Savings Account

    The federal government’s pandemic relief program expanded what H.S.A.s can pay for, including nonprescription medicine like pain relief and allergy pills, and menstrual products like tampons and pads. (The I.R.S. has a full list of eligible items.)

    Some employers match contributions to H.S.A.s as they do retirement savings. But self-employed people and contractors can open them, too.

    People often confuse H.S.A.s with other types of health accounts, such as flexible health spending accounts. But unlike F.S.A.s, health savings accounts are portable: If you change jobs or leave the work force, you keep the account. Contribution limits are higher for H.S.A.s, and there is no deadline to spend the cash. Unspent money can be invested for health needs in retirement.

    A study published last summer in JAMA Network Open, a journal from the American Medical Association, found that many people with high-deductible insurance didn’t have a health savings account. And more than half who had one had not contributed to it in the previous year. People with health plans bought through a government exchange were more likely to not have an H.S.A., even though the average deductible in the federal marketplace is high enough.

    How Has the Pandemic Changed Your Taxes?

    Nope. The so-called economic impact payments are not treated as income. In fact, they’re technically an advance on a tax credit, known as the Recovery Rebate Credit. The payments could indirectly affect what you pay in state income taxes in a handful of states, where federal tax is deductible against state taxable income, as our colleague Ann Carrns wrote. Read more.

    Mostly.  Unemployment insurance is generally subject to federal as well as state income tax, though there are exceptions (Nine states don’t impose their own income taxes, and another six exempt unemployment payments from taxation, according to the Tax Foundation). But you won’t owe so-called payroll taxes, which pay for Social Security and Medicare. The new relief bill will make the first $10,200 of benefits tax-free if your income is less than $150,000. This applies to 2020 only. (If you’ve already filed your taxes, watch for I.R.S. guidance.) Unlike paychecks from an employer, taxes for unemployment aren’t automatically withheld. Recipients must opt in — and even when they do, federal taxes are withheld only at a flat rate of 10 percent of benefits. While the new tax break will provide a cushion, some people could still owe the I.R.S. or certain states money. Read more.

    Probably not, unless you’re self-employed, an independent contractor or a gig worker. The tax law overhaul of late 2019 eliminated the home office deduction for employees from 2018 through 2025. “Employees who receive a paycheck or a W-2 exclusively from an employer are not eligible for the deduction, even if they are currently working from home,” the I.R.S. said. Read more.

    Self-employed people can take paid caregiving leave if their child’s school is closed or their usual child care provider is unavailable because of the outbreak. This works similarly to the smaller sick leave credit — 67 percent of average daily earnings (for either 2020 or 2019), up to $200 a day. But the caregiving leave can be taken for 50 days. Read more.

    Yes. This year, you can deduct up to $300 for charitable contributions, even if you use the standard deduction. Previously, only people who itemized could claim these deductions. Donations must be made in cash (for these purposes, this includes check, credit card or debit card), and can’t include securities, household items or other property. For 2021, the deduction limit will double to $600 for joint filers. Rules for itemizers became more generous as well. The limit on charitable donations has been suspended, so individuals can contribute up to 100 percent of their adjusted gross income, up from 60 percent. But these donations must be made to public charities in cash; the old rules apply to contributions made to donor-advised funds, for example. Both provisions are available through 2021. Read more.

    The findings suggest that health plans, employers and financial advisers could do more to explain how H.S.A.s work, simplify their use and encourage contributions, said an author of the study, Dr. Jeffrey T. Kullgren, associate professor of internal medicine and health management and policy at the University of Michigan.

    “Anything that makes it easier would be a good thing,” he said.

    H.S.A. providers increasingly are cutting fees and using technology to encourage use. Fidelity Investments this month will test an app that will allow clients with employer H.S.A.s to track account balances, contributions and spending. The app will also let users scan products to check if they are H.S.A.-eligible.

    Others are focusing on workers in the gig economy. Starship, a start-up, promotes its accounts through affiliations with ride-hailing and delivery companies. Its app allows workers to automatically invest contributions in low-cost index funds and exchange-traded funds. Because there is no required minimum balance, users are able to invest all of their contributions. But that would also leave no cash available to cover medical costs, unless the investments are sold. Starship sets the default minimum threshold before investing at $2,000, but users can lower it to zero, said Sean Engelking, the company’s chief executive.

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    Advanced Cancers Are Emerging, Doctors Warn, Citing Pandemic Drop in Screenings

    Yvette Lowery usually gets her annual mammogram around March. But last year, just as the pandemic was gaining a foothold and medical facilities were shutting down, the center where she goes canceled her appointment. No one could tell her when to reschedule.

    “They just said keep calling back, keep calling back,” said Ms. Lowery, 59, who lives in Rock Hill, S.C.

    In August, Ms. Lowery felt a lump under her arm but still couldn’t get an appointment until October.

    Eventually, she received a diagnosis of Stage 2 breast cancer, started chemotherapy in November and had a double mastectomy this month.

    an analysis of data by the Epic Health Research Network. Hundreds of thousands fewer screenings were performed last year than in 2019, according to the network data.

    “We still haven’t caught up,” said Dr. Chris Mast, vice president of clinical informatics for Epic, which develops electronic health records for hospitals and clinics.

    Another analysis of Medicare data suggested that as Covid cases spiked during certain periods in 2020, cancer screenings fell. The analysis — conducted by Avalere Health, a consulting firm, for Community Oncology Alliance, which represents independent cancer specialists — found that testing levels in November were about 25 percent lower than in 2019. The number of biopsies, used to diagnose cancer, decreased by about one-third.

    While it is too early to assess the full impact of the delays in screenings, many cancer specialists say they are concerned that patients are coming in with more severe disease.

    “There’s no question in practice that we are seeing patients with more advanced breast cancer and colorectal cancer,” said Dr. Lucio N. Gordan, the president of the Florida Cancer Specialists & Research Institute, one of the nation’s largest independent oncology groups. He is working on a study to see if, over all, these missed screenings resulted in more patients with later-stage cancers.

    And even though the numbers of mammograms and colonoscopies have rebounded in recent months, many people with cancer remain undiagnosed, doctors are reporting.

    Some patients, like Ms. Lowery, could not easily get an appointment once clinics reopened because of pent-up demand. Others skipped regular testing or ignored worrisome symptoms because they were afraid of getting infected or after losing their jobs, they couldn’t afford the cost of a test.

    “The fear of Covid was more tangible than the fear of missing a screen that detected cancer,” said Dr. Patrick I. Borgen, the chair of surgery at the Maimonides Medical Center in Brooklyn who also leads its breast center. His hospital treated such large numbers of coronavirus patients early on that “we’re now associated as the Covid hospital,” he said, and healthy people stayed away to avoid contagion.

    Even patients at high risk because of their genetic makeup or because they previously had cancer have missed critical screenings. Dr. Ritu Salani, the director of gynecologic oncology at the UCLA Health Jonsson Comprehensive Cancer Center said one woman, who was at risk for colon cancer, had a negative test in 2019 but didn’t go for her usual screening last year because of the pandemic.

    When she went to see her doctor, she had advanced cancer. “It’s just a devastating story,” Dr. Salani said. “Screening tests are really designed when patients aren’t feeling bad.”

    Ryan Bellamy felt no hurry last spring to reschedule a canceled colonoscopy, even though the presence of blood in his stool had prompted him to look up symptoms. “I really didn’t want to go to the hospital,” Mr. Bellamy said. He decided it was unlikely he had cancer. “They’re not following up with me so I’m OK with Googling,” he told himself.

    A resident of Palm Coast, Fla., Mr. Bellamy said that after his symptoms worsened, his wife insisted that he go for testing in December, and he had a colonoscopy in late January. With a new diagnosis of Stage 3 rectal cancer, Mr. Bellamy, 38, is undergoing radiation treatment and chemotherapy.

    Colon screening remained significantly lower in 2020, declining about 15 percent from 2019 levels, according to the Epic network data, although overall screenings were down 6 percent. The analysis looked at screenings for more than 600 hospitals in 41 states.

    Lung cancer patients have also delayed seeking appropriate care, said Dr. Michael J. Liptay, chairman of cardiovascular and thoracic surgery at Rush University Medical Center in Chicago. One patient had imaging that showed a spot on his lung, and he was supposed to follow up, just as the pandemic hit. “Additional work-up and care was deferred,” Dr. Liptay said. By the time the patient was fully evaluated, the cancer had increased in size. “It wasn’t a good thing to wait 10 months,” Dr. Liptay said, although he was uncertain whether earlier treatment would have changed the patient’s prognosis.

    Just as previous economic recessions led people to forgo medical care, the downturn in the economy during the pandemic has also discouraged many people from seeking help or treatment.

    “We know cancers are out there,” said Dr. Barbara L. McAneny, the chief executive of New Mexico Oncology Hematology Consultants. Many of her patients are staying away, even if they have insurance, because they cannot afford the deductibles or co-payments. “We’re seeing that, particularly with our poorer folks who are living on the edge anyway, living paycheck to paycheck,” she said.

    Some patients ignored their symptoms as long as they could. Last March, Sandy Prieto, a school librarian who lived in Fowler, Calif., had stomach pain. But she refused to go to the doctor because she didn’t want to get Covid. After having a telehealth visit with her primary care doctor, she tried over-the-counter medications, but they didn’t help with the pain and nausea. She continued to decline.

    “It got to the point where we didn’t have a choice,” said her husband, Eric, who had repeatedly urged her to go to the doctor. Jaundiced and in severe discomfort, she went to the emergency room at the end of May and was given a diagnosis of Stage 4 pancreatic cancer. She died in September.

    “If it wasn’t for Covid and we could have gotten her some place earlier, she would still be with us today,” said her sister, Carolann Meme, who had tried to persuade Ms. Prieto to go to an academic medical center where she might have gotten into a clinical trial.

    When patients like Ms. Prieto are not seen in person but treated virtually, doctors may easily miss important symptoms or recommend medication rather than tell them to come in, said Dr. Ravi D. Rao, the oncologist who treated Ms. Prieto. Patients may downplay how sick they feel or neglect to mention the pain in their hip, he said.

    “In my mind, telemedicine and cancer don’t travel together,” Dr. Rao said. While he also made use of telemedicine during the height of the pandemic, he says he worked to keep his offices open.

    Other doctors defended the use of virtual visits as a critical tool when office visits were too hazardous for most patients and staff. “We were grateful to have a robust telemedicine effort when people simply couldn’t come into the center,” said Dr. Borgen of Maimonides. But he acknowledged that patients were frequently reluctant to discuss their symptoms during a telehealth session, especially a mother whose young children could be listening to what they were saying. “It’s not private,” he noted.

    Some health networks say they took aggressive steps to try to counteract the effects of the pandemic. During the initial stay-at-home order last year, Kaiser Permanente, the large California-based managed care outfit, spotted a declining number of breast cancer screenings and diagnoses in the northern part of the state. “Doctors immediately got together” to begin contacting patients, said Dr. Tatjana Kolevska, medical director for the Kaiser Permanente National Cancer Excellence Program.

    Kaiser also relies on its electronic health records to make appointments for women who are overdue for their mammograms when they book an appointment with their primary care doctor or even want to get a prescription for new glasses.

    While Dr. Kolevska says she is waiting to see data for the system as a whole, she has been encouraged by the number of patients in her practice who are now up to date with their mammograms.

    “All of those things put in place have helped tremendously,” she said.

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    Tax Day Delayed to May 17, I.R.S. Says

    The Internal Revenue Service will again give Americans extra time to file their taxes as a result of the pandemic.

    Instead of the usual April 15 deadline, filers will instead have until May 17, the agency said Wednesday, an extension that will ease the burden on filers dealing with the economic upheaval caused by the coronavirus, which has put millions out of work or caused their hours to be cut.

    “This continues to be a tough time for many people, and the I.R.S. wants to continue to do everything possible to help taxpayers navigate the unusual circumstances related to the pandemic,” said Chuck Rettig, the I.R.S. commissioner.

    The one-month delay is not as much extra time as the I.R.S. offered last year, when the filing deadline was pushed to July 15. But it should make it easier for taxpayers to get a handle on their finances — as well as tax changes that took effect just this month with the signing of the American Rescue Plan.

    reminded taxpayers that they can make contributions until the due date for that tax year’s return. By contributing money to a tax-advantaged account, they can reduce their 2020 income — potentially making them eligible for stimulus money if they were otherwise slightly above the income limits.

    How Has the Pandemic Changed Your Taxes?

    Nope. The so-called economic impact payments are not treated as income. In fact, they’re technically an advance on a tax credit, known as the Recovery Rebate Credit. The payments could indirectly affect what you pay in state income taxes in a handful of states, where federal tax is deductible against state taxable income, as our colleague Ann Carrns wrote. Read more.

    Mostly.  Unemployment insurance is generally subject to federal as well as state income tax, though there are exceptions (Nine states don’t impose their own income taxes, and another six exempt unemployment payments from taxation, according to the Tax Foundation). But you won’t owe so-called payroll taxes, which pay for Social Security and Medicare. The new relief bill will make the first $10,200 of benefits tax-free if your income is less than $150,000. This applies to 2020 only. (If you’ve already filed your taxes, watch for I.R.S. guidance.) Unlike paychecks from an employer, taxes for unemployment aren’t automatically withheld. Recipients must opt in — and even when they do, federal taxes are withheld only at a flat rate of 10 percent of benefits. While the new tax break will provide a cushion, some people could still owe the I.R.S. or certain states money. Read more.

    Probably not, unless you’re self-employed, an independent contractor or a gig worker. The tax law overhaul of late 2019 eliminated the home office deduction for employees from 2018 through 2025. “Employees who receive a paycheck or a W-2 exclusively from an employer are not eligible for the deduction, even if they are currently working from home,” the I.R.S. said. Read more.

    Self-employed people can take paid caregiving leave if their child’s school is closed or their usual child care provider is unavailable because of the outbreak. This works similarly to the smaller sick leave credit — 67 percent of average daily earnings (for either 2020 or 2019), up to $200 a day. But the caregiving leave can be taken for 50 days. Read more.

    Yes. This year, you can deduct up to $300 for charitable contributions, even if you use the standard deduction. Previously, only people who itemized could claim these deductions. Donations must be made in cash (for these purposes, this includes check, credit card or debit card), and can’t include securities, household items or other property. For 2021, the deduction limit will double to $600 for joint filers. Rules for itemizers became more generous as well. The limit on charitable donations has been suspended, so individuals can contribute up to 100 percent of their adjusted gross income, up from 60 percent. But these donations must be made to public charities in cash; the old rules apply to contributions made to donor-advised funds, for example. Both provisions are available through 2021. Read more.

    The I.R.S. expects to process roughly 160 million returns by the end of the year. Nearly 49 million had been processed as of March 5, the 22nd day of the filing season, which started later than usual. Last year, there had been 65 million returns processed by March 6, but that was 40 days into the filing season.

    Pressure to extend the deadline had been mounting. The American Institute of Certified Public Accountants said on Tuesday that the pandemic had created “immeasurable hardship,” making it difficult for taxpayers and practitioners to meet the April 15 deadline.

    And lawmakers from both parties had called on the Internal Revenue Service to delay Tax Day, noting complicated changes to the tax code in the recently passed economic relief package.

    Representative Richard Neal of Massachusetts, the chairman of the House Ways and Means Committee, and Representative Bill Pascrell Jr. of New Jersey, both Democrats, called the extension “absolutely necessary.”

    “Under titanic stress and strain, American taxpayers and tax preparers must have more time to file tax returns,” they said in a statement. “And the I.R.S. itself started the filing season late, continues to be behind schedule and now must implement changes from the American Rescue Plan.”

    Mr. Rettig will testify about the 2021 filing season before an oversight subcommittee that Mr. Pascrell leads on Thursday.

    The delay was reported earlier by Bloomberg News. A congressional aide familiar with the plan initially told The New York Times the deadline was being extended to May 15; that day is a Saturday, and customarily a weekend Tax Day is pushed to the following Monday.

    Tara Siegel Bernard and Ron Lieber contributed reporting.

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