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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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California Sues Nursing Home Chain, Saying It Manipulated Ratings System

The result, prosecutors said, was that Brookdale “has been awarded higher star ratings than it deserved.” They added, “The chain’s manipulation has allowed Brookdale to attract prospective patients and their families to its facilities by misleading them about its quality of care.”

Prosecutors also accused Brookdale of illegally evicting or transferring residents so that the chain could “fill its beds with residents who will bring in more money.” In one instance highlighted in the suit, prosecutors said Brookdale discharged a 78-year-old resident who suffered from heart and kidney disease without removing his catheter.

The lawsuit seeks civil penalties and an injunction to prevent future unlawful conduct. Under California law, civil penalties are up to $2,500 per violation. In this case, where the violations are committed against seniors or people with disabilities, the law provides for an additional penalty of up to $2,500 per violation.

A Brookdale spokeswoman didn’t immediately respond to a request for comment.

The Times previously reported that a Brookdale facility in Lexington, Ky., told Medicare in 2017 that every resident got an average of 75 minutes of care each day. In reality, nurses at the Brookdale Richmond Place facility spent an average of less than 30 minutes a day with patients. Brookdale received five stars for staffing. Absent the inflated numbers, it probably would have received only one or two stars.

A former Brookdale nursing assistant said in a deposition last year that her supervisors had told her to falsify residents’ medical records to make it look as if they received more care than they did.

Heather Hunter, a spokeswoman for Brookdale, told The Times, “We have detailed policies in place to ensure compliance with C.M.S. reporting rules, and we are not aware of any instance where inaccurate or false information was submitted by any of our communities outside of the confines of the C.M.S. rules.”

President Biden nominated Mr. Becerra, whose office brought the case against Brookdale, for secretary of health and human services, which oversees C.M.S. The Senate has not yet voted on the nomination.

Robert Gebeloff contributed reporting.

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In U.S. nursing homes, where Covid-19 killed scores, even reports of maggots and rape don’t dock five-star ratings.

Twelve years ago, the U.S. government introduced a powerful new tool to help people make a wrenching decision: which nursing home to choose for loved ones at their most vulnerable. Using a simple star rating — one being the worst, five the best — the system promised to distill reams of information and transform an emotional process into one based on objective, government-blessed metrics.

The star system quickly became ubiquitous, a popular way for consumers to educate themselves and for nursing homes to attract new customers. During the coronavirus pandemic, with many locked-down homes unavailable for prospective residents or their families to see firsthand, the ratings seemed indispensable.

But a New York Times investigation, based on the most comprehensive analysis of the data that powers the ratings program, found that it is broken.

The ratings program, which is run by the U.S. Centers for Medicare & Medicaid Services, or C.M.S., relies on a mix of self-reported data from more than 15,000 nursing homes and on-site examinations by state health inspectors.

years of warnings, the system provided a badly distorted picture of the quality of care at the nation’s nursing homes. Many relied on sleight-of-hand maneuvers to improve their ratings and hide shortcomings that contributed to the damage when the pandemic struck.

More than 130,000 nursing-home residents have died of Covid-19, and The Times’s analysis found that people at five-star facilities were roughly as likely to die of the disease as those at one-star homes.

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How U.S. Ratings of Nursing Homes Mislead the Public

The pandemic laid bare the flaws in the government rating system.

The state health inspections do little to penalize homes with poor records of preventing and controlling infections. From 2017 to 2019, The Times found, inspectors cited nearly 60 percent — more than 2,000 — of the country’s five-star facilities at least once for not following basic safety precautions, like regular hand washing. Yet they earned top ratings.

In San Bernardino, Calif., inspectors wrote up Del Rosa Villa for four different infection-control violations. It kept its five stars. Ninety residents at the 104-bed facility have contracted the coronavirus, and 13 have died.

Del Rosa Villa officials didn’t respond to requests for comment.

Life Care Centers of Kirkland, Wash., the first nursing home in the United States to have documented coronavirus cases, was found in 2019 to have weak infection controls, despite its five stars. State inspectors wrote it up for failing to “consistently implement an effective infection control program.”

Thirty-nine of the facility’s residents have died from Covid-19. The home has 190 beds.

Leigh Atherton, a Life Care spokeswoman, said that citation was the only lapse in infection control that inspectors had identified over 32 previous visits. She said the home quickly fixed the problem.

If the rating system worked as intended, it would have offered clues as to which homes were most likely to have out-of-control outbreaks and which homes would probably muddle through.

That is not what happened.

The Times found that there was little if any correlation between star ratings and how homes fared during the pandemic. At five-star facilities, the death rate from Covid-19 was only half a percentage point lower than at facilities that received lower ratings. And the death rate was slightly lower at two-star facilities than at four-star homes.

A facility’s location, the infection rate of the surrounding community and the race of nursing home residents all were predictors of whether a nursing home would suffer an outbreak. The star ratings didn’t matter.

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A Love Letter to My Accountant

When it was my turn, it was well past 9 p.m. He looked over my papers, all my accounting of trying to make a life out of words. “Hmm,” he said, “hmm.” He told me I would owe a tax bill in the low thousands. I almost blacked out. “But,” he said gently, “that just means you’re successful. You’ve made this much from writing.”

My accountant taught me that even in a life of pursuing art, where uncertainty is built in, some care can be taken to make plans, to plan for success, not just wish to succeed, and in planning offer myself some ballast against nothing at all going according to plan. It’s a difficult lesson to learn — the lives of great artists are riddled with instability. But he also reminds me, every April 15, not to block my blessings, not to decide I already know how my artistic career will end, that life can surprise you with good things as well as bad.

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.

At the end of our first meeting, he said to me, gravely, “You are good at this. You are going to make money as an artist. You need to be ready for it,” and he told me what funds to put money in, which retirement plans to invest in, for the following year. I went back to him a year later, when I was getting married, and he gave me advice for my taxes then. He told me, poignantly, “Don’t get married on Christmas or New Year’s. It will ruin those days for you.”

By then, I had talked to him long enough to know that he had been married and divorced, and that he had seven adult daughters of his own, all trained as accountants — they helped him out during tax season. Sometimes I would call his office after negotiating a contract or finding out about a grant, and I would only get the machine. This was because, he’d explained to me, he took off six months out of the year to travel around West Africa to collect the art that I saw in his office.

The last time I saw him in person was the 2019 tax season. I was five months pregnant, my then-husband had just lost his job, and we were suddenly both living off a research stipend for a fellowship I had. He sat with us and assured us it would be OK. I was stressed about money, stressed about my baby’s future, stressed about how I was going to pay for my looming hospital bills. Talking to him was one of the few times during that turbulent pregnancy when I felt like I was being taken care of by another person, instead of taking care of everyone else — a gift for which I will always be grateful.

Last pandemic’s tax season was pushed back again and again by the catastrophe. I did my taxes in June on the back porch of the house I was living in during quarantine, paying a masked sitter $20 an hour for the privilege of talking to my accountant on the phone without a baby in the background. I realized my relationship with him is the most positive one I’ve ever had with a man over money. As I updated him on my pandemic year — marriage over, job offers gone, quarantining in another state — he only murmured sagely into the phone. He’d seen it all. “But I did what you told me to last year and paid my estimated tax,” I said.

“You listened to me?” he replied, with a fatherly warmth. “Of course,” I said. “None of my clients ever do,” he laughed. And then he said he’d set me up for 2021, because I’d followed his directions. It was one of my proudest moments in the hazy, heady year.

Kaitlyn Greenidge is the author of the forthcoming novel “Libertie” and the features director at Harper’s Bazaar.

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For Gig Workers and Business Owners, Taxes Are Even Trickier Now

The revamped credit “is a better program — there’s more money, and it’s available to more employers,” said Shelly Abril, the head of tax compliance at Gusto, a payroll services provider. “But with that comes all this extra complexity.”

Devon Lind plans to seek retroactive 2020 credits for his workers at Blender, a collection of businesses in Spokane, Wash. Blender’s two core businesses — Photoboxx, which sells photo printing and display technology, and Smash, a mobile “rage room” where people can destroy plates — both depend on events, and sales plunged last year. The company had nine employees before the pandemic. It laid off five.

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.

Because Blender took a Paycheck Protection Program loan, it was initially ineligible for the retention credit, but Mr. Lind now plans to seek it for two quarters last year. The credit “is really going to help us continue to retain employees as we’re gaining back business,” he said.

But extracting the most money allowed from the credit is complicated because of the way it interacts with P.P.P. proceeds — and the Internal Revenue Service hasn’t yet provided detailed guidance.

“There’s just tons of nuance in the credit,” said Andre Shevchuck, a partner at the accounting firm BPM. “We have instructed a lot of clients to first check in with their payroll provider to see how the rubber meets the road, and it may also make sense for businesses to talk to a C.P.A or a lawyer.”

Self-employed workers are normally not eligible for unemployment compensation, but the CARES Act extended benefits to them. Ms. Holcomb filed for unemployment when her contract job temporarily eliminated her hours.

Some who collected the money are in for a tax-time shock, though: The payments are taxed as income. States are supposed to offer recipients the option of having federal taxes withheld, but in their scramble to deal with a deluge of claims, some states didn’t do it — and many people, faced with urgent bills and a reduced income, declined the option. Researchers at the Century Foundation estimate that fewer than 40 percent of unemployment payments last year had taxes withheld.

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